From the Guidelines
For patients with hyperammonaemia, the safe dosage of L-Arginine is 200 mg/kg for ornithine transcarbamylase (otC) and carbamoyl phosphate synthase I (CPs) deficiencies, and 600 mg/kg for argininosuccinate synthase (Ass) and argininosuccinate lyase (Asl) deficiencies, while the dosage for L-Citrulline is not explicitly stated in the provided evidence. When considering the use of L-Arginine and L-Citrulline, it is crucial to prioritize the patient's specific condition and the potential risks associated with these supplements 1. The provided evidence focuses on the management of hyperammonaemia in pediatric patients receiving continuous kidney replacement therapy, highlighting the importance of careful dosage and administration of nitrogen-scavenging agents and urea cycle intermediates like L-Arginine and L-Citrulline 1. Some key points to consider when using L-Arginine include:
- The dosage should be tailored to the patient's specific deficiency, with 200 mg/kg for otC and CPs deficiencies, and 600 mg/kg for Ass and Asl deficiencies 1.
- The administration should be over 90 min as a bolus, followed by maintenance over 24 h 1.
- Patients with certain health conditions, such as kidney or liver disease, should be closely monitored due to the potential risks associated with L-Arginine supplementation 1. It is essential to consult with a healthcare provider before initiating supplementation with L-Arginine or L-Citrulline, especially for patients with pre-existing medical conditions or those taking medications that may interact with these supplements 1. In general, L-Arginine and L-Citrulline can increase nitric oxide production, improving blood flow and potentially benefiting cardiovascular health, exercise performance, and erectile function 1. However, side effects at higher doses can include digestive discomfort, diarrhea, bloating, and lower blood pressure, emphasizing the need for careful dosage and monitoring 1.
From the FDA Drug Label
DIRECTIONS Place drops under tongue 30 minutes before/after meals. Adults and children 12 years and over: Take 10 drops up to 3 times per day. Consult a physician for use in children under 12 years of age. The safe dosage of L-Arginine is:
- 10 drops up to 3 times per day for adults and children 12 years and over There is no information about L-Citrulline dosage in the provided drug label 2.
From the Research
Safe Dosages of L-Arginine and L-Citrulline
- The safe dosage of L-Arginine is between 6-8 g/day, as it has been shown to improve endothelial function and lower blood pressure in individuals with pronounced endothelial dysfunction and/or arginine deficiency 3.
- A dosage of 2 g tid or 4 g tid of L-Arginine has been used in patients with mild arterial hypertension, resulting in significant increases in plasma levels of arginine and citrulline, as well as total antioxidant status (TAS) 4.
- A low dose of L-Arginine (0.075 g·kg(-1) of body mass) was found to be just as effective as a high dose (0.15 g·kg(-1) of body mass) in increasing plasma L-Arginine concentrations, with no significant difference between conditions for NO(x), GH, IGF-1, or insulin 5.
- The optimal dose of L-Arginine and L-Citrulline for prevention and treatment of pre-eclampsia is unknown, but L-Arginine may be promising for pre-eclampsia prevention and treatment, with a potential reduction in mean systolic blood pressure and fetal growth restriction 6.
- A combination of oral L-Citrulline and L-Arginine has been shown to rapidly increase plasma L-Arginine concentration and enhance NO bioavailability, with a more rapid increase in plasma L-Arginine levels and marked enhancement of NO bioavailability than with single amino acid supplementation 7.