glutamine

Action and Spectrum

Actions and Spectrum: 

glutamine is a non-essential amino acid that is crucial in various biological processes. Here are the main aspects: 

• Protein Synthesis and Cell Growth: glutamine is a building block for protein synthesis and is essential for cell growth and proliferation. It provides the nitrogen atoms for synthesizing other amino acids, DNA, and RNA.  
• Energy Source: glutamine is an important energy source for cells, especially in rapidly dividing tissues such as the immune system, intestines, and certain types of cancer cells. It can be metabolized to produce ATP (adenosine triphosphate), the primary energy currency of cells. 
• Nitrogen Carrier and Ammonia Detoxification: It plays a crucial role in removing excess ammonia, a toxic byproduct of metabolism, by converting it into less harmful substances such as urea. This process, known as ammonia detoxification, primarily occurs in the liver. 
• Immune Function: glutamine is essential for the proper functioning of the immune system. It fuels immune cells, including lymphocytes and macrophages, enhancing their proliferation, activation, and cytokine production.  
• Intestinal Health: glutamine plays a vital role in maintaining the health and integrity of the gastrointestinal tract. It serves as the primary fuel source for the cells lining the intestine, helping to support the gut’s barrier function, and promoting intestinal cell regeneration.  
• Glutathione Production: glutamine synthesizes glutathione, a powerful antioxidant in the body. glutathione helps protect cells from oxidative stress and supports detoxification processes. 

The spectrum of activity of glutamine encompasses various physiological processes, including protein synthesis, cell growth, energy production, immune function, intestinal health, and antioxidant activity.

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Endari 

Nausea (19%) 

Abdominal pain (17%) 

Pain in extremity (13%) 

Chest pain (12%) 

Headache (18%) 

Cough (16%) 

Back pain (12%) 

Constipation (21%) 

NutreStore 

Nausea (31%) 

Rhinitis (19%) 

Rash (13%) 

Peripheral edema (81%) 

Tenesmus (19%) 

Dizziness (13%)  

1-10% 

Pruritus (6%) 

Black Box Warning

Black box warning: 

None 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

None 

Caution: 

glutamine and ammonia are the end products of this metabolism, and their levels may rise in people with hepatic impairment.  

Check liver and kidney function regularly. 

Pregnancy / Lactation

Pregnancy consideration: Insufficient data available 

Lactation: Excretion of the drug in human breast milk is known 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

glutamine is a non-essential amino acid with various pharmacological properties. Here are some critical aspects of the pharmacology of glutamine: 

• Metabolism: glutamine is readily metabolized in the body. It can be converted into glutamate, an excitatory neurotransmitter, through the action of the enzyme glutaminase. glutamate can further undergo conversion to gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.  
• Energy Production: glutamine is an important energy source for various cells, especially those with high energy demands, such as immune cells, intestinal cells, and specific cancer cells. It can be metabolized to produce ATP (adenosine triphosphate), the primary energy currency of cells, through a process known as glutaminolysis. 
• Nitrogen Carrier and Ammonia Detoxification: glutamine acts as a carrier of nitrogen in the body. It transports nitrogen from peripheral tissues to organs such as the liver and kidneys, which can be utilized for various metabolic processes. glutamine is also involved in detoxifying ammonia, a toxic byproduct of metabolism, by converting it into less harmful substances such as urea. 

Pharmacodynamics: 

The pharmacodynamics of glutamine refers to this amino acid’s biochemical and physiological effects on the body.  

• Protein Synthesis and Cell Growth: glutamine is a crucial component of protein synthesis, serving as a building block for the formation of proteins in the body. It supports cell growth, tissue repair, and maintenance. glutamine plays a role in promoting anabolism (building up) and inhibiting catabolism (breaking down) processes. 
• Nitrogen Balance: glutamine is involved in maintaining nitrogen balance in the body. It serves as a primary carrier of nitrogen, allowing the transport of nitrogen between tissues and organs. glutamine helps to replenish the nitrogen pool and supports various metabolic processes dependent on nitrogen. 
• Neurotransmitter Synthesis: glutamine is a precursor for synthesizing neurotransmitters such as glutamate and gamma-aminobutyric acid (GABA). glutamate is an excitatory neurotransmitter involved in neuronal signaling, while GABA is an inhibitory neurotransmitter that helps regulate neuronal activity. 
• Energy Production: glutamine serves as a source of energy for various cells, particularly those with high energy demands, such as immune cells and enterocytes (cells lining the intestine). glutamine can be metabolized to produce ATP, the primary energy currency of cells, through the process of glutaminolysis. 

Pharmacokinetics: 

Absorption 

glutamine is absorbed relatively quickly after administration, with a peak plasma time of approximately 30 minutes. 

Distribution 

glutamine has a relatively large volume of distribution (Vd) of approximately 200 mL/kg, suggesting extensive distribution throughout the body. 

Metabolism 

glutamine participates in various metabolic activities within the body. It can be metabolized to form glutamate, which is an important neurotransmitter. glutamine is also involved in synthesizing proteins, nucleotides, and amino sugars, indicating its role in cellular processes, and building essential molecules. 

Elimination and Excretion 

glutamine has a relatively short half-life of approximately 1 hour, indicating that it is rapidly cleared from the body. While glutamine is eliminated by glomerular filtration in the kidneys, it is almost completely reabsorbed by the renal tubules. This reabsorption process helps maintain glutamine levels in the body. 

Adminstartion

Administration: 

Oral administration 

Endari 

• Take with 8 ounces of a cool or room temperature liquid (such as water, milk, apple juice), or 4 to 6 ounces of a soft meal (such as applesauce, yoghurt), and mix well just before swallowing. 
• It is not necessary to completely dissolve the medication before taking it.

NutreStore 

• Before drinking, dilute single 5 g package in 8 oz of water. The amount of water can be changed based on the patient’s taste. 
• Take with food or snacks every 2 to 3 hours while awake. If you cannot eat or drink by mouth, a dose can be put off for up to two hours.

Storage 

Keep at 20–25°C (68–77°F) and out of bright sunlight. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: glutamine 

Why do we use glutamine? 

glutamine is an amino acid that plays a vital role in various processes in the human body.  

• Muscle Recovery and Growth: athletes and bodybuilders often use glutamine to enhance muscle recovery and growth. It helps reduce muscle soreness and promotes the repair of damaged muscle tissue. 
• Immune System Support: glutamine is essential for the proper functioning of the immune system. It is a fuel source for immune cells and aids in maintaining the integrity of the intestinal barrier, which is crucial for immune function. 
• Gut Health: glutamine is beneficial for maintaining the health of the gastrointestinal tract.  
• Energy Production: glutamine is involved in energy metabolism. It serves as a source of fuel for various cells in the body, including the cells of the immune system and the intestines. 
• Nitrogen Transport and Balance: It helps maintain the body’s nitrogen balance, essential for protein synthesis and overall nitrogen metabolism. 
• Wound Healing: glutamine has been studied for its potential role in accelerating wound healing, particularly in severe burns, surgical wounds, or traumatic injuries.