What is the recommended dose of glutathione (glutathione) for a patient with acute viral hepatitis?

Glutathione Dosing in Acute Viral Hepatitis

Glutathione is not a standard or guideline-recommended treatment for acute viral hepatitis, and no established dosing regimen exists in major hepatology guidelines.

Evidence-Based Treatment Recommendations

The major international hepatology guidelines (EASL, AASLD) do not include glutathione as a recommended therapy for acute viral hepatitis. The standard approach focuses on:

For Acute Hepatitis C

• Pegylated interferon-α monotherapy (pegylated IFN-α2a 180 µg/week or pegylated IFN-α2b 1.5 µg/kg/week for 24 weeks) achieves viral eradication in >90% of patients 1
• Treatment should be considered in patients not convalescing 2-4 months after disease onset 1

For Acute Hepatitis B

• Most patients (>95%) recover spontaneously without specific treatment 1
• Only patients with severe acute hepatitis B (characterized by coagulopathy with INR ≥1.5 or protracted course) should receive nucleoside analogue therapy 1

Supportive Care Remains the Cornerstone

• Bedrest if symptomatic, high-calorie diet, avoidance of hepatotoxic medications, and alcohol abstinence are the mainstays of management 2
• Hospitalization is indicated for severe nausea/vomiting preventing oral intake, INR ≥1.5 with any mental alteration, or signs of acute liver failure 3, 4
• Balanced crystalloid solutions (Ringer's lactate, Plasmalyte) are preferred over normal saline for IV rehydration 5

Glutathione Research Data (Not Guideline-Supported)

While glutathione is not recommended in guidelines, limited research exists:

Study in Chronic Hepatitis B (Not Acute)

• One small study (n=104) used 1200 mg glutathione IV daily for 8 weeks in chronic hepatitis B patients, showing improvements in liver enzymes and inflammatory markers 6
• This was studied in chronic, not acute hepatitis B, and was an adjunct to standard therapy

Physiologic Observations

• Acute viral hepatitis causes marked depletion of reduced glutathione in erythrocytes (0.79 ± 0.43 mmol/L vs normal 2.45 ± 0.15 mmol/L) during the acute phase 7
• Glutathione system enzymes show altered activity patterns during acute hepatitis B 8
• These are observational findings, not treatment recommendations

Critical Clinical Caveats

The absence of glutathione from all major hepatology guidelines (EASL 2011-2017, AASLD) is significant 1. When guidelines extensively detail supportive care measures but omit a therapy entirely, this suggests insufficient evidence for its use.

If considering glutathione despite lack of guideline support:

• The only published dosing is 1200 mg IV daily, studied only in chronic (not acute) hepatitis B 6
• No safety or efficacy data exist for acute viral hepatitis specifically
• This should never replace standard antiviral therapy when indicated (acute HCV, severe acute HBV) 1

Focus clinical efforts on:

• Early identification of patients requiring antiviral therapy 1
• Recognition of acute liver failure indicators (INR ≥1.5, encephalopathy) requiring immediate hospitalization 3, 4
• Ensuring adequate supportive care and monitoring 2