Glutathione Supplementation Guidelines

Established Clinical Indications

The American Society for Parenteral and Enteral Nutrition recommends parenteral glutamine supplementation for patients undergoing hematopoietic stem cell transplantation (HSCT) at a dose of approximately 0.6 g/kg/day 1
The Cystic Fibrosis Foundation states there are no data supporting the use of glutathione therapy for patients with cystic fibrosis 2, 3

The American Society for Parenteral and Enteral Nutrition suggests considering parenteral glutamine supplementation for surgical patients who cannot be fed adequately enterally and require exclusive parenteral nutrition (PN) 4, 5
The standard dosage for parenteral glutamine in surgical patients has been studied at 0.35 g/kg body weight 4
Glutamine administration in HSCT patients may minimize intestinal mucosal atrophy associated with exclusive PN, reduce liver damage caused by chemotherapy or radiotherapy, and potentially improve nitrogen balance, immune system function, and reduce infection risk 1

High-dose glutamine supplementation has been associated with increased mortality in critically ill patients with multi-organ failure, according to the Society of Critical Care Medicine 6
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 7

The recommended dose for parenteral administration in surgical or HSCT patients is 0.35-0.6 g/kg/day, as suggested by the American Society for Parenteral and Enteral Nutrition 4, 1

The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends a dose of 0.6 g/kg/day of parenteral glutamine for patients undergoing Hematopoietic Stem Cell Transplantation (HSCT) to minimize intestinal mucosal atrophy, reduce chemotherapy/radiotherapy-induced liver damage, and potentially improve nitrogen balance and immune function, with a Grade B recommendation 8, 9
For surgical patients who cannot be fed enterally and require exclusive parenteral nutrition, consider parenteral glutamine at 0.35-0.5 g/kg/day, although evidence is controversial and the recommendation is downgraded due to conflicting evidence 10

The 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 11

For patients undergoing HSCT, consider parenteral glutamine 0.6 g/kg/day, as recommended by ESPEN 8, 9
For surgical patients requiring exclusive PN, may consider parenteral glutamine 0.35-0.5 g/kg/day, although evidence is mixed 10
For patients undergoing conventional chemotherapy, do not use glutamine due to insufficient evidence and potential tumor promotion concerns 11