Clinical Applications of Glutathione

Established Biochemical Functions

Glutathione serves as a cofactor for glutathione peroxidase, catalyzing the reduction of hydrogen peroxide to water and lipid peroxides to lipid alcohols, preventing membrane damage and ferroptosis 1
Glutathione conjugates with toxic metabolites and xenobiotics through glutathione S-transferase enzymes, creating water-soluble compounds for cellular elimination 1
Glutathione protects against lipid peroxidation by converting oxidized glutathione disulfide back to its reduced form through glutathione reductase, which requires NADPH as a cofactor 1

For patients undergoing Hematopoietic Stem Cell Transplantation, parenteral glutamine at 0.6 g/kg/day is recommended to minimize intestinal mucosal atrophy, reduce chemotherapy/radiotherapy-induced liver damage, and potentially improve nitrogen balance and immune function, representing a Grade B recommendation from ESPEN 2
For platinum-based chemotherapy, injectable GSH at 1.5-2.5g IV before chemotherapy may reduce peripheral neuropathy through detoxification of platinum-induced reactive intermediates 1
The American Society of Clinical Oncology states GSH is ineffective for taxane-induced neuropathy prevention 1
In burn patients with >20% body surface area, enteral glutamine at 0.3-0.5 g/kg/day should be administered for 10-15 days, as it reduces infectious complications and mortality, representing a Grade B recommendation with 95% consensus 3, 4
For critically ill trauma patients, enteral glutamine at 0.2-0.3 g/kg/day can be administered for the first five days, with extension to 10-15 days for complicated wound healing 3, 4

ESPEN states there are insufficient consistent clinical data to recommend glutamine supplementation during conventional cytotoxic or targeted therapy, and therefore does not recommend its use 2
The Cystic Fibrosis Foundation states there are no data supporting the use of glutathione therapy for patients with cystic fibrosis 1, 2
In ICU patients except burn and trauma patients, additional enteral glutamine should not be administered, representing a Grade B recommendation with 92.31% consensus 3, 4
The National Kidney Foundation recommends that high-dose parenteral glutamine should not be administered to patients with acute kidney injury or chronic kidney disease with kidney failure 2
ESPEN guidelines state there is insufficient evidence to recommend glutamine supplementation in IBD patients 7
The Korean Association for the Study of the Liver guidelines do not recommend glutathione for NAFLD management 8

Only intravenous administration has established evidence in medical literature 1
GSH should not be confused with glutamine—they are different compounds with distinct indications and dosing regimens 1
Glutathione peroxidase requires selenium for optimal enzymatic activity, making adequate selenium status crucial for GSH function 1