Allopathy
OTX
FSSAI (Food Safety and Standards Authority of India)
L-arginine is a belonging amino acid belonging to the non-essential amino acid class.
L-arginine is also known as (S)-2-Amino-5-guanidinopentanoic acid, Arg and Arginine.
L-arginine is a cofactor for several enzymes involved in procedures, including sulphur metabolism and detoxifying certain substances essential for optimal well-being.
L-arginine deficiency is very uncommon in humans. It may lead to decreased sulfite oxidase activity and sulfite toxicity in a patient receiving long-term complete parenteral nutrition. Symptoms like tachycardia, tachypnea, headache, nausea, vomiting, and coma characterize it.
The highest amount of dietary L-arginine is found in dietary protein, commonly
in meat, fish, poultry, milk, dairy products, nuts, and seeds. Other dietary sources include barley, brown rice, buckwheat, chocolate, corn, oats, raisins and soy.
The stomach absorbs arginine into circulation, where it is subsequently transported to cells. It is metabolised by enzymes to produce nitric oxide (NO), which has functions in signalling, immunity, and vasodilation. The kidneys are used to remove extra arginine.
The common side effects of L-arginine include diarrhoea, headaches, nausea, diarrhoea, headaches and abdominal pain.
L-arginine is available in injectable solutions and oral powders.
Biochemical action of L-arginine
L-arginine belonging to the supplement class helps in several enzymatic processes. L-arginine acts via L-arginine enzyme-mediated biochemical pathways.
Arginine is a significant component in several biochemical processes that have a variety of consequences, including pH control, depolarization of endothelial cell membranes, immunity, and anticancer activity. It is a vital component in the urea cycle and the metabolism of macronutrients. Additionally, corticotropin-releasing factors, insulin, glucagon, prolactin, aldosterone, and somatostatin, are among the hormones whose release is influenced by arginine.
Growth hormone and immune function: Arginine stimulates the secretion of growth hormone, which consequently boosts the cytotoxic activity of neutrophils, macrophages, natural killer cells, and cytotoxic T lymphocytes.
Nitric oxide (NO)production: Given that NO plays several functions in various organs, the arginine-NO pathway, a subset of arginine metabolism, is important. In mammalian cells, NOS causes the radical chemical NO to be produced from l-arginine. It has a global effect and affects host defence, gene expression regulation, inflammation, and neurotransmission.
Antiobesity: L-arginine supplementation improves metabolic profiles, decreases white adipose tissue, and promotes the formation of brown adipose tissue. As a result, it shows potential for managing and preventing obesity.
L-arginine is available in injectable solutions and oral powders.
Injectable solutions: To be administered parenterally, as applicable.
Powders, oral: Powders must be mixed thoroughly with the appropriate amount of liquid and stirred well to dissolve the powder, as applicable.
L-arginine can be used as a supplement when the amount of L-arginine taken from the diet is insufficient.
L-arginine supplements taken by IV may be used to prevent and treat L-arginine deficiency, a condition in which the body needs L-arginine.
The L-arginine supplement helps the body break down medicines, ingested harmful compounds, proteins and genetic information like DNA.
L-arginine supplements may support healthy immunological function and neuronal cells.
Vitamins and natural supplements should not replace a balanced diet.
This product is not intended to diagnose, treat or prevent any disease(s).
L-arginine can help to support as a supplement for the following health benefits:
- Cardiovascular disease: Arginine supplementation increases endothelial function, particularly in hypercholesterolemia and atherosclerosis. The l-arginine-NO system has been linked to cardiovascular disorders such as hypertension, atherosclerosis, and stroke.
- Hyperlipidaemia: Some studies have found that l-arginine supplementation reduces total serum cholesterol levels in both the control and patient groups. After the medication, LDL cholesterol and serum triglycerides both decreased, while HDL cholesterol increased significantly.
- Hypertension: Dietary L-arginine has been demonstrated in certain studies to lower blood pressure in healthy individuals, people with mild blood pressure elevation and diabetes, and people with pulmonary hypertension, an uncommon high blood pressure that affects the arteries in the lungs and the right side of the heart. L-arginine infusions appear to reduce blood pressure in individuals with hypertension.
- Pregnancy: L-arginine infusions can lower blood pressure in women suffering from pregnancy-related problems. Pregnant women who take L-arginine directly may be able to avoid preeclampsia. Some studies revealed L-arginine to be useful in reducing the occurrence of preeclampsia and eclampsia while also prolonging pregnancy duration.
