Usage
- L-alanyl-L-glutamine is prescribed for the prevention and treatment of parenteral nutrition-associated intestinal atrophy, maintaining intestinal barrier function, and reducing the incidence of bacterial translocation in critically ill patients. It is also used to improve hydration and performance in dehydrated athletes.
- Pharmacological classification: Nutritional agent, conditionally essential amino acid, and dipeptide.
- L-alanyl-L-glutamine provides glutamine, an essential amino acid for rapidly dividing cells, particularly enterocytes and lymphocytes of the gut and immune system, respectively. During critical illness or catabolic stress, glutamine becomes conditionally essential, requiring exogenous supplementation. It serves as a primary energy source for enterocytes, supports gut integrity, and modulates immune function.
Alternate Names
- Alanyl glutamine
- L-Alanyl-L-glutamine
- Dipeptide alanyl-glutamine
- Brand names: Dipeptiven, Glamin
How It Works
- Pharmacodynamics: L-alanyl-L-glutamine is rapidly hydrolyzed into its constituent amino acids, L-alanine and L-glutamine, in the body. L-glutamine is utilized by enterocytes and immune cells as a primary energy source and supports the structural integrity of the intestinal mucosa.
- Pharmacokinetics: It is readily absorbed in the small intestine. It has high bioavailability because it bypasses hepatic first-pass metabolism when administered intravenously. Hydrolysis to L-alanine and L-glutamine predominantly occurs in the kidneys and other peripheral tissues. The absorbed amino acids enter systemic circulation and are distributed to various tissues. Elimination occurs through renal excretion of the parent dipeptide and its metabolites.
Dosage
Standard Dosage
Adults:
- Intravenous infusion: 0.5 to 1 g/kg/day (500 mg/kg/day to 1000 mg/kg/day)
- Dosage frequency: Divided into two to three infusions per day, administered at a controlled rate.
- Maximum dosage limits: Should not exceed 1.5 g/kg/day.
Children:
- Pediatric dosing based on weight or age: Safety and efficacy in children have not been fully established. Limited data suggest similar dosages, adjusted according to weight, might be appropriate, under careful monitoring.
- Pediatric safety considerations: Close monitoring of fluid and electrolyte balance is essential.
Special Cases:
- Elderly Patients: Dosage adjustments may be required based on renal function and overall health.
- Patients with Renal Impairment: Dose reduction or increased interval between doses is needed.
- Patients with Hepatic Dysfunction: Generally, no dose adjustment is necessary.
- Patients with Comorbid Conditions: Consult with a clinical pharmacist or specialist for dose adjustments based on patient specific factors.
Clinical Use Cases
- Intubation: Standard dose.
- Surgical Procedures: Standard dose perioperatively.
- Mechanical Ventilation: Standard dose as supportive therapy.
- Intensive Care Unit (ICU) Use: Standard dose for critically ill patients.
Dosage Adjustments:
- Dose modifications are made based on the patient’s renal function, hydration status, electrolyte balance, and other relevant factors.
Side Effects
Common Side Effects
- Generally, well-tolerated when administered intravenously.
- Mild and transient gastrointestinal discomfort (nausea, vomiting) might occur with rapid intravenous administration.
Rare but Serious Side Effects
- Allergic reactions (rash, itching, shortness of breath)
- Severe metabolic acidosis.
Contraindications
- Hypersensitivity to L-alanyl-L-glutamine.
- Severe hepatic impairment with encephalopathy
- Renal failure requiring dialysis
- Patients with known metabolic disorders affecting glutamine metabolism.
Drug Interactions
- No significant clinically relevant drug interactions have been identified.
Pregnancy and Breastfeeding
- There are no adequate or well-controlled studies in pregnant women. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- It is not known if L-alanyl-L-glutamine is excreted in human milk. Use with caution in breastfeeding mothers.
Drug Profile Summary
- Mechanism of Action: Provides glutamine, an essential nutrient for intestinal and immune cells, supporting gut barrier function and immune response.
- Side Effects: Generally well-tolerated; rarely allergic reactions or metabolic acidosis.
- Contraindications: Hypersensitivity, severe liver or kidney impairment.
- Drug Interactions: None known.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: Adults: 0.5 to 1 g/kg/day IV; Children: dose adjustment based on weight; special considerations for renal and hepatic impairment.
- Monitoring Parameters: Renal function, liver function, electrolytes, blood glucose.
Popular Combinations
- Often co-administered with standard parenteral nutrition solutions.
Precautions
- Monitor fluid and electrolyte balance.
- Renal and hepatic function monitoring.
- Adjust dose for patients with organ dysfunction.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for L-alanyl-L-glutamine?
A: The standard adult dosage is 0.5 to 1 g/kg/day administered intravenously. Pediatric doses are adjusted based on weight.
Q2: How is L-alanyl-L-glutamine administered?
A: It is administered intravenously, typically as part of a parenteral nutrition regimen.
Q3: What are the primary uses of L-alanyl-L-glutamine?
A: It is used to support gut integrity and function in critically ill patients receiving parenteral nutrition.
Q4: What are the common side effects?
A: Generally well-tolerated, but rarely nausea, vomiting, or allergic reactions.
Q5: Are there any contraindications?
A: Contraindicated in patients with hypersensitivity and severe liver or kidney impairment.
Q6: How does it work?
A: It supplies glutamine, vital for enterocytes and immune cells, promoting gut health and immune function.
Q7: What precautions should be taken?
A: Monitor renal and hepatic function, electrolytes, and fluid balance.
Q8: Can it be used in pregnant or breastfeeding women?
A: Use with caution; consult a specialist. Safety not fully established.
Q9: How does L-alanyl-L-glutamine interact with other drugs?
A: No known clinically significant drug interactions.
Q10: Are there any specific monitoring parameters for patients receiving L-alanyl-L-glutamine?
A: Closely monitor renal and hepatic function, along with electrolyte and fluid balance. Pay attention to blood glucose levels, especially in diabetic patients.
