Alanyl glutamine

Summary

Alanyl-glutamine (L-alanyl-L-glutamine; Dipeptiven) is a stable dipeptide used as a parenteral glutamine supplement in critically ill or post-surgical patients who cannot receive adequate enteral nutrition. It overcomes the poor solubility and instability of free glutamine in solution. It is also used as an oral rehydration supplement in some formulations (e.g., Sustamine).

Mechanism of Action

Alanyl-glutamine is a stable dipeptide that serves as a soluble, stable source of glutamine. After hydrolysis in vivo, it releases L-alanine and L-glutamine, which support intestinal epithelial integrity, immune cell function, protein synthesis, gluconeogenesis, and nitrogen balance. Glutamine acts as a primary fuel for enterocytes and lymphocytes and is a precursor for nucleotide synthesis.

Routes of Administration

Goals & Uses

• Gut mucosal integrity preservationGastrointestinal HealthModerate
• Post-surgical recoveryPerioperative CareModerate
• Oral rehydration and exercise recoverySports Nutrition / HydrationLow
• Immune function supportImmunologyModerate
• Parenteral nutrition support in critically ill patientsClinical NutritionHigh

Contraindications

• Severe renal failureRenal ImpairmentHigh
• Hypersensitivity to alanine or glutamineAllergyHigh
• HyperammonemiaMetabolic DisorderHigh
• Severe hepatic failureHepatic ImpairmentHigh

Adverse Effects

• Electrolyte imbalancesMetabolicUncommon
• Nausea and gastrointestinal discomfortGastrointestinalCommon
• Phlebitis at infusion siteLocal/vascularUncommon
• HyperammonemiaMetabolicUncommon
• Elevated liver enzymesHepaticUncommonIncrease in AST/ALT or other hepatic markers

Drug Interactions

• Lactulose / ammonia-lowering agentsLow
• Valproic acidModerate

Population Constraints

• Patients with epilepsy or CNS disordersNeurologicalRelative
• Pediatric patientsAgeRelative
• Pregnant or lactating womenReproductiveRelative
• Patients with short bowel syndrome or malabsorptionGastrointestinalRelative

Regulatory Status

• European UnionApprovedApproved: Parenteral nutrition supplement providing glutamine to adult ICU and post-surgical patientsDipeptiven approved in EU and many European countries as a parenteral nutrition additive.
• United StatesUnapprovedNo FDA-approved parenteral drug product; marketed as dietary supplement ingredient (Sustamine) for oral use. Parenteral formulations used off-label or via compounding.
• United KingdomApprovedApproved: Parenteral glutamine supplementation in hypercatabolic/hypermetabolic patientsAvailable as licensed parenteral nutrition additive (Dipeptiven) in the UK.

Approved as a parenteral nutrition additive in the EU and many countries. FDA-cleared as a dietary ingredient for oral use in the US; the parenteral formulation (Dipeptiven) is not FDA-approved but is widely used outside the US. Oral formulations are marketed as supplements in the US (not FDA-approved as a drug).

Evidence & Sources

No sources recorded yet.