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InteliHealth
Natural Standard content

Arginine

Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain arginine. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacist or health care provider before starting.



Evidence

Scientists have studied arginine (also known as L-arginine) for the following health problems:

Growth hormone reserve test/pituitary disorder diagnosis
Intravenously administered arginine can be used to evaluate growth hormone reserve in individuals with suspected growth hormone deficiency (for example, in patients with suspected panhypopituitarism, growth/stature abnormalities, gigantism/acromegaly, or pituitary adenoma). This is a U.S. Food and Drug Administration (FDA)-labeled indication for arginine.
Inborn errors of urea synthesis
In patients with inborn errors of urea synthesis, high blood ammonia levels and metabolic alkalosis may occur, particularly in patients with ornithine carbamoyl transferase (OCT) deficiency or carbomoyl phosphate synthetase (CPS) deficiency. Arginine can be a helpful treatment by shifting the way the body processes nitrogen, but it should be avoided in patients with hyperargininemia (high arginine levels). Other drugs may have similar benefits, such as citrulline, sodium benzoate, or sodium phenylbutyrate, although dialysis may be necessary initially. This use of arginine should be supervised by a qualified health care professional.
Coronary artery disease, angina
There is evidence from several studies that arginine taken by mouth or by injection improves exercise tolerance and blood flow in arteries of the heart. Benefits have been shown in some patients with coronary artery disease and angina. Further research is needed to establish doses that are safe and effective and to compare arginine with prescription drugs used for the same purposes.
High blood pressure
A small study suggests that arginine taken by mouth may help to dilate the arteries and temporarily reduce blood pressure in hypertensive patients with type 2 diabetes. Large, high-quality studies are needed to make a recommendation.
High cholesterol
Animal and early human data suggest there may be a role for arginine in the development of high cholesterol and heart disease. Large, well-designed studies are needed to study these effects.
Immunomodulator
Early study results suggest that arginine supplementation may enhance the immune response elicited by the pneumococcal vaccine in older people. More studies are needed to confirm these results.
Intrauterine growth
Early studies in pregnant mothers suggest that arginine supplements may improve growth in fetuses that are small for gestational age. Additional studies are needed.
MELAS syndrome
One study found that two years of supplementation with oral L-arginine significantly improved endothelial function in patients with MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke). Further research is merited in this area.
Myocardial infarction
Study results of arginine supplementation after myocardial infarction (heart attack) are mixed. Further research is needed before a recommendation can be made. A cardiologist and pharmacist should be consulted prior to initiation of arginine therapy.
Noncardiac check pain/esophageal motor disorders
Small studies in humans suggest that oral but not intravenous arginine supplements may improve noncardiac chest pain associated with esophageal motor disorders. Large, well-designed studies are needed.
Preeclampsia (high blood pressure in pregnancy)
Early study suggests that prolonged dietary supplementation with L-arginine may decrease blood pressure that is too high in pregnant women. Further research is needed to confirm these results.
Heart failure
Studies of arginine in patients with chronic heart failure have shown mixed results. Some studies report improved exercise tolerance. Additional studies are needed.
Peripheral vascular disease, claudication
Intermittent claudication is the leg pain and fatigue that occur with exercise in some people with clots in the arteries in their legs. A small number of studies suggest that arginine therapy may improve walking distance. Further research is needed before a strong recommendation can be made.
Heart protection in coronary artery bypass grafting
Arginine-supplemented blood cardioplegic solution is thought to have protective properties for the heart when used in coronary artery bypass grafting. Further research is needed to make a conclusion.
Critical illness
Some studies indicate that arginine may provide benefits when added to nutritional supplements during critical illnesses (for example, in patients in intensive care units). However, it is unclear what the specific role of arginine may be in improving recovery. One study shows no difference in length of ICU hospital stay or death rate with the use of a high-protein formula enriched with arginine, fiber and antioxidants in early nutrition therapy in critically ill patients.

