Treatments for high ammonia levels aim to reduce the amount of ammonia in the blood and manage complications. A person may also require treatment for a condition causing elevated ammonia levels.

High ammonia levels, also known as hyperammonemia, often occur due to issues with the liver. The liver is responsible for processing ammonia and turning it into urea that the body then releases in urine.

In some people, infections or issues with the urinary cycle can also cause ammonia levels in the blood to increase.

Hyperammonemia can lead to acute or chronic neurological symptoms. Left untreated, it can lead to potentially life threatening complications.

Treatment targets ammonia levels and helps address complications. A person may also receive treatments for any underlying condition causing the elevated levels.

This article reviews the goals of treatment, as well as the available treatment options for people with high ammonia levels.

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The primary goals of treatment for high ammonia levels involve reducing ammonia levels in the blood and controlling potential complications.

Doctors may use certain medications to lower ammonia levels in the blood directly. However, there is uncertainty as to whether these medications are beneficial.

One 2018 review suggests that altering the gut microbiota may help treat high ammonia levels in the blood. However, currently, not enough evidence supports their use.

Lactulose is a synthetic sugar that can help reduce ammonia levels in the blood. It works by decreasing intestinal production and absorption of ammonia. It also draws ammonia from the blood into the colon, where the body excretes it.

Side effects

Lactulose may cause mild side effects, which can include:

  • diarrhea
  • gas
  • nausea

Lactitol is another synthetic sugar that is similar to lactulose. It can also reduce ammonia levels by inhibiting both intestinal production and absorption of ammonia.

Side effects

Similar to lactulose, lactitol may also cause gastrointestinal side effects, such as:

  • nausea
  • diarrhea
  • gas

Rifaximin is an antibiotic. Some people may have high ammonia levels due to ammonia-producing bacteria. As such, rifaximin can help reduce the number of these bacteria. A doctor may use a combination of rifaximin and lactulose to help lower ammonia levels.

Side effects

Potential side effects of using rifaximin may include:

  • nausea
  • stomach pain
  • headaches

Sodium benzoate decreases the metabolism of the amino acid, glycine, in the liver, brain, and kidney. In doing so, it may help lower ammonia levels in the blood. Sodium benzoate is not available by itself in the United States. Doctors only prescribe it in combination with sodium phenylacetate.

Side effects

The side effects of sodium benzoate may include:

Glycerol phenylbutyrate works in the pancreas. It may help lower blood ammonia levels in people with hepatic encephalopathy, a severe nervous system disorder that occurs due to advanced liver disease.

Side effects

Though generally well-tolerated, glycerol phenylbutyrate can cause some side effects, such as:

L-ornithine phenylacetate contains both L-ornithine and phenylacetate in the form of salt. It activates the urea cycle in the liver, which may help eliminate excess ammonia in the blood.

Doctors may recommend it for people with liver scarring or other conditions that affect the liver.

Side effects

Possible side effects can include severe stomach cramping and diarrhea.

A 2018 study found that people with acute liver failure who took the medication tolerated it well.

However, the researchers note that additional studies are necessary to fully determine its safety and effectiveness for reducing ammonia levels.

Spherical carbon adsorbent (AST-120) may help absorb ammonia levels in the blood in people with hepatic encephalopathy.

According to a 2019 review, AST-120 was more effective at removing ammonia from the blood than a placebo.

However, the authors note that all of the studies included in the review were of low quality. They recommend additional studies to help determine whether AST-120 can help people with advanced liver disease.

Side effects

An older study from 2014 found that participants taking AST-120 reported the same number of adverse events as the placebo group. The majority of side effects reported included gastrointestinal issues.

Liver or stem cell transplants may help people with high blood ammonia levels. Both may help activate the urea cycle that transforms ammonia into urea for disposal.

Side effects

Both types of transplants come with possible side effects. These can include:

In addition, a person may have difficulty finding a donor, making a transplant less viable than other treatment options.

For some people, support from an artificial liver may help increase the organ’s metabolic activity, which would potentially help reduce ammonia levels.

Artificial live support options include:

  • HepatAssist
  • AMC bioartificial liver
  • Excorp

Read more about artificial liver support systems.

Side effects

The main potential side effect of artificial liver support is bleeding. Additionally, it may only reduce ammonia levels by a minor amount.

High ammonia levels in the blood often indicate a problem with the liver, but other underlying conditions can also be responsible.

A doctor can help determine whether an underlying condition is causing high ammonia levels and provide treatment for both the elevated levels and any underlying condition.