Alanyl glutamine
Also known as: AGln, Ala-Gln, Ala‑Gln, Alanyl‑Glutamine, Alanylglutamine, Dipeptiven, L-alanyl-L-glutamine, L‑alanyl‑L‑glutamine, Sustamine
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Summary
Alanyl‑glutamine (AG) is a dipeptide composed of alanine and glutamine that is approved as a prescription amino‑acid supplement. It can be given intravenously, orally, or added to peritoneal dialysis fluids. Research explores its role in supporting cellular stress responses, improving fluid retention, reducing postoperative adhesions, and potentially protecting the peritoneal membrane during dialysis.
Mechanism of Action
After administration, AG is rapidly hydrolyzed to free alanine and glutamine, supplying glutamine to rapidly dividing cells such as enterocytes, immune cells, and mesothelial cells. Glutamine supports nucleotide synthesis, oxidative‑stress defenses, and heat‑shock protein expression, which together can modulate inflammation, improve cellular barrier function, and influence the cascade of adhesion formation. In the context of dialysis fluids, these actions are hypothesized to counteract glucose‑induced pseudohypoxia and preserve membrane transport.
What the Research Shows
A 2023 randomized double‑blind phase 1/2 trial in women undergoing myomectomy showed that a single intraperitoneal bolus of AG (≈1 g/kg) reduced the incidence and severity of postoperative adhesions, with 100 % of treated patients showing improvement versus 30 % of placebo (p≈0.04). A 2021 beverage‑hydration study found that adding 2 g/L AG to an electrolyte solution increased the beverage hydration index at 240 min (1.15 vs water) and reduced self‑reported bloating. A 2012 Cochrane review of liver‑transplant nutrition noted that parenteral regimens containing AG did not improve survival but showed weak evidence for shorter hospital stays when combined with other nutrients. Reviews of peritoneal dialysis highlight AG as an emerging additive to mitigate glucose‑induced membrane damage, but clinical data are still limited.
Reported Benefits
Current human data suggest AG may lower postoperative adhesion formation after abdominal surgery and modestly enhance fluid retention when included in oral rehydration drinks. In parenteral nutrition for liver‑transplant patients, AG‑containing formulas have been associated with reduced length of hospital stay, although survival benefits are unproven. Preclinical and review literature propose membrane‑protective effects in peritoneal dialysis, but these remain theoretical.
Limitations of the Evidence
Evidence is confined to a single small surgical trial, one hydration study, and indirect findings from nutrition reviews; no large randomized trials have confirmed efficacy for adhesion prevention, dialysis membrane protection, or clinical outcomes in transplant patients. Many conclusions stem from mechanistic hypotheses or heterogeneous nutrition protocols, and the Cochrane analysis reported high risk of bias across included studies. Consequently, the therapeutic claims remain provisional.
Safety Considerations
In the myomectomy trial, no serious adverse events or differences in routine safety labs were reported, indicating good short‑term tolerability of intraperitoneal AG. The hydration study reported fewer bloating symptoms compared with water. Overall, AG appears well tolerated in the limited human studies, but systematic safety data are sparse, especially for chronic intravenous use in renal or transplant populations.
How It Is Administered
AG can be administered intravenously as part of parenteral nutrition solutions, orally as a dietary supplement, or added to peritoneal dialysis fluid for intraperitoneal instillation. In the myomectomy study a single intraperitoneal bolus (~1 g/kg) was used; the hydration study employed 2 g/L in a beverage. Formulations are typically sterile aqueous solutions.
Routes of Administration
Goals & Uses
- Intestinal mucosal protectionGut HealthModerate
- Gut mucosal integrity preservationGastrointestinal HealthModerate
- Immune functionImmunologyModerate
- Post-surgical recoveryPerioperative CareModerate
- Nutritional supportNutritionModerate
- Gut mucosal integrityGastrointestinalModerate
- Oral rehydration and exercise recoverySports Nutrition / HydrationLow
- Immune function supportImmunologyModerate
- Parenteral nutrition support in critically ill patientsClinical NutritionHigh
- Immune modulationImmunologyModerate
Contraindications
- Severe hepatic impairmentOrganModerateLiver function concerns
- Severe renal failureRenal ImpairmentHigh
- Hypersensitivity to alanine or glutamineAllergyHigh
- Known hypersensitivity to alanyl‑glutamineAllergyHigh
- HyperammonemiaMetabolic DisorderHigh
- Severe hepatic failureHepatic ImpairmentHigh
- Hypersensitivity to alanyl‑glutamine or excipientsAllergyHigh
Adverse Effects
- Electrolyte imbalancesMetabolicUncommon
- Hyperammonemia (rare)MetabolicRare
- Mild gastrointestinal upsetGastrointestinalCommon
- HyperglycemiaMetabolicUncommonAbnormally high blood glucose
- Injection site reactionsLocalCommon
- Nausea and gastrointestinal discomfortGastrointestinalCommon
- NauseaGastrointestinalCommonFeeling of sickness or urge to vomit
- Phlebitis at infusion siteLocal/vascularUncommon
- HyperammonemiaMetabolicUncommon
- Elevated liver enzymesHepaticUncommonIncrease in AST/ALT or other hepatic markers
Drug Interactions
- Lactulose / ammonia-lowering agentsLow
- Valproic acidModerate
- Renal‑clearing drugs (e.g., aminoglycosides)Moderate
- High protein nutrition formulasLow
Population Constraints
- Patients with epilepsy or CNS disordersNeurologicalRelative
- Severe renal impairmentOrgan ImpairmentRelative
- Pediatric patientsAgeRelative
- Pregnant or lactating womenReproductiveRelative
- NeonatesPediatricRelative
- Neonates and preterm infantsPediatricRelative
- Patients with short bowel syndrome or malabsorptionGastrointestinalRelative
Regulatory Status
- European UnionUnapprovedUsed in medical nutrition products under EU food supplement regulations.