Overall, the scientific data of supplementation of only L-arginine do not universally show benefit to date, nor do they show harm. At this time, there is no rationale for the routine supplementation of arginine alone to enhance recovery from serious illness. Because of the potential for harm, this amino acid should only be administered to critically ill patients in large doses under carefully monitored study conditions.
Erectile dysfunction
Early studies suggest that men with low nitrate or nitrite levels in their urine may find arginine supplements useful for treating erectile dysfunction. One study of a combination including arginine, glutamate and yohimbine hydrochloride reported improvement in patients with mild to moderate erectile dysfunction. It should be noted that yohimbine alone is often used in sexual dysfunction, and therefore the effects caused by arginine in this combination therapy are difficult to determine.
Migraine headache
Preliminary studies suggest that adding arginine to ibuprofen therapy may decrease migraine headache pain.
Recovery after surgery
One study suggests that arginine may provide benefits when used as a supplement after surgery. However, it is not clear what the specific role of arginine may be in improving immune function or what dose is safe or effective.
Transplant
Dietary supplementation with L-arginine and canola oil has been associated with decreased rejection rates after the first month in renal transplant patients. Due to reductions in cardiac events, long-term benefits for patient survival may be particularly important. Further research is needed to confirm these results.
Dental pain management
Studies have found that ibuprofen arginate reduced pain faster after dental surgery compared with conventional ibuprofen alone. In another study, patients treated with ibuprofen arginate rated its overall effectiveness higher than did those treated with ibuprofen alone. Adverse event profiles were similar. Further research is merited.
Diabetes (type 1 and 2)
Early studies in humans suggest arginine supplements may improve certain measures of disease severity in diabetes, such as insulin sensitivity. Large, well-designed studies are needed to clarify this relationship.
Diabetes (long-term complications)
Early studies in humans suggest arginine supplements may help the body fight some of the long-term complications of diabetes, including heart disease and nerve damage. Well-designed studies are needed to clarify this relationship.
Fetal health in pre-eclampsia
Early studies have found potential benefit of arginine supplements in the fetal health and growth during pre-eclampsia. Additional studies are needed.
Gastrointestinal cancer surgery
Supplementation with an oral combination of arginine, omega-3 fatty acids and RNA or glutamine may reduce length of hospital stay, infections and inflammatory response after surgery in gastrointestinal cancer patients. There is conflicting evidence as to when to give the combination — either before or after surgery. Both strategies seem superior to conventional treatment (no artificial nutrition) at reducing infections after surgery and reducing hospital stay. Further research is needed to determine the possible effects of arginine alone.
Wound healing
Arginine has been suggested to improve the rate of wound healing in elderly individuals. One study showed positive effects of an enteral diet supplemented with arginine and fiber in wound healing after surgery in head and neck cancer patients. Further research of arginine alone for wound healing is necessary to make a conclusion.
Pressure ulcers
Studies of arginine for pressure ulcers show mixed results. Further research is needed before a conclusion can be drawn.
Pulmonary hypertension
Early studies looked at the effect of arginine on exercise performance and blood vessel activity in the lungs of patients with pulmonary hypertension. Although initial results are promising, additional studies are needed to understand this action.
Raynaud's phenomenon
Early studies in humans have looked at the effect of arginine on blood vessel activity in Reynaud's phenomenon, but effects are not clear. Large, well-designed trials are needed.
Recurrent airway infection
Early studies suggest argininge supplements may decrease patients' risk for infection. Large, well-controlled studies are needed to clarify this relationship.
Restenosis
Early studies in patients after stent placement suggest intravenous arginine may have a positive effect on blood vessel thickness, a measure of risk for restenosis. Additional studies are needed.
Senile dementia
There is currently inadequate information available to make any recommendations about the use of arginine in senile dementia.
Burns
One study reports that supplementation with 15 milligrams of arginine may help with the recovery of immune function and protein function in partial-thickness burn patients. More data are necessary to make a recommendation.
Kidney disease
It has been suggested that arginine may be a useful supplement in people diagnosed with kidney failure. However, results from available studies do not support this claim.
Cyclosporine toxicity
Animal studies have found that arginine blocks the toxic effects of cyclosporine, a drug used to prevent organ transplant rejection. However, results from studies in humans have not found that arginine offers any protection from cyclosporine-induced toxicity.
Infertility
Although there are several studies in this area, it is not clear what effects arginine has on improving the likelihood of getting pregnant. Early evidence does not support the finding that arginine has any benefits in women who are undergoing in vitro (test tube) fertilization treatments or in men who have abnormal sperm.
Interstitial cystitis
Arginine has been proposed as a treatment for inflammation of the bladder. However, most well-designed studies in humans have not found that arginine offers any improvements in treating symptoms such as urinary frequency or urgency.
Acute mountain sickness (AMS)
Based on preliminary study, L-arginine supplementation is not beneficial in the prophylactic treatment of AMS.
Asthma
Although it has been suggested that arginine may be a treatment for asthma, studies in humans have actually found that arginine worsens inflammation in the lungs and contributes to asthma symptoms. Therefore, taking arginine by mouth or by inhalation is not recommended in people with asthma.
Adrenoleukodystrophy
Adrenoleukodystrophy is a rare inherited metabolic disorder characterized by the loss of fatty coverings (myelin sheath) on nerve fibers in the brain and the progressive destruction of the adrenal gland. Adrenoleukodystrophy is inherited as an X-linked genetic trait that results in dementia and adrenal failure. Injections of arginine are proposed to help manage the disorder. However, study results are inconclusive. Further research is needed to evaluate the use of arginine in adrenoleukodystrophy.
Autonomic failure
Arginine has been studied in autonomic failure, a condition that may include low blood pressure, but the effect is unclear. Well-designed studies will help clarify this relationship.
Breast cancer
Early human trials have found conflicting evidence for arginine supplementation in breast cancer. High-quality studies are needed.
Chemotherapy adjuvant
Early human studies suggest arginine supplements may be beneficial to patients undergoing chemotherapy. Larger, high-quality studies are needed.
Chronic anal fissure
Early studies suggest a potential benefit of arginine application in chronic anal fissure. Additional studies are needed.
Chronic glomerulonephritis
Early clinical trials in humans suggest arginine may provide a small benefit to patients with worsening kidney function. High-quality studies are needed to better understand this.
Coronary stenting
Early studies in patients after stent placement suggest intravenous arginine may have a positive effect on blood vessel thickness, a measure of risk for restenosis. Additional studies are needed.
Critical limb ischemia
Early human studies suggest intravenous arginine may increase blood flow in patients with critical limb ischemia. Large, well-designed trials are needed.
Exercise performance
Overall, currently available study results conclude that arginine supplementation does not improve exercise performance.
Kidney protection during angiography
The contrast media or dye used during angiography to map a patient's arteries can be toxic to the kidneys, especially in those with pre-existing kidney disease. One study found that injections of L-arginine did not help to protect the kidney from the contrast media or dye used in these patients.
Other
The U.S. Food and Drug Administration has approved arginine for several uses. Arginine is available by prescription to evaluate function of the pituitary gland, to manage chemical imbalances after appropriate electrolytes have been administered and to treat urea cycle disorders.


