L-Arginine is an essential amino acid and arginine hydrochloride is its synthetic derivative. Arginine hydrochloride can contribute to the detection of growth hormone deficiency, which can result in panhypopituitarism, pituitary dwarfism, chromophobe adenoma, postsurgical craniopharyngioma, hypophysectomy, pituitary trauma, and other problems related to growth. The drug can also be used to reveal pituitary function or malfunction in gigantism and acromegaly. In patients with high ammonia concentration or urea cycle disorders, arginine injections can control symptoms and serve as regulators. When used as dietary supplements, arginine tablets can improve exercise capacity in patients with stable angina pectoris. Arginine injection was approved by the FDA in February 1973.
Growth Hormone Deficiency Diagnosis: In patients with normal pituitary function, Arginine causes the pituitary to release growth hormone. Patients with impaired pituitary function who receive arginine will have lower or no increase in plasma concentrations of growth hormone after administration of arginine.
Urea Cycle Disorders (UCDs): The urea cycle helps the body maintain low blood concentrations of ammonia and glutamine which result from protein breakdown. Under normal circumstances, the cycle requires numerous enzyme-catalyzed steps and ultimately forms nitrogenous waste including urea. Hyperammonemia may occur when there is if a deficiency exists in one or more urea cycle enzymes or a cofactor: N-acetylglutamate synthetase (NAGS), carbamyl phosphate synthetase (CPS), argininosuccinate synthetase (ASS), ornithine transcarbamylase (OTC), or argininosuccinate lyase (ASL), hyperammonemia may occur. If any of these enzymes are deficient, arginine becomes an essential amino acid. If it is not available, protein catabolism occurs, which increases ammonia concentrations. Exogenous or supplemental arginine is administered to patients with urea cycle disorders to restore serum levels and prevent the breakdown of endogenous protein. This treatment also lowers the blood ammonia level and increases stimulate an alternative pathway for nitrogen waste excretion, which increase the amount of nitrogen excreted in the urine.
Metabolic Alkalosis: Arginine has a high chloride content and can serve as an alternative treatment for severe metabolic alkalosis.
Cardiovascular disease: Arginine is a precursor of nitric oxide, a potent vasodilator. Nitric oxide can induce vasodilation in patients with atherosclerosis.
Arginine injection is classified as FDA pregnancy category B. Basal and post-stimulation concentrations of growth hormone are elevated in pregnant women. No reliable studies have examined arginine injection in pregnant women.
It is not known if intravenous arginine is secreted in human milk; however, systemically administered amino acids are secreted into breast milk in quantities not likely to be harmful to the infant. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.
Aluminum Hydroxide: Aluminum hydroxide and magnesium hydroxide (as well as other antacids) may interact with urinary acidifiers by alkalinizing the urine. Frequent use of these high dose antacids should be avoided in patients receiving urinary acidifiers.
Aluminum Hydroxide; Magnesium Carbonate: Aluminum hydroxide and magnesium hydroxide (as well as other antacids) may interact with urinary acidifiers by alkalinizing the urine. Frequent use of these high dose antacids should be avoided in patients receiving urinary acidifiers.
Colchicine: Colchicine is an alkaloid that is inhibited by acidifying agents. The colchicine dose may need adjustment.
Methadone: As methadone is a weak base, the renal elimination of methadone is increased by urine acidification. Acidifying agents may lower the serum methadone concentration. Reabsorption of circulating methadone is pH-dependent. Studies demonstrate that methadone is cleared faster from the body with an acidic urinary pH as compared with a more basic pH.
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