Note: Dose is presented as grams of l-glutamine.
Sickle cell disease: Note: Only the Endari brand/formulation is approved for sickle cell disease (SCD); avoid the use of other glutamine formulations for SCD (Quinn 2018).
Children ≥5 years and Adolescents: Endari: Oral Powder:
<30 kg: Oral: 5 g (1 packet) twice daily; total daily dose: 10 g/day.
30 to 65 kg: Oral: 10 g (2 packets) twice daily; total daily dose: 20 g/day.
>65 kg: Oral: 15 g (3 packets) twice daily; total daily dose: 30 g/day.
Supplement (nutritional):
Sympt-X: Children and Adolescents: Oral: 0.25 to 0.5 g/kg/day given in 3 divided doses; usual adult dose: 10 g/dose.
Glutasolve: Children >3 years and Adolescents: Oral: 15 g (1 packet)/dose; frequency determined based on patient's clinical status, indication, and nutritional assessment.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Nutritional supplements/medical foods are contraindicated in renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution. Nutritional supplements/medical foods are contraindicated in liver impairment.
(For additional information see "Glutamine (including L-glutamine [pharmaceutical grade] and supplements): Drug information")
Oral mucositis prevention, in patients with head and neck cancer receiving chemoradiotherapy (off-label use): Oral: 10 g 3 times daily throughout chemoradiotherapy (Tsujimoto 2015) or 10 to 30 g/day during chemoradiotherapy (MASCC/ISOO [Elad 2020]).
Sickle cell disease : Endari: Note: Only the Endari brand/formulation is approved for sickle cell disease (SCD); avoid the use of other glutamine formulations for SCD (Quinn 2018).
Prevention of vaso-occlusive pain in patients with frequent episodes (≥2 in the prior year), either as an adjunct to hydroxyurea or as an alternative in patients unable to tolerate hydroxyurea (Niihara 2018):
<30 kg: Oral: 5 g (1 packet) twice daily (total dose 10 g/day).
30 to 65 kg: Oral: 10 g (2 packets) twice daily (total dose 20 g/day).
>65 kg: Oral: 15 g (3 packets) twice daily (total dose 30 g/day).
Supplement (nutritional):
Note: Several products are available and specific dosing may not be represented here; refer to manufacturer labeling for product-specific dosing.
GlutImmune, GlutaMent, GlutaSolve, Glutapak-10, Sympt-X: Oral: Average dose: 10 g 3 times per day; dosing range: 5 to 30 g/day.
Glutamine (capsules, tablets): Oral: 500 mg daily.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Generic: 500 mg
Packet, Oral:
Endari: 5 g (1 ea, 60 ea)
Tablet, Oral:
Generic: 500 mg
May be product dependent
Sympt-X is available in US in 300 g jars, 500 g jars and packets (10 g L-glutamine + 5 g maltodextrin)
Oral:
Endari: Children ≥5 years and Adolescents: Mix each dose with 240 mL cold or room temperature beverage (eg, water, milk, apple juice) or with 4 to 6 ounces of semi-solid food (eg, applesauce, yogurt); do not use hot beverage or food. Complete dissolution is not required prior to administration. Prepare immediately prior to administration; do not save for later use.
Glutasolve: Children >3 years and Adolescents: Mix each 22.5 g packet (containing l-glutamine 15 g) with 120 mL hot or cold beverage. May also be mixed in applesauce, pudding, or yogurt. Stir well and use immediately.
Feeding tube administration: Mix with 60 to 120 mL warm water; do not mix directly with enteral formula. Flush tube with 15 to 30 mL water before and after administration. Use immediately after preparation.
Sympt-X: Children and Adolescents: Mix dose with 180 to 240 mL water, juice, or another beverage (<40°C [104°F]); may not completely dissolve; may also be mixed with semi-solid foods such as yogurt or smoothie. Use immediately after preparation. May administer via feeding tube.
Oral:
Endari: Mix each dose with 240 mL cold or room temperature beverage (eg, water, milk, apple juice) or with 120 to 180 mL of food (eg, applesauce or yogurt). Complete dissolution is not required prior to administration. Prepare immediately prior to administration.
GlutaMent: Do not mix with hot beverages as this may reduce potency; mix 1 packet with 120 to 180 mL of water, juice or other liquid. May also add to applesauce, pudding, or yogurt. For mucositis, mix each 10 g packet with 120 mL water; administer using a swish-and-swallow technique. If administering via feeding tube, mix 1 packet with 30 mL water; mix well and administer slowly via syringe; flush with 15 to 30 mL water before and after administration. Do not mix directly with enteral formula.