Unproven Uses

Arginine has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before taking arginine for any unproven use.

AIDS/HIV
Ammonia toxicity
Angioplasty
Anti-aging
Anti-inflammatory
Anti-platelet
Anxiety
Beta-hemoglobinopathies
Cancer
Cardiac transplantation
Chemotherapy in breast cancer
Chronic pain
Cirrhosis
Cold prevention
Cystic fibrosis
Enhanced immune function
Glaucoma
Growth hormone stimulation
Heart attack
Hemolytic uremic syndrome
Hepatic encephalopathy
Increased muscle mass
Infantile necrotizing enterocolitis
Infection
Inflammatory bowel disease
Ischemic stroke 		Liver disease
Lower esophageal sphincter relaxation
Low sperm count
Metabolic acidosis
Metabolic syndrome
Obesity
Osteoporosis
Pain
Peritonitis
Preeclampsia
Preterm labor contractions
Recovery from trauma
Sepsis
Sexual arousal disorder
Sexual function in women
Sickle cell anemia
Stimulating growth hormone
Stress
Stroke
Stomach motility disorders
Stomach ulcers
Supplementation to a low protein diet
Thrombotic thrombocytopenic purpura
Tissue trauma and sepsis
Tumors
Ulcerative colitis


Potential Dangers

Allergies

People with a known allergy should avoid arginine. Signs of allergy may include rash, itching or shortness of breath. Anaphylaxis (severe allergic reaction) has occurred after arginine injections.

