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Arginine

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Also listed as: L-arginine
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 2-Amino-5-guanidinopentanoic acid, agmatine, Arg, arginine, arginine hydrochloride (intravenous formulation), Ark1, decarboxylated arginine, dipeptide arginyl aspartate, HeartBar®, L-arg, L-arginine, L-arginine aspartate, NG-monomethyl-L-arginine, Sargenor®, Spedifen®.
  • Dietary sources of arginine: Almonds, barley, Brazil nuts, brown rice, buckwheat, cashews, cereals, chicken, chocolate, coconut, corn, dairy products, filberts, gelatin, meats, oats, peanuts, pecans, raisins, sesame seeds, sunflower seeds, walnuts.
  • Combination products: Prelox® (Pycnogenol® and L-arginine aspartate).
  • Note: Arginine analogs (N(omega)-nitro-L-arginine methyl ester, N(G)-nitro-L-arginine methyl ester, N-monomethyl-L-arginine, dimethylarginine), and ibuprofen arginate are not specifically discussed in this monograph.

Background
  • L-arginine was first isolated in 1886, reportedly from the extract of a lupine (Lupinus spp.) seedling. Lupinus is a genus in the legume (Fabaceae) plant family.
  • Arginine is a semiessential amino acid; although the body normally makes enough of it, supplementation with additional amounts is sometimes needed. Arginine is found in foods containing protein.
  • Arginine is a chemical precursor to nitric oxide (a blood vessel-widening agent called a vasodilator). Early evidence suggests that arginine may help treat medical conditions that improve with increased vasodilation. These conditions include chest pain, atherosclerosis (clogged arteries), heart disease or failure, erectile dysfunction, intermittent claudication/peripheral vascular disease, and vascular headaches (headache-inducing blood vessel swelling).
  • Arginine also triggers the body to make protein and has been studied for healing wounds, bodybuilding, enhancing sperm production, and preventing tissue wasting in people with critical illnesses. However, caution is warranted. Arginine use was associated with death in certain groups of heart patients. Caution is also needed when using arginine to treat pre-eclampsia (high blood pressure in pregnancy).
  • Arginine hydrochloride has high chloride content and has been used to treat metabolic alkalosis. This use should be under the supervision of a qualified healthcare professional.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Arginine is sometimes injected intravenously to measure growth hormone levels in people being tested for growth hormone deficiencies, such as panhypopituitarism, gigantism, acromegaly, or pituitary adenoma. The U.S. Food and Drug Administration (FDA) has approved this use.

A


Patients with inborn errors of urea synthesis may have high ammonia levels in the blood and metabolic alkalosis. There is strong evidence supporting the use of arginine for this condition. Arginine should be avoided in patients with hyperargininemia (high arginine levels in the blood). A qualified healthcare professional should supervise use by all patients.

A


There is good scientific evidence that dietary supplementation with L-arginine may help patients with coronary artery disease, angina, or atherosclerosis, due to its effects on increasing vasodilation (blood vessel widening). Larger, longer-term studies are needed to confirm these initial positive effects.

B


Arginine has been studied in patients with heart failure. Longer-term studies are required to confirm the clinical benefit of L-arginine supplementation in patients with heart disease.

B


Peripheral vascular disease, also known as intermittent claudication, is a narrowing of blood vessels in the legs and feet caused by fatty plaque deposits. This condition causes decreased blood flow to the legs and feet, resulting in leg pain and tiredness. A small number of studies report that arginine therapy may improve walking distance in patients with claudication. Further research is needed.

B


Adrenoleukodystrophy (ALD) is a rare inherited metabolic disorder characterized by both the loss of fatty coverings (myelin sheaths) on nerves in the brain and the progressive destruction of the adrenal glands. This condition results in dementia and adrenal failure. Arginine injections may help manage this disorder; however, most study results are inconclusive. Further research is needed to evaluate the use of arginine in ALD.

C


Limited research has examined the effect of L-arginine on altitude sickness symptoms. Larger, well-designed trials are required before conclusions can be made.

C


Early research suggests that arginine helps heal chronic anal fissures, which are small tears that develop in the anus. Additional studies are needed.

C


In limited research, the combination of L-lysine and L-arginine reduced symptoms of anxiety. The effect of L-arginine alone is unknown. Studies investigating arginine alone are needed.

C


Arginine has been studied for treating autonomic failure, a condition that may include low blood pressure. Its effect is unclear. Well-designed studies are needed.

C


The effect of L-arginine on birth outcomes has been studied. Additional research is needed before conclusions can be made.