- Peripheral arterial disease: L-arginine may improve symptoms and circulation in those with cardiovascular problems, whether taken orally or through a short-term infusion. In situations of peripheral artery disease, dietary l-arginine has been demonstrated to improve vasodilation, limb blood flow, and walking ability.
- Erectile dysfunction: Oral L-arginine may enhance sexual function in men who have erectile dysfunction owing to a physical cause. Given the importance of NO in the corpus cavernosum, the effect of supplemental arginine on erectile function has been studied.
- Angina: Taking L-arginine by mouth decreases symptoms and improves exercise tolerance and quality of life in people with angina. But it doesn't seem to help widen blood vessels that are narrowed in angina.
- Diabetes: L-arginine taken orally alleviates angina symptoms, enhances exercise capacity, and improves quality of life. It does not, however, significantly widen constricted blood vessels. L-Arginine has also shown potential in the treatment of diabetes because it promotes the production of insulin and glucagon, which are both essential in glucose metabolism.
- Cancer: L-Arginine has also shown potential in treating diabetes because it promotes the production of insulin and glucagon, which are both critical in glucose metabolism. The significance of L-Arginine in cancer is complicated. While it improves immune function and wound healing, it can also promote cancer cell development through angiogenesis. There has been little research into its direct effects on cancer. Caution is suggested since L-arginine may interfere with cancer therapy or worsen specific cancers.
L-arginine supplementation may be administered parenterally and orally.
Typically, intravenous (IV) injections are used to give L-arginine parenterally. The element will enter the bloodstream directly via this process.
L-arginine supplements are available as oral powders that can be taken orally. It is best taken with a meal or food.
The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).
Vitamins and natural supplements should not replace a balanced diet.
This product is not intended to diagnose, treat or prevent any disease(s).
Intravenous solution: 30g/300mL
Powder, oral: 500 mg, 3000 mg
L-arginine is available in injectable solutions and oral powders.
L-arginine should be used as a supplement that helps in several biochemical processes along with appropriate dietary restrictions.
- Avoid alcoholic beverages.
- Stay within your daily calorie needs.
- Avoid smoking cigarettes.
- Limit foods and drinks with added sugars, saturated fat, and sodium.
The dietary restriction should be individualized as per patient requirements.
Recommended Daily Allowance (RDA)
The RDA of L-arginine is 45 μg/day.
Upper Tolerable Intake (UTL):
The UTL set for L-arginine is 2 mg/day
- Hypersensitivity; sensitive to L-arginine.
- Hepatic impairment
- Hyperkalaemia
- Hypophosphataemia
- Septic shock
- Hypotension
- Liver disease
Caution must be taken while administering intravenous arginine because an overdose might have adverse effects such as severe hyponatremia.
Caution is necessary for using high doses of 30 g/day in cancer patients, as even short-term use for 3 days may be linked to increased tumour growth.
L-arginine supplements should be used cautiously in liver/biliary tract dysfunction.
High doses of L-arginine injection with high osmolality can cause local irritation and phlebitis.
L-arginine supplements may need to be used with caution by people who have renal issues since too much L-arginine consumption may damage kidney function.
Alcohol Warning
Caution is advised when consuming alcohol with L-arginine.
Breast Feeding Warning
Detection in breast milk is unclear; Use cautiously during breastfeeding.
Pregnancy Warning
Food Warning
Limit the consumption of foods and beverages higher in added sugars, saturated fat, and sodium alcoholic beverages, as these substances could hinder L-arginine absorption.
The adverse reactions related to L-arginine can be categorized as-
- Common: Nausea, diarrhoea, abdominal pain, itching, rash and hives.
- Less Common: Blood pressure changes, flushing (skin redness), headaches and electrolyte imbalances.
- Rare: Asthma, kidney failure and blood sugar level changes.
The clinically relevant drug interactions of L-arginine are briefly summarized here
- Antihypertensive medicines: Use with concern as possible additive hypotensive effects might develop—potential benefits under professional supervision.
- Nitrates: Use with concern as additive vasodilation and hypotensive effects may occur.
- Sildenafil: Use with concern as additive vasodilation and hypotensive effects are possible in theory—potential benefits with supervision.