Side Effects

Arginine has been well tolerated by most people, but there is a possibility of serious adverse effects in some individuals. Stomach discomfort, including nausea, stomach cramps or an increased number of stools, may occur. People with asthma may experience a worsening of symptoms if arginine is inhaled. This adverse effect may be caused by arginine allergies.

Other side effects may include low blood pressure and changes in numerous chemicals and electrolytes in the blood. Examples of side effects include high potassium, high chloride, low sodium, low phosphate, high blood urea nitrogen and high creatinine levels. People with liver or kidney disease may be especially sensitive to these complications and should avoid using arginine except under medical supervision. After injections of arginine, low back pain, flushing, headache, numbness, restless legs, venous irritation and death of surrounding tissues have been reported.

In theory, arginine may increase the risk of bleeding. If you use anticoagulants (blood thinners) or antiplatelet drugs and are considering using arginine, speak with your health care provider. Arginine may also increase blood sugar levels. Caution is advised if you take prescription drugs to control your sugar levels. Arginine may alter potassium levels, especially in patients with liver disease. L-arginine may aggravate aspects of sickle cell disease.

Pregnancy And Breast-Feeding

Arginine cannot be recommended as a supplement during pregnancy and breast-feeding because there is not enough scientific information available.


Interactions

Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements.

Interactions With Drugs

Because arginine can increase the activity of some hormones in the body, many possible drug interactions may occur. The prescription drugs aminophylline and the sweetening agent Xylitol can decrease the effect that arginine has on glucagon. Estrogens (found in birth control pills and hormone replacement therapies) may increase the effects of arginine on growth hormone, glucagon and insulin. In contrast, progestins (also found in birth control pills and some hormone replacement therapies) may decrease the responsiveness of growth hormone to arginine.

When used alone or with arginine, some diuretics such as spironolactone or blood pressure drugs such as enalapril (Vasotec) may cause potassium levels in the blood to get too high. Monitoring of blood potassium levels may be required. Arginine should be used carefully with drugs such as nitroglycerin or sildenafil (Viagra) because blood pressure may fall too low. Other adverse effects such as headache and flushing may occur when arginine is used with these drugs. Because arginine may cause the stomach to make more acid, it may reduce the effectiveness of drugs that block stomach acid such as ranitidine (Zantac) or esomeprazole (Nexium).

In theory, arginine may increase the risk of bleeding when used with anticoagulants (blood thinners) or antiplatelet drugs. Examples include warfarin (Coumadin), heparin and clopidogrel (Plavix). Some pain relievers may also increase the risk of bleeding if used with arginine. Examples include aspirin, ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve, Anaprox). It is also possible that arginine may raise blood sugar levels. Patients taking oral or injected drugs for diabetes should be monitored closely by their health care provider while using arginine. Dosing adjustments may be necessary.

Studies suggest that a combination of ibuprofen and arginine (ibuprofen arginate) has relieves pain faster than does ibuprofen alone. Use of other pain relievers (Motrin, Advil) with ibuprofen arginate may cause an increased risk of bleeding and, possibly, toxic effects. Patients should consult their health care provider before taking these medications.

Interactions With Herbs And Dietary Supplements

Arginine may block the benefits of lysine in treating cold sores. It may increase the activity of growth hormone if used with ornithine. In theory, arginine may increase the risk of bleeding when taken with products such as Ginkgo biloba and garlic (Allium sativum). Arginine may raise blood sugar levels. People using other herbs or supplements that may alter blood sugar levels, such as bitter melon (Momordica charantia), should be monitored closely by their health care provider while using arginine. Dosing adjustments may be necessary. Arginine should be used with caution in patients taking potassium supplements because of the possible additive effect


Dosing

The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.

Most people likely do not need to take arginine supplements because the body usually makes sufficient amounts.