C


In limited research, L-arginine increased blood flow. Because of conflicting results from one study, additional research is needed.

C


The therapeutic effect of arginine in breast cancer patients is unclear. Results from early human studies are mixed. High-quality studies are needed.

C


Arginine may improve immune function and protein function in burn patients. Further research is needed before a conclusion can be drawn.

C


A combination of beta-hydroxyl beta-methyl butyrate, glutamine, and arginine has been tested in patients with cachexia associated with cancer, but conclusions could not be drawn. Further research is required.

C


Early human studies suggest that arginine supplements may benefit patients undergoing chemotherapy. Larger, high-quality studies are needed.

C


Limited human research reported that arginine taken by mouth improved noncardiac chest pain in patients with esophageal disorders. Large, well-designed studies are needed.

C


Preliminary evidence indicates that L-arginine may increase blood flow. The clinical importance of this is unclear. Further research is required before conclusions can be made.

C


In preliminary research, L-arginine increased cognitive function in elderly patients with cerebrovascular disease. Better-designed studies are needed.

C


The impact of L-arginine supplementation on critical illness is unclear. Further research is needed.

C


Results of preliminary studies of the effect of L-arginine on cyclosporine toxicity in renal transplant patients are mixed. Well-designed randomized controlled trials are needed to clarify the effects of L-arginine.

C


Recent studies suggested that an arginine-containing toothpaste reduced teeth sensitivity. An arginine-containing product was also effective in reducing dental caries. Additional research is needed to confirm these effects.

C


The effect of L-arginine on type 2 diabetic patients has been investigated. Large, well-designed studies are needed to understand the effect of arginine on type 2 diabetes.

C


Early human research indicates that L-arginine may play a role in reducing complications associated with diabetes. However, further research is required before conclusions can be made.

C


Early studies showed that arginine supplements helped treat erectile dysfunction (ED) in men with low nitrate or nitrite levels in their blood or urine. A combination of L-arginine, glutamate, and yohimbine hydrochloride was used to treat ED. However, because a combination product was used, and yohimbine hydrochloride is an FDA-approved therapy for this condition, the effects of arginine alone are unknown. More research is needed with arginine alone.

C


Despite common use by athletes, the effect of arginine for exercise performance enhancement has not been studied extensively. Well-designed studies investigating arginine alone are needed before conclusions can be made.

C


A combination of arginine, RNA, and omega-3 fatty acids may reduce the length of hospital stays and infections after surgery in gastrointestinal cancer patients. More research with arginine alone is needed.

C


Arginine-supplemented blood cardioplegic solution (solution that stops the heart temporarily, e.g., during surgery) may help protect the heart in patients undergoing coronary artery bypass grafting. Further research is needed before a firm conclusion can be drawn.

C


Early research in humans reported that arginine taken by mouth reduced blood pressure in patients with high blood pressure. Larger, high-quality studies are needed before a conclusion can be made.

C


Some research suggests that arginine may help treat high cholesterol. Results of different studies conflict, however, and more research is needed.

C


L-arginine has immunomodulating effects in patients undergoing surgery for colorectal cancer and in children with airway infections. In HIV outpatients, L-arginine in combination with omega-3 fatty acids and a nutritional supplement had no additional effects on immune response over a nutritional supplement alone. Additional well-designed research is needed.

C


Limited research has investigated the effect of L-arginine on male and female infertility. Further research is required before conclusions can be made.

C


Preliminary research of pregnant mothers suggests that arginine supplements improve growth in smaller-than-average fetuses. Additional studies are needed.

C


Early studies found that supplementation with L-arginine significantly improved endothelial function in patients with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke). Further research is merited in this area.

C


Limited research suggests that L-arginine may decrease symptoms associated with creatine deficiency syndromes. Further research is required before conclusions can be drawn.

C


In preliminary research, treatment with N-acetyl cysteine (NAC) and L-arginine restored gonadal function in patients with polycystic ovary syndrome. Further research is required before conclusions can be drawn.

C


Effects of L-arginine in women with pre-eclampsia are mixed. Longer-term treatment appeared to be more effective than short-term treatment. Further research is needed before a conclusion can be made.

C


Studies of arginine for pressure ulcers show mixed results. Further research is needed before a conclusion can be drawn.

C


Injection of L-arginine into surgically inserted stents was investigated, with mixed results. Early research suggested that L-arginine might or might not prevent restenosis (arterial narrowing) in the arteries. Further well-designed studies are required.