Glutapak-10: Prior to use, mix with 60 to 120 mL liquid or semisolid food. If administering via feeding tube, mix each 10 g packet with 60 to 120 mL water, and flush feeding tube before and after administration. Do not mix directly with enteral formula. Use immediately after preparation.
GlutaSolve: Mix each 22.5 g packet (containing l-glutamine 15 g) with 120 mL water. May also be mixed in hot or cold beverages, applesauce, pudding, or yogurt. If administering via feeding tube, mix with 60 to 120 mL warm water for 20 seconds. Flush tube with 15 to 30 mL water before and after administration. Use immediately after preparation. Do not mix directly with enteral formula.
GlutImmune: Mix with food or hot or cold beverages.
Sympt-X: Mix dose (10 g) with 180 to 240 mL water, juice, or another beverage; may also be mixed with semi-solid foods such as yogurt or smoothie. Use immediately after preparation. May administer via feeding tube.
Endari: Store at 20°C to 25°C (68°F to 77°F). Protect from direct sunlight. Mix immediately prior to administration.
Sympt-X: Protect from heat, freezing, light, and moisture.
Other products: Store at controlled room temperature.
Endari: Reduce the acute complications of sickle cell disease (FDA approved in ages ≥5 years and adults).
NutreStore: Treatment of short bowel syndrome (SBS) when used in combination with specialized nutritional support and growth hormone therapy (FDA approved in adults).
Nutritional supplement: Medical food used to promote GI tract healing and nutritional supplementation with GI disorders, HIV/AIDS, cancer, and other critical illnesses (OTC products: Consult product-specific labeling for recommended indications and ages).
Note: A medical food is formulated to be administered enterally under the supervision of a physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements are established by medical evaluation. Medical foods are not drugs and, therefore, are not subject to any FDA regulatory requirements that specifically apply to drugs (eg, requirement for written/oral prescription prior to dispensing, premarket review or approval, proof of safety and efficacy).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Cardiovascular: Chest pain (12%)
Central nervous system: Headache (18%)
Gastrointestinal: Flatulence (22%), constipation (21%), nausea (19%), abdominal pain (17%)
Neuromuscular & skeletal: Limb pain (13%), back pain (12%)
Respiratory: Cough (16%)
Frequency not defined:
Cardiovascular: Peripheral edema, vascular disease
Central nervous system: Chills, depression, hypoesthesia, insomnia, pain
Dermatologic: Nail disease, pruritus, skin rash
Endocrine & metabolic: Dehydration, increased thirst
Gastrointestinal: Abdominal distention, Crohn disease, gastric ulcer, gastrointestinal fistula, hemorrhoids, pancreatitis, tenesmus, vomiting, xerostomia
Genitourinary: Fungal vaginosis, mastalgia
Hepatic: Hepatic insufficiency
Hypersensitivity: Hypersensitivity reaction
Infection: Bacterial infection, infection, viral infection
Local: Injection site reaction
Neuromuscular & skeletal: Myalgia
Respiratory: Flu-like symptoms, laryngitis, pharyngitis, rhinitis
Renal: Nephrolithiasis, pyelonephritis
Miscellaneous: Fever
Endari: There are no contraindications listed in the manufacturer's labeling.
OTC labeling: Renal or liver impairment; Reye syndrome; shock; multi-organ failure
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Renal impairment: Use with caution in patients with renal impairment.
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program
Lactulose: Glutamine may diminish the therapeutic effect of Lactulose. Specifically, glutamine may diminish the ammonia-lowering effects of lactulose. Risk C: Monitor therapy
Endogenous glutamine can be detected in cord blood and concentrations are decreased in low birth-weight infants (Ivorra 2012).
Renal function; hepatic function.
Glutamine is considered a "conditionally essential" amino acid during metabolic stress and injury. Glutamine is a precursor for nicotinamide adenine dinucleotide (NAD). In sickle cell disease, NAD and its reduced form, NADH, have a role in regulating and preventing red blood cell oxidative damage; in sickle red blood cells, the ratio of NADH to total NAD is lower, which results in a decreased NAD redox potential (Niihara 1998). Glutamine may improve NAD redox potential in sickle red blood cells through increased availability of reduced glutathione.
Distribution: Adults (healthy): IV: Vd: ~200 mL/kg
Metabolism: Hepatic metabolism to glutamate and ammonia
Half-life elimination: Adults (healthy): IV: ~1 hour
Time to peak, serum: Adults (healthy): ~30 minutes
Capsules (Glutamine Oral)
500 mg (per each): $0.09
Pack (Endari Oral)
5 g (per each): $24.60
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