GLUVITA LIQUID SHOTS

Indications

• Support in catabolic states
• Improvement of gastrointestinal health
• Enhancement of immune function
• Treatment of glutamine deficiency
• Support during chemotherapy

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Supplemental L-glutamine may exert its effects through multiple mechanisms. It protects the gastrointestinal tract's integrity, particularly the large intestine, by preventing translocation of Gram-negative bacteria. It serves as a primary fuel for enterocytes, colonocytes, and lymphocytes. By supplying additional L-glutamine, it may reverse catabolic states, enhance lymphocyte proliferation, and support the production of interleukin-2 and interferon-gamma. Furthermore, L-glutamine enhances phagocytosis by immune cells, contributing to improved immune responses.

Pharmacodynamics

Glutamine is crucial for protein synthesis and nitrogen metabolism. It acts as a nitrogen donor in the biosynthesis of various compounds, including other amino acids, purines, and pyrimidines. The enzyme glutamine synthetase converts glutamic acid to glutamine, thereby incorporating ammonia into organic compounds. Additionally, L-glutamine improves the redox potential of nicotinamide adenine dinucleotide (NAD), which is essential in various metabolic pathways.

Pharmacokinetics

Glutamine is widely distributed in body tissues, with skeletal muscle being the primary storage site. It is metabolized primarily in the liver and kidneys. The absorption of glutamine occurs in the intestine, and it is utilized rapidly by tissues with high metabolic demands, particularly during periods of stress or illness. Its plasma half-life is relatively short, necessitating regular supplementation in clinical settings.

Adverse effects

• Nausea
• Vomiting
• Abdominal pain
• Constipation
• Diarrhea
• Headache

Precautions

• Use with caution in patients with a history of liver disease
• Monitor renal function in patients receiving high doses

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and the benefits outweigh the risks.

Breast-feeding

It is not known whether glutamine is excreted in human milk. Caution should be exercised when administering to breastfeeding women.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Powder for oral solution
• Capsules

Mechanism of action

Supplemental L-glutamine's possible immunomodulatory role may be accounted for in a number of ways. L-glutamine appears to play a major role in protecting the integrity of the gastrointestinal tract and, in particular, the large intestine. During catabolic states, the integrity of the intestinal mucosa may be compromised with consequent increased intestinal permeability and translocation of Gram-negative bacteria from the large intestine into the body. The demand for L-glutamine by the intestine, as well as by cells such as lymphocytes, appears to be much greater than that supplied by skeletal muscle, the major storage tissue for L-glutamine. L-glutamine is the preferred respiratory fuel for enterocytes, colonocytes and lymphocytes. Therefore, supplying supplemental L-glutamine under these conditions may do a number of things. For one, it may reverse the catabolic state by sparing skeletal muscle L-glutamine. It also may inhibit translocation of Gram-negative bacteria from the large intestine. L-glutamine helps maintain secretory IgA, which functions primarily by preventing the attachment of bacteria to mucosal cells. L-glutamine appears to be required to support the proliferation of mitogen-stimulated lymphocytes, as well as the production of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma). It is also required for the maintenance of lymphokine-activated killer cells (LAK). L-glutamine can enhance phagocytosis by neutrophils and monocytes. It can lead to an increased synthesis of glutathione in the intestine, which may also play a role in maintaining the integrity of the intestinal mucosa by ameliorating oxidative stress. The exact mechanism of the possible immunomodulatory action of supplemental L-glutamine, however, remains unclear. It is conceivable that the major effect of L-glutamine occurs at the level of the intestine. Perhaps enteral L-glutamine acts directly on intestine-associated lymphoid tissue and stimulates overall immune function by that mechanism, without passing beyond the splanchnic bed. The exact mechanism of L-glutamine's effect on NAD redox potential is unknown but is thought to involve increased amounts of reduced glutathione made available by glutamine supplementation. This improvement in redox potential reduces the amount of oxidative damage which sickle red blood cells are more susceptible to. The reduction in cellular damage is thought to reduce chronic hemolysis and vaso-occlusive events. L-glutamine has important functions in regulation of gastrointestinal cell growth, function, and regeneration. Under normal conditions, glutamine concentration is maintained in the body by dietary intake and synthesis from endogenous glutamate. Data from clinical studies indicate that the role of and nutritional requirements for glutamine during catabolic illness, trauma, and infection may differ significantly from the role of and nutritional requirements for glutamine in healthy individuals. Glutamine concentrations decrease and tissue glutamine metabolism increases during many catabolic disease states, and thus glutamine is often considered a "conditionally essential" amino acid.

Pharmacodynamics

Like other amino acids, glutamine is biochemically important as a constituent of proteins. Glutamine is also crucial in nitrogen metabolism. Ammonia (formed by nitrogen fixation) is assimilated into organic compounds by converting glutamic acid to glutamine. The enzyme which accomplishes this is called glutamine synthetase. Glutamine can then be used as a nitrogen donor in the biosynthesis of many compounds, including other amino acids, purines, and pyrimidines. L-glutamine improves nicotinamide adenine dinucleotide (NAD) redox potential.