C


Early research in humans investigated the effect of arginine on blood vessel activity in Raynaud's phenomenon, a condition causing the blood vessels in the fingers, toes, nose, and ears to narrow in response to cold temperatures or stress. However, the effects of arginine are not clear. Large, well-designed trials are needed.

C


In early research, arginine combined with other supplements helped recovery after surgery. However, the role of arginine alone is unclear. More research is needed.

C


Early research suggests that arginine supplements may decrease the risk of respiratory (lung) infections. Large, well-controlled studies are needed to clarify this relationship.

C


Based on preliminary research, L-arginine may be useful for pregnant scleroderma patients. Further research is required before conclusions can be drawn.

C


Clinical studies investigating the effects of L-arginine on sickle cell anemia are limited; however, early research suggests the potential for immune benefits. Further research is required in this field.

C


In human research, L-arginine improved kidney function in kidney transplant patients, and improved quality of life and exercise tolerance in heart transplant recipients. Additional clinical research is required.

C


In early research, L-arginine improved endometrial thickness in patients with a thin endometrium. Further studies are required before conclusions can be drawn.

C


Available evidence argues against supplementary L-arginine taken by mouth or inhaled.

D


Arginine has been proposed as a treatment for interstitial cystitis (inflammation of the bladder). However, most human studies found a lack of effect.

D


Overall evidence from early human research fails to support the use of L-arginine for kidney disease or failure. Until the evidence is more consistent, conclusions cannot be made in this field.

D


The contrast media, or dye, used during angiography to map a patient's arteries may be poisonous (toxic) to the kidneys, especially among people with kidney disease. Researchers have studied L-arginine as a way to protect the kidneys in patients with long-term kidney failure who were undergoing angiography. The authors found a lack of evidence that injections of L-arginine protected the kidney from damage due to contrast agents.

D


In human research, arginine appeared to lack benefit in wound healing. Further research is required before conclusions can be made.

D


Until potential safety issues are addressed, L-arginine should be avoided by myocardial infarction patients.

F
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Aging, AIDS/HIV (prevention of wasting), ammonia toxicity, amyotrophic lateral sclerosis (ALS), angioplasty, antibacterial, anti-inflammatory, antioxidant, anti-platelet agent, beta-hemoglobinopathies, cancer, chronic pain, cirrhosis, cold prevention, colorectal cancer (diagnosis), cystic fibrosis, dental pain (ibuprofen arginate), depression, endocrine disorders (metabolic syndrome), epilepsy, eye disorders, food uses (meat quality), functional gastrointestinal disorders, glaucoma, growth, heavy metal/lead toxicity, hemolytic uremic syndrome (HUS), hepatic encephalopathy, high blood pressure (newborn; PPHN), hyperhomocysteinemia, increased muscle mass, infection, inflammation, inflammatory bowel disease (IBD), iron overload, ischemic stroke, liver disease, liver protection, lower esophageal sphincter relaxation, malaria, metabolic abnormalities (metabolic syndrome), metabolic acidosis, migraine (ibuprofen arginate), mitochondrial disorders, neurological problems, neuropathy, obesity, osteoporosis / osteopenia, pain, parasites, peritonitis, post-menopausal bone loss, pre-term labor contractions, pruritus (itching), rabies, sepsis, sexual arousal, sexual function in women, stomach motility disorders, stomach ulcers, stress, stroke, supplementation to a low protein diet, thrombotic thrombocytopenic purpura (TTP), trauma (recovery), tuberculosis, tumors, ulcerative colitis, vaccine adjunct (stabilizer), vascular disorders, weight loss.

Dosing

Dietary Sources of Arginine

  • Walnuts, filberts (hazelnuts), pecans, Brazil nuts, sesame and sunflower seeds, brown rice, raisins, coconut, gelatin, buckwheat, almonds, barley, cashews, cereals, chicken, chocolate, corn, dairy products, meats, oats, peanuts.