Adults (Aged 18 Or Older)

Tablets/capsules: There are no standard or well-established doses of arginine, and many different doses have been used and studied. A dose that has been studied for treating coronary artery disease is two to three grams taken by mouth three times daily for three to six months. A studied dose for heart failure is 5.6 to 12.6 grams taken by mouth every day, divided into two or three equal doses, taken for six weeks. For myocardial infarction, three grams of L-arginine three times per day for 30 days has been used. For erectile dysfunction, 1.6 grams taken by mouth three times daily for six weeks has been studied. For low sperm count, four grams daily for three months has been used; a daily oral dose of 80 milliliters of 10 percent L-arginine HCL has also been used for six months for male infertility. For women undergoing in vitro (test tube) fertilization, a dose of 16 grams daily by mouth has been studied, although this therapy should be discussed with the health care provider coordinating the in vitro program. For interstitial cystitis, a dose of 500 milligrams has been taken by mouth three times daily for six weeks. A dose of 8.5 grams of arginine daily has been studied in patients with pressure ulcers for four weeks. For the long-term management of inborn disorders of the urea cycle, doses between 0.5 to 2 grams daily have been used. A dose of 8.5 grams of arginine daily has been studied in patients with pressure ulcers for four weeks. For long-term complications of diabetes, a daily oral dose of 30 milligram per kilogram body weight has been used. For immune enhancement following vaccination in the elderly, a dose of 15 grams daily arginine for four weeks has been used.

Intravenous: The U.S. Food and Drug Administration has approved arginine for treating certain electrolyte disturbances. Doses of arginine used intravenously depend on specific institutional dosing guidelines and should be given under the supervision of a health care provider.

Children (Younger Than 18)

Arginine supplements are not recommended in children because there is not enough scientific information available and because of potential side effects.


Summary

Arginine has been suggested as a treatment for many conditions. There is research supporting the use of arginine in treating some heart and vascular conditions, erectile dysfunction and migraine headache pain; for improving recovery after operations; and as a supplement during critical illnesses. However, it is not clear what doses are safe and effective. There is not enough scientific evidence to support the use of arginine for other medical conditions. Arginine may cause electrolyte disturbances and stomach discomfort. Supplements should be avoided in pregnant or breast-feeding women, in children and in people with kidney and liver disease. Arginine may increase the risk of bleeding or increase blood sugar levels. Safety of use beyond six months has not been well studied. Consult your health care provider immediately if you have any side effects.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.


Resources

  1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
  2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Arginine

Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

  1. Alexander JW, Metze TJ, McIntosh MJ, et al. The influence of immunomodulatory diets on transplant success and complications. Transplantation 2005;79(4):460-465.
  2. Angdin M, Settergren G, Liska J, et al. No effect of L-arginine supplementation on pulmonary endothelial dysfunction after cardiopulmonary bypass. Acta Anaesthesiol Scand 2001;45(4):441-448.
  3. Bath PM, Willmot M, Leonardi-Bee J, Bath FJ. Nitric oxide donors (nitrates), L-arginine, or nitric oxide synthase inhibitors for acute stroke. Cochrane Database Syst Rev 2002;(4):CD000398.
  4. Bednarz B, Jaxa-Chamiec T, Gebalska J, et al. L-arginine supplementation prolongs exercise capacity in congestive heart failure. Kardiol Pol 2004;60(4):348-353.
  5. Bennett-Richards KJ, Kattenhorn M, Donald AE, et al. Oral L-arginine does not improve endothelial dysfunction in children with chronic renal failure. Kidney Int 2002;Oct, 62(4):1372-1378.
  6. Black P, Max MB, Desjardins P, et al. A randomized, double-blind, placebo-controlled comparison of the analgesic efficacy, onset of action, and tolerability of ibuprofen arginate and ibuprofen in postoperative dental pain. Clin Ther 2002;Jul, 24(7):1072-1089.
  7. Braga M, Gianotti L, Nespoli L, et al. Nutritional approach in malnourished surgical patients: a prospective randomized study. Arch Surg 2002;Feb, 137(2):174-180.
  8. Caparros T, Lopez J, Grau T. Early enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet: the effect on nosocomial infections and outcome. JPEN J Parenter Enteral Nutr 2001;Nov-Dec, 25(6):299-308. Discussion, 308-309.
  9. Carrier M, Pellerin M, Perrault LP, et al. Cardioplegic arrest with L-arginine improves myocardial protection: results of a prospective randomized clinical trial. Ann Thorac Surg 2002;Mar, 73(3):837-841. Discussion, 842.
  10. Cassone Faldetta M, Laurenti O, Desideri G, et al. L-arginine infusion decreases plasma total homocysteine concentrations through increased nitric oxide production and decreased oxidative status in Type II diabetic patients. Diabetologia 2002;45(8):1120-1127.
  11. Colagrande L, Formica F, Porta F, et al. L-arginine effects on myocardial stress in cardiac surgery: preliminary results. Ital Heart J 2005;6(11):904-910.
  12. Colagrande L, Formica F, Porta F, et al. Reduced cytokines release and myocardial damage in coronary artery bypass patients due to L-arginine cardioplegia supplementation. Ann Thorac Surg 2006;81(4):1256-1261.
  13. de Luis DA, Aller R, Izaola O, et al. Postsurgery enteral nutrition in head and neck cancer patients. Eur J Clin Nutr 2002;Nov, 56(11):1126-1129.
  14. de Luis DA, Izaola O, Cuellar L, et al. Effects of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients. Eur J Clin Nutr 2003;Jan, 57(1):96-99.
  15. Desjardins P, Black P, Papageorge M, et al. Ibuprofen arginate provides effective relief from postoperative dental pain with a more rapid onset of action than ibuprofen. Eur J Clin Pharmacol 2002;Sep, 58(6):387-394.
  16. Dudek D, Legutko J, Heba G, et al. L-arginine supplementation does not inhibit neointimal formation after coronary stenting in human beings: an intravascular ultrasound study. Am Heart J 2004;147(4):E12.
  17. Facchinetti F, Saade GR, Neri I, et al. L-arginine supplementation in patients with gestational hypertension: a pilot study. Hypertens Pregnancy 2007;26(1):121-130.
  18. Fossel ET. Improvement of temperature and flow in feet of subjects with diabetes with use of a transdermal preparation of L-arginine: a pilot study. Diabetes Care 2004;27(1):284-285.
  19. Frias, Soriano L, Lage Vazquez MA, et al. The effectiveness of oral nutritional supplementation in the healing of pressure ulcers. J Wound Care 2004;13(8):319-322.
  20. Gianotti L, Braga M, Nespoli L, et al. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gasterointestinal cancer. Evid Based Nurs 2003;Apr, 6(2):47.
  21. Gosselink MP, Darby M, Zimmerman DD, et al. Treatment of chronic anal fissure by application of L-arginine gel: a phase II study in 15 patients. Dis Colon Rectum 2005;48(4):832-837.
  22. Hladunewich MA, Derby GC, Lafayette RA, et al. Effect of L-arginine therapy on the glomerular injury of preeclampsia: a randomized controlled trial. Obstet Gynecol 2006;107(4):886-895.
  23. Houwing RH, Rozendaal M, Wouters-Wesseling W, et al. A randomised, double-blind assessment of the effect of nutritional supplementation on the prevention of pressure ulcers in hip-fracture patients. Clin Nutr 2003;22(4):401-405.
  24. Huynh NT, Tayek JA. Oral arginine reduces systemic blood pressure in type 2 diabetes: its potential role in nitric oxide generation. J Am Coll Nutr 2002;Oct, 21(5):422-427.