- United StatesUnapprovedConsidered a dietary supplement; not FDA‑approved as a drug.
- United KingdomApprovedApproved: parenteral nutrition
Approved in the US as Dipeptiven for parenteral nutrition; also approved in EU and UK for similar indications.
Evidence & Sources
- Journal ArticleModerateKrediet RT2022-01-01T00:00:00.000000Z
- Journal ArticleModerateChizen DR, et al.2023-01-01T00:00:00.000000Z
- Journal ArticleModerateMillard-Stafford M, et al.2021-01-01T00:00:00.000000Z
- Journal ArticleHighLanger G, et al.2012-01-01T00:00:00.000000Z
- Journal ArticleModerateHausinger R, et al.2022-01-01T00:00:00.000000Z
- Journal ArticleModerateSchmitt CP, Aufricht C2017-01-01T00:00:00.000000Z
Frequently Asked Questions
What is alanyl‑glutamine used for?
It is a prescription dipeptide supplement that supplies glutamine to cells. Current research investigates its use to reduce surgical adhesions, improve fluid retention in rehydration drinks, and as an additive in peritoneal dialysis or parenteral nutrition, but it is not approved for these specific indications.
How is alanyl‑glutamine given?
AG is available for intravenous infusion (often as part of parenteral nutrition), oral ingestion as a powder or solution, and can be mixed into peritoneal dialysis fluid for intraperitoneal delivery. Dosing in studies has ranged from 2 g/L in beverages to about 1 g per kilogram body weight for a single intraperitoneal dose.
Is alanyl‑glutamine safe?
Short‑term studies report no serious adverse events and fewer gastrointestinal complaints compared with water. However, comprehensive safety data are limited, especially for long‑term intravenous use, so monitoring for typical infusion reactions and renal considerations is advisable.
Does alanyl‑glutamine prevent adhesions after surgery?
A small phase 1/2 trial in women undergoing myomectomy found a statistically significant reduction in adhesion incidence and severity after a single intraperitoneal dose of AG, with no serious side effects. Larger trials are needed to confirm this benefit.
Can alanyl‑glutamine improve dialysis outcomes?
Review articles suggest that adding AG to peritoneal dialysis solutions may counteract glucose‑induced membrane stress and preserve function, but clinical evidence is currently limited to experimental rationale and early‑stage investigations.
What is Alanyl glutamine used for?
Alanyl glutamine is educationally associated with: Intestinal mucosal protection, Gut mucosal integrity preservation, Immune function, Post-surgical recovery, Nutritional support, Gut mucosal integrity, Oral rehydration and exercise recovery, Immune function support, Parenteral nutrition support in critically ill patients, Immune modulation. Educational only — not medical advice.
How is Alanyl glutamine administered?
Recorded routes of administration: Intravenous, Oral.
What are the potential side effects of Alanyl glutamine?
Reported adverse effects include: Electrolyte imbalances, Hyperammonemia (rare), Mild gastrointestinal upset, Hyperglycemia, Injection site reactions, Nausea and gastrointestinal discomfort, Nausea, Phlebitis at infusion site, Hyperammonemia, Elevated liver enzymes. This list is not exhaustive — consult a qualified clinician.
Who should avoid Alanyl glutamine?
Recorded contraindications: Severe hepatic impairment, Severe renal failure, Hypersensitivity to alanine or glutamine, Known hypersensitivity to alanyl‑glutamine, Hyperammonemia, Severe hepatic failure, Hypersensitivity to alanyl‑glutamine or excipients. Consult a qualified clinician before use.