Recommended Dose of Branched-Chain Amino Acids
For patients with liver cirrhosis and hepatic encephalopathy, the recommended dose of oral BCAAs is 0.25 g/kg/day, or approximately 30-34 g/day for most adults. 1
Dosing by Clinical Context
Liver Cirrhosis with Complications
- Standard therapeutic dose: 0.25 g/kg/day orally for management of overt hepatic encephalopathy 1
- Alternative dosing: 34 g/day has been shown to reduce hospitalizations due to complications including infection, gastrointestinal bleeding, ascites, and hepatic encephalopathy in patients with symptomatic alcoholic cirrhosis 1
- Intravenous L-ornithine-L-aspartate (LOLA): 30 g/day when used in combination therapy for hepatic encephalopathy 1
Parenteral Nutrition in Liver Disease
- BCAA-enriched solutions containing 35-45% BCAAs are recommended for patients with overt hepatic encephalopathy who require parenteral nutrition 1
- These specialized hepatic formulas are high in BCAAs but low in tryptophan, aromatic amino acids, and sulfur-containing amino acids 1
General Nutritional Support in Cirrhosis
- Total protein intake should be 1.2-1.5 g/kg/day from diverse sources, with BCAAs naturally present in protein-containing foods 1
- The American Association for the Study of Liver Diseases does not recommend long-term BCAA supplementation beyond achieving recommended protein intake targets from diverse protein sources 1
Important Clinical Considerations
Duration and Monitoring
- Long-term supplementation (12-24 months) has demonstrated benefits in preventing progressive hepatic failure and improving quality of life in cirrhotic patients 1
- Studies showing clinical benefit used doses of 0.20-0.25 g/kg/day or 30 g/day 1
Limitations and Caveats
- No long-term safety data exists beyond 12 weeks of continuous BCAA supplementation 2
- Cost and palatability may significantly affect patient compliance with oral BCAA supplements, as they are not reimbursed in most countries 1
- The evidence for mortality benefit remains equivocal, with meta-analyses showing improvement in mental state but no definitive survival advantage 1
When NOT to Use Supplemental BCAAs
- In well-nourished cirrhotic patients who can achieve adequate protein intake (1.2-1.5 g/kg/day) through diverse dietary sources, supplemental BCAAs beyond this target are not recommended 1
- In healthy individuals seeking muscle building, complete protein sources providing 1.6-2.2 g/kg body weight daily are preferred over isolated BCAA supplements 2
Route-Specific Dosing
Oral administration is preferred when possible, with doses of 0.25 g/kg/day divided throughout the day 1
Intravenous administration in acute hepatic encephalopathy has used solutions containing leucine 11 g/L, isoleucine 9 g/L, and valine 8.4 g/L in 20% dextrose 3