L-alanyl-L-glutamine is a stable, highly soluble dipeptide composed of the amino acids L-alanine and L-glutamine. It serves as a superior source of glutamine, a conditionally essential amino acid, particularly in catabolic states like critical illness, major surgery, or trauma. In the Indian context, it is widely used in hospital settings as part of parenteral nutrition to support gut integrity, immune function, and nitrogen balance. The 20gm dose is typically administered via intravenous infusion.
Adult: Typically 1.5 to 2.0 ml/kg body weight per day of a 200 mg/ml solution (equivalent to 0.3 to 0.4 g/kg/day of the dipeptide). The standard 20 gm vial often provides a daily dose for a 50-70 kg patient. Maximum daily dose should not exceed 2.0 g/kg or 40-50 g total.
Note: MUST be diluted before use. The 20 gm (100 ml of 200 mg/ml solution) is added to other amino acid solutions or mixed with parenteral nutrition bags containing carbohydrates, lipids, electrolytes, and trace elements. Administer via central or peripheral venous line as a continuous infusion over 12-24 hours as part of total parenteral nutrition. Never administer as a rapid bolus injection.
L-alanyl-L-glutamine acts as a stable, soluble carrier for glutamine. Glutamine is a primary fuel source for rapidly dividing cells, including enterocytes of the small intestine and immune cells (lymphocytes, macrophages). During severe metabolic stress, endogenous glutamine synthesis cannot meet demand, leading to a deficiency. Supplementation helps maintain intestinal mucosal barrier function, supports immune cell proliferation and function, improves nitrogen balance, and may reduce the risk of infections and hospital stay duration.
Pregnancy: Category C: Animal reproduction studies have not been conducted. Should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, typically reserved for critically ill pregnant women requiring parenteral nutrition.
Driving: No known effects on driving ability, as it is administered in a controlled hospital setting.
| Antiepileptics (e.g., Valproate) | Additive risk of hyperammonemia. | Major |
| Corticosteroids | May counteract the protein-sparing effect; increased monitoring needed. | Moderate |
| Nephrotoxic drugs (e.g., Aminoglycosides, NSAIDs) | Increased risk of renal dysfunction affecting glutamine/ammonia clearance. | Moderate |
| Chemotherapy (e.g., Methotrexate, 5-FU) | Theoretical interaction via nucleotide synthesis pathways; clinical significance unclear. | Minor |
Same composition (L-alanyl-L-glutamine (20gm)), different brands: