Glutamine for mucositis and neuropathy
Oral glutamine, an amino acid that gut and mouth lining cells use for fuel, may reduce the severity of mouth ulcers during head and neck chemoradiation; mucositis guidelines suggest it for that use. Intravenous glutamine in transplant patients is not recommended, and evidence for preventing nerve damage is thin.
Overview
Glutamine is the main energy substrate of rapidly dividing enterocytes and oral mucosa. The 2020 MASCC/ISOO mucositis guidelines suggest oral glutamine for the prevention of oral mucositis in head and neck cancer patients receiving radiotherapy with chemotherapy, based on several small randomised trials, and recommend against parenteral glutamine in haematopoietic stem cell transplantation, where one trial suggested higher relapse. Trials of oral glutamine to prevent oxaliplatin and paclitaxel neuropathy are small and unblinded with inconsistent results, so it is not recommended for neuropathy. Glutamine is inexpensive and well tolerated; the theoretical concern that it feeds tumours has not been borne out clinically for oral use.
How it works
Supplying the preferred fuel of mucosal cells is proposed to speed epithelial repair after radiation and cytotoxic injury.
- MASCC/ISOO 2020 suggestion for head and neck chemoradiation
- Cheap and safe orally
- Small trials
- Parenteral use discouraged in transplant
- Neuropathy evidence weak
Latest papers
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