- l-Lysine: When administering both amino acids, concern must be taken because supplemental arginine has been shown to affect the herpes simplex virus' ability to reproduce, based on a limited number of studies. High doses of arginine may be harmful because they may compete with lysine for tissue uptake.
The common side of L-arginine includes the following:
- Nausea
- Diarrhoea
- Headaches
- Abdominal pain.
- Itching
- Rash
L-arginine should be prudent in the following group of special populations.
- Pregnancy:
There is no sufficient scientific evidence traceable regarding the use and safety of L-arginine for use in special populations.
- Paediatrics:
L-arginine supplements are the best way to help children get enough L-arginine daily. L-arginine is LIKELY SAFE for children at doses below the UL.
The RDA for L-arginine in paediatrics ranges from 2-43 mcg/day.
Dosage Adjustment for Paediatric Patients
Pituitary Stimulation
Used as a diagnostic pituitary stimulant to measure human growth hormone (hGH) reserve for conditions such as panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, acromegaly, gigantism, and problems of growth and stature
0.5 g/kg IV infused over 30 minutes; not to exceed 30 g/dose.
- Geriatrics:
There is no sufficient scientific evidence traceable regarding the use and safety of L-arginine for use in special populations.
- Lactating mothers:
There is no sufficient scientific evidence traceable regarding the use and safety of L-arginine for use in special populations
Dosage Adjustment in Kidney Impairment
There are no specific dosage adjustments provided.
Dosage Adjustment in Hepatic Impairment
There are no specific dosage adjustments provided.
Dosage Adjustment for Adult Patients
Pituitary Stimulation
Used as a diagnostic pituitary stimulant to measure human growth hormone (hGH) reserve for conditions such as panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, acromegaly, gigantism, and problems of growth and stature
300 mL (30 g) IV infused over 30 minutes
Hemoglobinopathies & Thalassemia (Orphan)
Indicated for treatment of beta-hemoglobinopathies and beta-thalassemia
The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of L-arginine. Overconsumption of L-arginine may lead to vasodilation and hypotension, which is caused due to overproduction of NO.
There is no specific antidote or treatment for excessive intake of supplemental L-arginine. When an overdose is suspected or experience any unusual symptoms after L-arginine supplement use or dietary intake, L-arginine supplements should be terminated immediately. Supportive treatment should also be given, along with addressing any symptoms that persist or worsen, and physical therapy might be added if necessary.
Biochemistry profile of L-arginine
L-Arginine is a critical amino acid precursor to NO, a vital signalling molecule. NO is essential for vascular health because it regulates blood vessel dilatation and contraction. L-Arginine participates in a variety of metabolic processes. It is a substrate for NO enzymes, such as nitric oxide synthase (NOS). L-Arginine is also a precursor for ornithine and citrulline, which are both involved in the urea cycle, which eliminates from the body in the form of ammonia. L-Arginine is also necessary for protein synthesis, wound healing, immunological function, and hormone release, including insulin and growth hormone. L-Arginine metabolism can influence tumour growth and immunological responses in conditions like cancer. Its varied roles indicate its importance in a variety of physiological processes.
Kinetic profile:
- Absorption: After ingestion, l-arginine is absorbed from the gastrointestinal tract into the bloodstream, which transporters facilitate.
- Distribution: Once in the bloodstream, arginine circulates via the circulatory system to numerous tissues and cells.
- Metabolism: Arginine is sensitive to reactions involving enzymes within cells. Nitric oxide synthase (NOS) converts arginine into nitric oxide (NO) and citrulline. NO possesses a variety of physiological impacts and functions as a signalling molecule.
- Elimination: To maintain balance, the body removes excess arginine and its byproducts. Urinary excretion of these substances through filtration and excretion by the kidneys is essential.
- Braun L, Cohen M. October 1, 2014.Herbs and Natural Supplements; 4th Edition Vol-2. Australia. Elsevier.
- National Institute of Nutrition. 2011. Dietary guidelines for Indians; 2nd Edition. Hyderabad. India
Tessari P. 2019. Nonessential amino acid usage for protein replenishment in humans: a method of estimation; American Society for Nutrition. Department of Medicine, University of Padova, Padova, Italy
Wu, Guoyao et al. “Role of L-Arginine in Nitric Oxide Synthesis and Health in Humans.” Advances in experimental medicine and biology vol. 1332 (2021): 167-187. doi:10.1007/978-3-030-74180-8_10