Adults (18 years and older)

  • Note: There is no current suggested daily intake or tolerable upper intake for arginine. This amino acid is considered to be nonessential. The therapeutic dosage (maximum dose considered to be safe) is 400-6,000 milligrams.
  • For altitude sickness, 4 grams in 200 milliliters of fruit punch, three times daily, has been taken by mouth while ascending to altitude (24 hours) and while at altitude (for 24 hours).
  • For asthma, a single dose of 50 milligrams of L-arginine per kilogram of body weight has been taken by mouth.
  • For breast cancer, 30 grams daily for three days has been taken by mouth.
  • For burns, 15 grams of L-arginine has been taken by mouth daily (duration unknown).
  • As a chemotherapy adjuvant, 30 grams has been taken by mouth daily for three days.
  • For chest pain (noncardiac): L-arginine (dose and duration unknown) has been taken by mouth.
  • For cognitive function, 1.6 grams of L-arginine has been taken by mouth daily for three months.
  • For coronary artery disease (CAD), up to 9 grams of arginine has been taken by mouth daily in divided doses for three days to six months. 15 grams of L-arginine has been taken by mouth daily in addition to CardiketT (isosorbide dinitrate) for 10 days. A dose of 3.2 grams has been taken by mouth twice daily for six months. Three grams of L-arginine has been taken by mouth three times daily for the first three days, followed by 9 grams on day 4. Patients with Prinzmetal's angina pectoris took 9.26 grams by mouth daily for an unknown duration.
  • For diabetes (type 2), 3 grams of L-arginine has been taken by mouth three times daily. Three grams of L-arginine in 10 milliliters of saline has been infused as a single dose.
  • For diabetic complications (peripheral neuropathy), 3 grams of L-arginine has been taken by mouth three times. A cream containing 4 milligrams of L-arginine per square centimeter has been applied to the feet in the morning and evening daily for two weeks.
  • For erectile dysfunction, 5 grams of L-arginine has been taken by mouth daily for six weeks.
  • For exercise performance, a single dose of 6 grams of L-arginine in a 500-milliliter beverage has been taken by mouth. Six grams of L-arginine in Gatorade® has been taken by mouth twice daily for 28 days, as have 6 grams of L-arginine daily with meals for 14 days and 14.2 grams of L-arginine daily for six months.
  • For heart failure, 5.6-12.6 grams of L-arginine has been taken by mouth daily for up to six weeks. Doses of 15 grams have been taken by mouth daily for five days. A dose of 2 grams of L-arginine has been taken by mouth three times daily for three months.
  • For hyperlipidemia (high cholesterol), 7 grams of L-arginine has been taken by mouth three times daily for four weeks.
  • For hypertension (cardiac and pulmonary), 12 grams of L-arginine has been taken by mouth daily for four weeks. A single dose of 2 grams of L-arginine as an adjunct to 60 milligrams of isosorbide mononitrate has been taken by mouth. A dose of 0.5-1.5 grams of L-arginine per 10 kilograms of body weight has been taken by mouth for one week.
  • As an immunomodulator, L-arginine (dose unknown) has been taken by mouth for 60 days.
  • For infertility, up to 4 grams or 16 grams of L-arginine has been taken by mouth daily for unknown duration.
  • For interstitial cystitis, 1.5-2.4 grams of L-arginine has been taken by mouth daily for up to three months.
  • For intrauterine growth retardation, 3 grams has been taken by mouth daily for 20 days.
  • For MELAS syndrome, L-arginine (dose unknown) has been taken by mouth for up to two years. Intravenous L-arginine (dose and duration unknown) has been used.
  • For myocardial infarction (heart attack), 3 grams of L-arginine has been taken by mouth three times daily for up to six months. A dosage of 3 grams of L-arginine has been taken by mouth three times daily for 30 days.
