What Can I Take to Lower My Ammonia Levels?

October 14, 2025 •

3 min read

High ammonia levels in the blood, a condition known as hyperammonemia, can lead to serious neurological complications like hepatic encephalopathy, especially in people with liver disease. Fortunately, several pharmacological treatments are available for those asking, 'What can I take to lower my ammonia levels?'. These medications work through different mechanisms to reduce ammonia levels and manage the underlying conditions causing them.

Quick Summary

This article discusses the primary and specialized medications used to lower high ammonia levels, such as lactulose and rifaximin, alongside ammonia-scavenging drugs. It explains their mechanisms, indications for use in conditions like hepatic encephalopathy and urea cycle disorders, and the importance of professional medical supervision for proper management.

Key Points

Consult a Doctor: High ammonia levels are a medical condition requiring professional diagnosis and supervision; never self-medicate.
Lactulose is First-Line: This synthetic sugar is a primary treatment for hepatic encephalopathy, working by trapping ammonia in the gut for removal.
Rifaximin Targets Gut Bacteria: As a non-absorbable antibiotic, rifaximin reduces the gut bacteria that produce ammonia and is often used alongside lactulose.
Specialized 'Ammonia Scavengers' Exist: For congenital urea cycle disorders, medications like Ravicti bypass the liver to help the body excrete nitrogen waste.
Intravenous Treatment for Acute Crisis: In cases of severe, acute hyperammonemia, intravenous medications like Ammonul (sodium phenylacetate and benzoate) are used in a hospital setting.
Diet and Supplements Play a Role: Dietary protein management, and possibly supplements like probiotics or branched-chain amino acids, are part of a comprehensive treatment plan.

Understanding Hyperammonemia

Ammonia is a toxic waste product of protein breakdown, primarily converted to urea by the liver for kidney excretion. Impaired liver function or urea cycle defects cause ammonia buildup (hyperammonemia), which can lead to hepatic encephalopathy as ammonia affects brain function. Symptoms range from confusion to coma. Treatment depends on the cause and severity and requires medical supervision.

Primary Medications for Lowering Ammonia

Medications for high ammonia often target the gut, where bacteria produce much of the body's ammonia.

Lactulose

Lactulose is a synthetic sugar used for hepatic encephalopathy. It is broken down by gut bacteria into lactic acid, which traps ammonia in the colon for excretion. Its osmotic effect also increases bowel movements, expelling trapped ammonia. It is an oral liquid and the appropriate amount is determined by a healthcare professional. Common side effects include gas and diarrhea.

Rifaximin (Xifaxan)

Rifaximin is a non-absorbable antibiotic often used with lactulose. It reduces ammonia-producing gut bacteria with minimal systemic absorption. It's taken orally, and a healthcare provider will determine the suitable amount and frequency. Rifaximin is used when lactulose alone is insufficient or for preventing hepatic encephalopathy recurrence.

Other Pharmacological Treatments

Ammonia Scavengers

For urea cycle disorders, ammonia scavengers provide an alternative way to remove nitrogen. Oral options include glycerol phenylbutyrate (Ravicti) and sodium phenylbutyrate (Buphenyl) for chronic management. Intravenous sodium phenylacetate and sodium benzoate (Ammonul) are emergency treatments for acute, severe hyperammonemia.

Other Interventions

L-ornithine L-aspartate (LOLA) can assist the liver in converting ammonia. Laxatives like polyethylene glycol (PEG) may be used for rapid bowel emptying. Zinc supplements can help if a deficiency is present with cirrhosis.

Dietary and Supplementary Interventions

Dietary changes, with medical guidance, are also important. A low-protein diet may be needed for urea cycle disorders, but for hepatic encephalopathy, adequate protein is encouraged. Branched-chain amino acids (BCAAs) may help in hepatic encephalopathy, and probiotics may promote beneficial gut bacteria.

Comparison of Key Ammonia-Lowering Treatments


Feature	Lactulose	Rifaximin (Xifaxan)	Ammonia Scavengers (e.g., Ravicti, Ammonul)
Mechanism	Osmotic laxative; converts NH3 to NH4+ in colon for excretion.	Non-absorbable antibiotic; reduces ammonia-producing gut bacteria.	Bypasses urea cycle; promotes alternative nitrogen elimination.
Primary Use	Hepatic encephalopathy (first-line treatment).	Hepatic encephalopathy (often with lactulose).	Urea cycle disorders; emergency IV for acute hyperammonemia.
Administration	Oral liquid or enema.	Oral tablets.	Oral liquid (Ravicti), IV (Ammonul).
Key Side Effects	Diarrhea, gas, bloating, nausea.	Nausea, headache, stomach pain.	Sodium-related issues (in benzoate), GI side effects, headache.
Tolerance	May cause uncomfortable GI side effects that limit compliance.	Generally well-tolerated with minimal systemic absorption.	Taste issues and dosing challenges with some oral formulations.

Who Should Take These Medications?

These medications are prescribed by healthcare professionals for specific conditions:

Liver disease and hepatic encephalopathy: Lactulose and Rifaximin are standard treatments.
Urea cycle disorders: Ammonia scavengers like Ravicti or Buphenyl are for long-term management, with IV Ammonul for emergencies.
Chronic kidney disease: Management of ammonia levels may be necessary in late-stage disease.

Conclusion

Treating high ammonia requires identifying the cause and getting medical guidance. Lactulose and rifaximin are key gut-targeting therapies for hepatic encephalopathy, while ammonia scavengers are used for urea cycle disorders. Diet and supplements can also play a role. A doctor must determine what you can take to lower your ammonia levels based on your condition. Following a prescribed regimen is essential for managing hyperammonemia effectively. For more information, consult resources like the American Liver Foundation.

Medical Guidance is Essential

Never self-medicate; a diagnosis from a healthcare professional is mandatory.
Lactulose and rifaximin are primary medications for hepatic encephalopathy, targeting gut ammonia.
Ammonia scavengers manage urea cycle disorders by promoting nitrogen excretion.
Acute hyperammonemia is an emergency requiring hospital care and IV medications.
Dietary modifications, including protein intake, are key but should be managed by a dietitian.
Monitoring and adherence are crucial for effective management.

Frequently Asked Questions

Lactulose is broken down by gut bacteria into lactic acid, creating an acidic colon environment. This converts ammonia (NH3) into the non-absorbable ammonium ion (NH4+), trapping it in the colon. As an osmotic laxative, it also increases bowel movements to flush out the trapped ammonium.

No, rifaximin is not a replacement but is often used in combination with lactulose. Rifaximin is an antibiotic that reduces ammonia-producing bacteria, while lactulose flushes ammonia from the gut.

Ammonia scavengers are medications that help the body eliminate excess nitrogen through alternative pathways, bypassing a defective urea cycle. They are primarily used for chronic management of urea cycle disorders and in acute hyperammonemic emergencies.

Dietary management is a key component, but it is not sufficient on its own for most conditions causing hyperammonemia. It must be used in conjunction with a medication regimen prescribed by a doctor.

No, there are no reliable over-the-counter medications specifically approved to lower dangerously high ammonia levels. Conditions causing hyperammonemia, like hepatic encephalopathy or urea cycle disorders, require prescription medication and medical supervision.

Chronic management often involves oral medications like lactulose, rifaximin, or oral ammonia scavengers. Acute, severe hyperammonemia is a medical emergency that requires immediate hospitalization and intravenous medications like Ammonul.

Monitoring ammonia levels helps doctors assess the effectiveness of the treatment, adjust dosages as needed, and detect any potential complications. It's an important part of managing the condition safely.