Ornithine l-aspartic acid (LOLA) is used in the management of hepatic encephalopathy (HE), a common complication of cirrhosis of the liver. LOLA is a combination of the amino acids ornithine and aspartic acid, and it is believed to facilitate the detoxification of ammonia, a neurotoxin that accumulates when liver function declines. The primary mechanism involves stimulating both the urea cycle in hepatocytes and glutamine synthesis in peripheral tissues, thereby promoting ammonia removal from the bloodstream.

Several randomized controlled trials and meta-analyses support the efficacy of LOLA in lowering serum ammonia levels and improving neuropsychiatric symptoms in patients with HE due to cirrhosis. For example, a 2013 Cochrane review and subsequent studies have found that LOLA, administered intravenously or orally, is more effective than placebo and comparable to some established treatments, such as lactulose, in reducing ammonia and improving mental status. However, the evidence is mixed regarding its impact on overall mortality and long-term outcomes, and some guidelines suggest its use as adjunctive rather than first-line therapy.

In summary, the use of Ornithine l-aspartic acid in cirrhosis is scientifically validated for the specific indication of hepatic encephalopathy, with moderate-quality evidence supporting its efficacy in ammonia reduction and symptom improvement.