  • For peripheral vascular disease and claudication, 24 grams of L-arginine has been taken by mouth daily for eight weeks, and 3.3 grams of L-arginine has been taken by mouth twice daily. Eight grams of L-arginine has been given intravenously twice daily for three weeks.
  • For pre-eclampsia (high blood pressure in pregnancy), 3 grams of L-arginine has been taken by mouth daily, in addition to standard therapy, for three weeks. Three grams of L-arginine has been taken by mouth every six hours, or intravenously (10 grams every eight hours) if the L-arginine taken by mouth was not tolerated, from diagnosis until day 10 postpartum. A dose of 4 grams of L-arginine has been taken by mouth daily for 10-12 weeks. A single intravenous infusion of L-arginine (20 grams per 500 milliliters) has been used. Five consecutive single daily infusions of L-arginine (20 grams per 500 milliliters), followed by 4 grams of arginine taken by mouth daily for two weeks, have been used. A dosage of L-arginine (20 grams per 500 milliliters) has been infused over two hours for four consecutive days.
  • For prevention of restenosis after coronary angioplasty (PTCA), intravenous infusions of 200 milligrams of L-arginine per kilogram of body weight have been taken by mouth over two hours prior to and during coronary intervention, as has 500 milligrams intracoronarily immediately before stent implantation, followed by 6 grams of L-arginine taken by mouth daily for two weeks. A dose of 600 milligrams per 6 milliliters of L-arginine has been dispatched via catheter over 15 minutes after stent deployment.
  • For Raynaud's phenomenon, 8 grams of L-arginine has been taken by mouth daily for 28 days.
  • For respiratory infections, L-arginine (dose unknown) has been taken by mouth for 60 days.
  • For transplants, 0.1 gram of L-arginine per kilogram of body weight has been taken by mouth daily for six weeks, and 6 grams has been taken by mouth twice daily for six weeks. Also, 0.5 grams of L-arginine per kilogram has been given intravenously over 60 minutes, two hours prior to surgery.
  • For wound healing, 30 grams of arginine aspartate, containing 17 grams of arginine, has been taken by mouth in three divided doses for two weeks. A dose of 36.2 grams of L-arginine HCl has been taken by mouth daily for five days.
  • For anal fissures, a gel containing 400 milligrams of L-arginine per milliliter has been applied to the skin five times daily for at least 12 weeks.
  • For adrenoleukodystrophy (ALD), arginine butyrate (dose unknown) has been intravenously infused over four months.
  • For autonomic failure, a single dose of 0.5 grams of L-arginine per kilogram of body weight has been given intravenously.
  • For cardiovascular disease, 5 milligrams per kilogram of body weight per minute has been infused intravenously for 20 minutes prior to exercise testing. Infusion of 60 grams of L-arginine over 20 minutes has also been reported.
  • For circulation problems, a single dose of 30 grams of L-arginine has been intravenously given over 60 minutes.
  • For cyclosporine toxicity, graded doses of L-arginine (50, 100, or 150 milligrams per kilogram of body weight) have been delivered intravenously over three consecutive hours.
  • For growth hormone reserve test/pituitary disorder diagnosis, 30 grams of arginine hydrochloride has been injected.
  • For heart protection during coronary artery bypass grafting (CABG), a single venous infusion of 10% arginine hydrochloride (30 grams) over 15 minutes has been used. A dose of 7.5 grams of L-arginine in 500 milliliters of cardioplegic solution has been given intravenously.
  • For inborn errors of urea synthesis, doses of FDA-approved prescription parenteral arginine hydrochloride generally depend on specific institutional dosing guidelines.
  • For kidney protection during angiography, 330 milligrams of L-arginine per kilogram of body weight has been given intravenously over 20-30 minutes.
  • For malaria, 3, 6, and 12 grams of intravenous L-arginine has been infused over 30 minutes.

