Usage
- Glutathione is prescribed for the treatment of nerve damage caused by the drug cisplatin. It’s also used as an adjunct treatment in cisplatin chemotherapy. It is being investigated for potential use in conditions like HIV, Parkinson’s disease, Alzheimer’s disease, autism, cystic fibrosis, and cardiovascular diseases.
- It is classified as an antioxidant.
- Glutathione acts by neutralizing free radicals and reducing oxidative stress, protecting cells from damage. It also plays a role in detoxification and immune system function. In cisplatin chemotherapy, it helps prevent nerve damage and other toxicities caused by the drug.
Alternate Names
- GSH
- Gamma-L-Glutamyl-L-cysteinylglycine
How It Works
- Pharmacodynamics: Glutathione is a potent antioxidant, scavenging free radicals and protecting cells from oxidative damage. It plays a vital role in detoxification by conjugating with toxins, making them water-soluble for excretion. It also supports immune function through lymphocyte activation.
- Pharmacokinetics:
- Absorption of oral glutathione is controversial, with some studies suggesting limited bioavailability. Liposomal and sublingual forms may offer better absorption. Intravenous administration provides direct delivery into the bloodstream. Inhalation and topical routes are also used.
- Glutathione is synthesized within the body from the amino acids glycine, cysteine, and glutamic acid, primarily in the liver.
- Glutathione is metabolized and eliminated through various pathways, including renal and hepatic excretion.
- Mode of Action: Glutathione donates electrons to neutralize free radicals, protecting cellular components from oxidative damage. It participates in detoxification reactions through glutathione S-transferases, which conjugate glutathione with toxins, facilitating their elimination. It also modulates immune function by influencing lymphocyte proliferation and activity.
Dosage
Standard Dosage
Adults:
Oral glutathione dosage is not standardized. Studies have used doses ranging from 250-1000 mg daily. For IV administration, 1400 mg three times per week for 4 weeks has been studied. Inhaled glutathione has been used at 600 mg twice daily. The optimal dosage and route of administration depend on the specific clinical situation.
Children:
Limited data is available for pediatric dosing. In studies of cystic fibrosis, oral glutathione has been used at 65 mg/kg/day divided into three doses with meals. Pediatric dosing should be carefully determined based on the child’s weight and medical condition.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on organ function.
- Patients with Renal Impairment: Dose modifications should be considered based on renal function.
- Patients with Hepatic Dysfunction: Dose adjustments may be required due to impaired glutathione synthesis.
- Patients with Comorbid Conditions: Dosage adjustments may be necessary in patients with other medical conditions.
Clinical Use Cases
Dosage recommendations for specific clinical situations are not well-established. The following are examples of dosages used in research studies:
- Cisplatin-induced neuropathy: IV administration of 600 mg/day for 2-5 days during chemotherapy or 1.5 g/m² before chemotherapy has been studied.
Dosage Adjustments
Dosage adjustments may be necessary based on individual patient factors, including renal or hepatic dysfunction, and other medical conditions.
Side Effects
Common Side Effects
Limited data exists on the frequency of side effects. Some reported side effects include abdominal cramps, bloating, and loose stools. Inhaled glutathione may exacerbate asthma symptoms, including wheezing.
Rare but Serious Side Effects
Severe hepatic injury has been reported with IV glutathione. Stevens-Johnson syndrome is a theoretical risk.
Long-Term Effects
Long-term use of oral glutathione has been linked to lower zinc levels. The long-term safety of other routes of administration is not well-established.
Adverse Drug Reactions (ADR)
Severe hepatic injury and Stevens-Johnson syndrome are potentially serious ADRs.
Contraindications
- Asthma (inhaled glutathione)
- Hypersensitivity to glutathione
- Pregnancy and breastfeeding (due to lack of safety data)
Drug Interactions
High doses of acetaminophen may deplete glutathione levels. Mild interactions have been reported with at least 89 different drugs. It is essential to review a patient’s medication list for potential interactions.
Pregnancy and Breastfeeding
Glutathione should be avoided during pregnancy and breastfeeding due to insufficient safety data. Some studies have shown that it may cause harm to the developing fetus and the breastfeeding baby if the mother takes glutathione. Although some researchers showed that taking glutathione during pregnancy is beneficial, it is best to avoid taking glutathione during this period because more research is needed.
Drug Profile Summary
- Mechanism of Action: Antioxidant, free radical scavenger, detoxification, immune modulation.
- Side Effects: Abdominal cramps, bloating, loose stools, wheezing (inhaled), hepatic injury (IV), Stevens-Johnson syndrome (theoretical).
- Contraindications: Asthma (inhaled), hypersensitivity, pregnancy, breastfeeding.
- Drug Interactions: Acetaminophen, at least 89 mild drug interactions.
- Pregnancy & Breastfeeding: Avoid.
- Dosage: Varies depending on the condition and route of administration. No standardized dosage exists.
- Monitoring Parameters: Liver function tests, renal function tests, monitor for allergic reactions.
Popular Combinations
Intravenous glutathione is sometimes used in combination with intravenous Vitamin C. However, this combination can have potential risks, such as kidney stones and hemodialysis in patients with G6PD deficiency.
Precautions
- Pre-existing medical conditions should be evaluated before initiating glutathione therapy.
- Patients with asthma should not use inhaled glutathione.
- Avoid alcohol, as it may decrease glutathione levels.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Glutathione?
A: There is no standard recommended dosage for glutathione. Dosing varies based on the route of administration and the condition being treated. Oral dosages range from 250-1000 mg daily in research studies. IV dosages and frequency also vary depending on the indication.
Q2: What are the main uses of Glutathione?
A: Glutathione is primarily used to treat cisplatin-induced neuropathy and as an adjunct treatment in cisplatin chemotherapy. It’s being investigated for potential benefits in a range of other conditions, but more research is needed.
Q3: What are the common side effects of Glutathione?
A: Common side effects are rare and may include abdominal cramps, bloating, and loose stools. Inhaled glutathione may worsen asthma symptoms.
Q4: Is Glutathione safe during pregnancy and breastfeeding?
A: Glutathione should be avoided during pregnancy and breastfeeding due to a lack of safety data.
Q5: How does glutathione work in the body?
A: It acts as a potent antioxidant, detoxifying agent, and immune modulator.
Q6: What are the potential drug interactions with Glutathione?
A: High doses of acetaminophen can deplete glutathione levels. Mild interactions have been reported with numerous other medications.
A: Yes, glutathione is available in various forms, including oral (standard, liposomal, sublingual), intravenous, inhaled, and topical formulations.
Q8: What should patients avoid while taking Glutathione?
A: Patients should avoid alcohol and discuss any other medications or supplements they are taking with their doctor. Patients with asthma should not use inhaled glutathione.
Q9: What is the role of glutathione in cisplatin chemotherapy?
A: Glutathione helps to reduce nerve damage and other toxic side effects caused by cisplatin.
Q10: What conditions is glutathione being investigated for?
A: Glutathione is being studied for potential use in conditions like HIV, Parkinson’s disease, Alzheimer’s disease, autism, cystic fibrosis, and cardiovascular diseases.