  25. Kawano H, Motoyama T, Hirai N, et al. Endothelial dysfunction in hypercholesterolemia is improved by L-arginine administration: possible role of oxidative stress. Atherosclerosis 2002;161(2):375-380.
  26. Kimber J, Watson L, Mathias CJ. Cardiovascular and neurohormonal responses to i. v. l-arginine in two groups with primary autonomic failure. J Neurol 2001;248(12):1036-1041.
  27. Koga Y, Akita Y, Nishioka J, et al. L-arginine improves the symptoms of strokelike episodes in MELAS. Neurology 2005;64(4):710-712.
  28. Koga Y, Akita Y, Junko N, et al. Endothelial dysfunction in MELAS improved by l-arginine supplementation. Neurology 2006;66(11):1766-1769.
  29. Lebret T, Herve JM, Gorny P, et al. Efficacy and safety of a novel combination of L-arginine, glutamate, and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Eur Urol 2002;Jun, 41(6):608-613.
  30. Lekakis JP, Papathanassiou S, Papioannou TG, et al. Oral L-arginine improves endothelial dysfunction in patients with essential hypertension. Int J Cardiol 2002;Dec, 86(2-3):317-323.
  31. Mansoor JK, Morrissey BM, Walby WF, et al. L-arginine supplementation enhances exhaled NO, breath condensate VEGF, and headache at 4,342 m. High Alt Med Biol 2005;6(4):289-300.
  32. Maxwell AJ, Zapien MP, Pearce GL, et al. Randomized trial of a medical food for the dietary management of chronic, stable angina. J Am Coll Cardiol 2002;39(1):37-45.
  33. McGovern MM, Wasserstein MP, Aron A, Perrine SP. Biochemical effect of intravenous arginine butyrate in X-linked adrenoleukodystrophy. J Pediatr 2003;Jun, 142(6):709-713.
  34. Mehlisch DR, Ardia A, Pallotta T. A controlled comparative study of ibuprofen arginate versus conventional ibuprofen in the treatment of postoperative dental pain. J Clin Pharmacol 2002;Aug, 42(8):904-911.
  35. Miller HI, Dascalu A, Rassin TA, et al. Effects of an acute dose of L-arginine during coronary angiography in patients with chronice renal failure: a randomized, parallel, double-blind clinical trial. Am J Nephrol 2003;Mar-Apr, 23(2):91-95.
  36. Nagaya N, Uematsu M, Oya H, et al. Short-term oral administration of L-arginine improves hemodynamics and exercise capacity in patients with precapillary pulmonary hypertension. Am J Respir Crit Care Med 2001;163(4):887-891.
  37. Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference. Evidence-Based Clinical Reviews, USA. Elsevier/Mosby, 2005.
  38. Neri I, Blasi I, Facchinetti F. Effects of acute L-arginine infusion on non-stress test in hypertensive pregnant women. J Matern Fetal Neonatal Med 2004;16(1):23-26.
  39. Neri I, Jasonni VM, Gori GF, et al. Effect of L-arginine on blood pressure in pregnancy-induced hypertension: a randomized placebo-controlled trial. J Matern Fetal Neonatal Med 2006;19(5):277-281.
  40. Oka RK, Szuba A, Giacomini JC, et al. A pilot study of L-arginine supplementation on functional capacity in peripheral arterial disease. Vasc Med 2005;Nov, 10(4):265-274.
  41. Palloshi A, Fragasso G, Piatti P, et al. Effect of oral L-arginine on blood pressure and symptoms and endothelial function in patients with systemic hypertension, positive exercise tests, and normal coronary arteries. Am J Cardiol 2004;93(7):933-935.
  42. Parnell MM, Holst DP, Kaye DM. Augmentation of endothelial function following exercise training is associated with increased L-arginine transport in human heart failure. Clin Sci (Lond) 2005;109(6):523-530.
  43. Polan ML, Hochberg RB, Trant AS, Wuh HC. Estrogen bioassay of ginseng extract and ArginMax, a nutritional supplement for the enhancement of female sexual function. J Womens Health (Larchmt) 2004;13(4):427-430.
  44. Rytlewski K, Olszanecki R, Korbut R, Zdebski Z. Effects of prolonged oral supplementation with l-arginine on blood pressure and nitric oxide synthesis in preeclampsia. Eur J Clin Invest 2005;35(1):32-37.
  45. Rytlewski K, Olszanecki R, Lauterbach R, et al. Effects of oral L-arginine on the foetal condition and neonatal outcome in preeclampsia: a preliminary report. Basic Clin Pharmacol Toxicol 2006;99(2):146-152.
  46. Schlaich MP, Oehmer S, Schneider MP, et al. Effects of nitric oxide synthase inhibition and L-arginine on renal haemodynamics in young patients at high cardiovascular risk. Atherosclerosis 2007;192(1):155-160.
  47. Schramm L, La M, Heidbreder E, et al. L-arginine deficiency and supplementation in experimental acute renal failure and in human kidney transplantation. Kidney Int 2002;61(4):1423-1432.
  48. Schulman SP, Becker LC, Kass DA, et al. L-arginine therapy in acute myocardial infarction: the Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. JAMA 2006;4, 295(1):58-64.
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Last updated May 13, 2008


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