Glutamine (Oral Route)

Overview

Glutamine is an orally-administered medication marketed under several brand names including Enterex Glutapak-10, Resource Glutasolve, Sympt-X, and Sympt-X GI. The medication is based on a naturally-occurring substance in the body which may be synthesized in some cases. The chemical made by the body functions as a way to regulate cell growth and function but the medication is primarily prescribed as a way to treat short bowel syndrome. However, this severe condition cannot be treated with the medication alone. Treatment is often combined with human growth hormone and a very specialized diet.

When taking Glutamine for the treatment of short bowel syndrome, it is very important that the patient follows the dietary guidelines that are outlined by the prescribing physician. Specific dietary needs including vitamin intake may vary due to the patient's general physical condition and other medical conditions. The medication is usually taken as a powder, tablet, or capsule that is taken with water or food. In addition to its primary use as a treatment of short bowel syndrome, some forms of Glutamine are used to treat both adults and children who have sickle cell disease.

Conditions Treated

Type Of Medicine

  • Amino Acid Replacement

Side Effects

Glutamine may produce some unwanted effects in addition to the ones that are intended by the prescribing physician. The chances of these side effects may vary wildly from patient to patient with certain predispositions affecting the outcome, but some of them are serious enough to merit medical attention if they occur. A doctor should be contacted immediately if a patient taking Glutamine demonstrates any of the following symptoms:

  • Blood in urine
  • Changes in skin color
  • Chills
  • Cold hands and feet
  • Confusion
  • Cough
  • Difficulty swallowing
  • Dizziness
  • Fainting
  • Fast heartbeat
  • Fever
  • Frequent and painful urination
  • Headache
  • Hives
  • Itching
  • Lightheadedness
  • Lower back or side pain
  • Pain, redness, or swelling in arm or leg
  • Puffiness or swelling of the eyelids or around the eyes, face, lips or tongue
  • Rapid, shallow breathing
  • Shortness of breath
  • Skin rash
  • Stomach pain
  • Sudden decrease in amount of urine
  • Tightness in chest
  • Unusual tiredness or weakness
  • Wheezing

In addition to these serious side effects, there are also side effects that are temporary in nature and not expected to need medical care. Rather, they will go away when the body adjusts to the new levels of Glutamine in the system. If these are more intense than expected or last too long they may indicate that there is a more serious medical condition causing them. While a patient is coping with these side effects there may be some ways to reduce or eliminate them.

Some of the more common temporary side effects include the following symptoms:

  • Cough or hoarseness
  • Frequent urge to defecate
  • Straining while passing stools

Although they are less common, some patients demonstrate these temporary side effects:

  • Abnormal or decreased touch sensation
  • Back pain
  • Bacterial infection
  • Bleeding after defecation
  • Bleeding, burning, blistering, discoloration of skin, coldness, feeling of pressure, infection, inflammation, hives, itching, numbness, lumps, pain, redness, rash, scarring, stinging, soreness,
  • swelling, tingling, tenderness, ulceration, or warmth at site
  • Bloated full feeling
  • Body aches or pain
  • Breast pain, female
  • Chest pain
  • Change in the color, amount, or odor of vaginal discharge
  • Congestion
  • Constipation
  • Crohn's disease, aggravated
  • Dark urine
  • Decreased urination
  • Diarrhea
  • Difficulty having a bowel movement (stool)
  • Difficulty in moving
  • Discoloration of fingernails or toenails
  • Discouragement
  • Dry mouth
  • Dryness or soreness of throat
  • Ear or hearing symptoms
  • Excess air or gas in stomach or intestines
  • Feeling sad or empty
  • Feeling unusually cold shivering
  • Flatulence
  • Full or bloated feeling
  • General feeling of discomfort or illness
  • Increase in heart rate
  • Indigestion
  • Irritability
  • Joint pain
  • Lack of appetite
  • Light-colored stools
  • Loss of appetite
  • Loss of interest or pleasure
  • Muscle aches and pains
  • Muscle pain or stiffness
  • Nausea
  • Pain in joints
  • Pain or burning while urinating
  • Pains in stomach, side, or abdomen, possibly radiating to the back
  • Passing gas
  • Pressure in the stomach
  • Rash
  • Rectal bleeding
  • Runny nose
  • Shivering
  • Sleeplessness
  • Sneezing
  • Sore throat
  • Stomach bloating, burning, cramping, or pain
  • Stuffy nose
  • Sunken eyes
  • Sweating
  • Swelling of abdominal or stomach area
  • Swelling of face
  • Swelling of hands, ankles, feet, or lower legs
  • Swollen joints
  • Tender, swollen glands in neck;
  • Thirst
  • Trouble concentrating
  • Trouble sleeping
  • Trouble in swallowing
  • Unable to sleep
  • Uncomfortable swelling around anus
  • Unpleasant breath odor
  • Unusual tiredness or weakness
  • Voice changes
  • Vomiting
  • Vomiting of blood
  • Weight loss
  • Wrinkled skin
  • Yellow eyes or skin

While this list is extensive, medication can affect a patient unpredictably and they may suffer from side effects that are not on this list. If any other symptoms or side effects are noticed check with the prescribing physician to determine if Glutamine is causing them.