Children (younger than 18 years)

  • There is no proven safe or effective dose of arginine in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to arginine. Symptoms may include rash, itching, or shortness of breath. Anaphylaxis has occurred after arginine injections. In clinical research, one patient experienced a mild allergic skin reaction to intravenous L-arginine. Hives have also been reported.
  • For treatment of allergy to arginine, epinephrine and antihistamines have been suggested.

Side Effects and Warnings

  • Note: According to the U.S. Food and Drug Administration (FDA) website, pediatric overdosing of arginine hydrochloride injection (R-Gene 10®) has been reported, due to packaging and labeling confusion. Revisions have since been made to the product's packaging. The new label warns that R-Gene 10® infusions should be used cautiously in children to prevent overdose, which may result in hyperchloremic metabolic acidosis, cerebral edema, or possibly death.
  • There is no current suggested daily intake or tolerable upper intake for arginine. This amino acid is considered to be nonessential. The therapeutic dosage (maximum dose considered to be safe) is 400-6,000 milligrams.
  • In general, L-arginine is well tolerated when taken by mouth, delivered intravenously, or applied to the skin.
  • Arginine may cause bloating; diarrhea; endocrine changes; gastrointestinal discomfort; hives; increased blood urea nitrogen, serum creatine, and serum creatinine; increased inflammatory response; leg restlessness, lower back pain; nausea, numbness (with arginine injection); rash; reduction in hematocrit; severe tissue necrosis with extravasation; systemic acidosis; or venous irritation. In heart disease patients, arginine may cause high white blood cell count, increased post-heart attack deaths, lack of energy and strength, and vertigo or increased blood pressure (in heart transplant patients).
  • Arginine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Arginine may change blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.
  • Use cautiously in patients with impaired kidney function or those at risk for hyperkalemia (abnormally high levels of blood potassium), including those with diabetes or using drugs that elevate potassium levels, such as potassium-sparing diuretics and potassium supplements, as arginine may cause hyperkalemia. Fatal cardiac arrhythmia occurred in one patient.
  • Use caution with phosphodiesterase inhibitors (e.g., sildenafil [Viagra®]), due to a theoretical risk of additive blood vessel widening and blood pressure lowering.
  • Use with caution in postmenopausal patients, as night sweats and flushing have been reported.
  • Use with caution in patients with herpes virus, as L-arginine may worsen this condition. L-arginine may increase the risk of herpes simplex cold sores.
  • Use with caution in individuals at risk for headaches, as headache has been a reported side effect. In mountain climbers, L-arginine increased the risk of developing a headache.
  • Use with caution in patients with immunological disorders.
  • Use cautiously in patients with acrocyanosis, sickle cell anemia, and hyperchloremic acidosis, as arginine may cause worsening of symptoms.
  • Use cautiously in patients with guanidinoacetate methyltransferase (GAMT) deficiency. This enzyme is involved in the conversion of amino acids such as arginine to creatine.
  • Avoid in women with high-risk pregnancies, as, in women with multiple diseases, intravenous arginine resulted in premature delivery, pre-eclampsia, and death in two cases.
  • Avoid use in those with low blood pressure or those using blood pressure-lowering agents, due to the reported blood vessel-widening and blood pressure-lowering effects of L-arginine.
  • Avoid with nitrates, as concurrent use may result in additive blood pressure-lowering and blood vessel-widening effects.
  • Avoid use in patients given spironolactone, because arginine monohydrochloride has resulted in abnormally high potassium levels and fatal cardiac arrhythmia.
  • Avoid use in patients with asthma, as arginine may cause an allergic and response, aggravate airway inflammation, and amplify inflammatory airway response. In human research, L-arginine increased exhaled nitric oxide, suggesting increased inflammatory response in asthmatic and cystic fibrosis subjects.
  • Avoid use in patients at risk for or with a history of heart attack, as arginine may worsen outcomes and increase the risk of mortality.
  • Avoid use in breast cancer patients.
  • Avoid with known allergy or hypersensitivity to arginine. Symptoms may include rash, itching, or shortness of breath. Anaphylaxis has occurred after arginine injections. In clinical research, one patient experienced a mild allergic skin reaction to intravenous L-arginine. Hives have been reported.
  • Avoid in pregnant or breastfeeding women, due to a lack of sufficient available safety and efficacy data.

Pregnancy and Breastfeeding

  • Avoid in pregnant or breastfeeding women, due to a lack of sufficient available safety and efficacy data.

Interactions

Interactions with Drugs

  • Arginine may cause low blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.
  • Arginine may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Arginine may change blood sugar levels. Caution is advised when using medications that may affect blood sugar levels. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Arginine may also interact with ACE (angiotensin-converting enzyme) inhibitors, agents that increase potassium levels (including angiotensin II receptor antagonists and heparin), agents used to treat blood disorders, aminophylline, antacids, antibiotics, anticancer agents, anti-inflammatories, antimalarials, antiobesity agents, antiseizure agents, aspirin, cardiac glycosides, cholesterol- and lipid-lowering drugs, contraceptives, cyclophosphamide, cyclosporine, diuretics, estrogens, glucagon, growth hormones, H2 blockers, immunosuppressants, iron salts, isoproterenol, nicotine, nitrates, nitroderivatives, phenylephrine, phosphodiesterase inhibitors, potassium salts, propofol, proton pump inhibitors, sertraline, or spironolactone.

Interactions with Herbs and Dietary Supplements

  • Arginine may lower blood pressure. Caution is advised in patients taking herbs or supplements that lower blood pressure.
  • Arginine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Arginine may change blood sugar levels. Caution is advised when using herbs or supplements that may also change blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Arginine may also interact with agents that increase potassium levels, antacids, antibacterials, anticancer agents, anti-inflammatories, antimalarials, antiobesity agents, antioxidants, antiseizure agents, athletic performance enhancers, branched-chain amino acids, cardiac glycosides, cholesterol- and triglyceride-lowering herbs and supplements, citrulline, conjugated linoleic acid, cream, creatine, dietary cholesterol, diuretics, ginkgo, green tea extract, immunosuppressants, iron, L-citrulline, lysine, magnesium, N-acetyl cysteine, omega-3 fatty acids, ornithine, pine bark extract, piplartine, Pycnogenol®, salt, sodium, vitamin C, vitamin E, vulnerary agents, watermelon, yohimbine, or xylitol.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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