Dosage

The dosage of Glutamine that will be prescribed for a patient depends on a number of factors including their overall health, other medical conditions, and other mitigating circumstances. A doctor's orders in regard to the prescription should be followed rather than the recommended dosage from the manufacturer. The prescribing physician may be in possession of facts about the patient's medical condition that the average recommendations do not consider. Changing the dose prescribed by the doctor is not recommended and could be dangerous to the health of the patient. The amount of medicine taken per dose will also depend on the number of doses taken each day and the amount of time between doses.

For patients who are taking Glutamine powder for the treatment of short bowel syndrome, the adult dose will be 30 grams per day divided into six 5g doses. These doses will be taken 2-3 hours apart with either a meal or a snack as well as plenty of water. Children taking it for this purpose must have their dose determined by their pediatrician. If a dose is missed, it is advisable to skip to the next dose on the schedule to avoid double-dosing, which can lead to an overdose if the doses are taken too close together.

Interactions

Certain drug combinations will produce unwanted effects, and Glutamine may react with other prescription and non-prescription medication in this manner. While there are no specific drug interaction warnings, there is still a chance of a drug interaction that may enhance the side effects of one or both drugs and the side effects they produce on their own may interfere with the way in which the drugs are intended to work. It is important for the patient to inform their doctor of all drugs they are currently taking before taking Glutamine. There is also a possibility that food, drink, alcohol, or tobacco can interact poorly with Glutamine. All specific guidance from the prescribing physician regarding dietary restrictions should be followed closely to avoid these ill effects.

Certain medical conditions may preclude a patient from taking Glutamine for the treatment of their short bowel syndrome. For example, Liver disease is known to be made worse if Glutamine is taken without any additional precautions. There may be a number of other conditions that could be worsened by Glutamine or that could make the medication less effective than it would normally be.

Warnings

When Glutamine is prescribed it is important to keep up regular doctor's visits because examinations and tests will be required to determine whether or not the medication is working as intended. The doctor should also check regularly to ensure that the more serious side effects of Glucamine are not afflicting the patient.

There is a certain risk that there may be an allergic reaction to the Glutamine or other substances in the medication. If the patient has ever had a severe allergic reaction of any kind, further allergy testing may need to be performed before prescribing Glutamine. Although there have been many studies determining Glutamine is safe to use for adults, no studies have been done to ensure that it is safe for children. There is also a shortage of information regarding how the medicine affects the elderly. Older patients may need to have their dosages carefully modified to meet their requirements and potential sensitivities to the drug.

There is also a concern that Glutamine may be harmful to pregnant women based on animal studies, but there has not been a study to determine if this is true in humans. Doctors may wish to err on the side of caution and seek alternative therapies. Women who are nursing may wish to forgo the medication until they are no longer breastfeeding in order to minimize the possibility that the medication could be transferred to the infant.

Storage

The storage method of the medication will depend on its form, and specific directions on the label should be followed carefully. Mistakes made while storing this medication may make it unusable. In general, Glutamine needs to be stored in its original container at room temperature well away from sources of moisture, heat, cold, or direct light. It is not recommended that the powder be refrigerated and it should not be allowed to freeze. It is important to keep this medication in a secure area of the house out of the reach of children. If the Glutamine expires or is no longer needed it should be disposed of in accordance with local guidelines. Ask a doctor or pharmacist regarding how to dispose of medications if you are unsure of how to do it.

Summary

Glutamine is intended for the treatment of short bowel disease, which is a lack of function in the small intestine. This rare and debilitating disorder can also be caused by surgical removal of a certain portion of the intestine as a result of trauma, Chrohns disease, or necrotizing enterocolitis.

While it is not a cure for the symptoms that normally come with this condition, Glutamine can significantly improve the condition of the patient when it is combined with a healthy diet and hormone therapy. However, those who use it need to be made aware of the potential for serious side effects that in some cases may be worse than the disease and commit to the dietary restrictions that are essential to the process of recovery from short bowel disease.