3. PHARMACOLOGY AND MECHANISM OF ACTION

The pharmacological effects of exogenous glutathione largely derive from its capacity to participate in redox reactions and conjugation pathways. Key mechanisms described in the literature include:

• Antioxidant activity: GSH donates electrons to reactive oxygen and nitrogen species, limiting oxidative damage to lipids, proteins, and nucleic acids. In doing so, it is converted to GSSG, which can be reduced back to GSH by glutathione reductase using NADPH.^2,3,5
• Detoxification: Through glutathione S-transferases, GSH conjugates electrophilic metabolites and xenobiotics, facilitating their excretion via bile or urine.^3,5
• Redox signaling and enzyme regulation: GSH helps maintain the redox state of cysteine residues within proteins, influencing the activity of various enzymes and transcription factors involved in inflammation, apoptosis, and cell stress response.^2,5
• Support of other antioxidant systems: Adequate GSH stores are required to maintain the function of other antioxidant defenses, including the detoxification of hydrogen peroxide via glutathione peroxidase.⁵

Because endogenous glutathione levels are tightly regulated, intravenous administration leads to a transient rise in circulating GSH that may influence these biochemical pathways for a limited period following infusion.

4. PHARMACOKINETICS OF INTRAVENOUS GLUTATHIONE

Pharmacokinetic studies in humans indicate that intravenous glutathione is rapidly distributed and cleared from the circulation. In evaluations involving both healthy volunteers and patients receiving high-dose IV GSH, plasma glutathione concentrations increased sharply during infusion and declined quickly once administration ceased, with a reported plasma half-life on the order of minutes to tens of minutes.⁶ These studies also demonstrated rapid oxidation of reduced GSH to GSSG and other downstream metabolites.

Urinary excretion of glutathione-related metabolites, including GSH and cysteine, increases significantly after high-dose IV administration, reflecting renal handling and elimination of these compounds.⁶

Because endogenous glutathione levels are tightly regulated, IV administration produces only a transient rise in circulating GSH. As a result, IV glutathione is typically administered intermittently in investigational clinical settings rather than as a continuous infusion. The short duration of plasma elevation is an important consideration when interpreting the time course of any pharmacodynamic effects reported in clinical studies.

5. HISTORICAL AND INVESTIGATIONAL CLINICAL USES OF IV GLUTATHIONE

Intravenous glutathione has been investigated across a variety of conditions where oxidative stress and inflammation are believed to contribute to pathophysiology. The following subsections summarize selected areas of study. Inclusion of a condition indicates published investigation, not established therapeutic benefit.

5.1 Neurodegenerative Disorders (e.g., Parkinson’s Disease)

Intravenous glutathione has been explored as an adjunct in Parkinson’s disease in several small clinical and observational studies. A commonly cited randomized, double-blind, placebo-controlled pilot trial evaluated IV glutathione 1,400 mg administered three times weekly for 4 weeks in patients with idiopathic Parkinson’s disease whose symptoms were not fully controlled by standard therapy.⁷ The primary objectives of this study were to assess feasibility, safety, and tolerability, with exploratory analyses of motor outcomes.

Earlier open-label evaluations used IV glutathione doses ranging from approximately 600 to 1,400 mg several times per week.^8-10 However, these studies were generally small, of short duration, and not powered to draw definitive conclusions. Current literature views IV glutathione in Parkinson’s disease as investigational rather than established therapy.

5.2 Peripheral Obstructive Arterial Disease

A randomized, double-blind, placebo-controlled trial evaluated intravenous glutathione administered twice daily for 5 days in patients with peripheral obstructive arterial disease.¹¹ In this study, the glutathione group demonstrated statistically significant changes in pain-free walking distance and selected macro- and microcirculatory parameters compared with placebo. Because the trial included a limited number of participants and was of short duration, the findings are considered preliminary and exploratory.

These results have been interpreted as hypothesis-generating with respect to redox modulation in peripheral arterial disease, but they have not led to broader clinical adoption. Intravenous glutathione remains an investigational adjunct in this setting, and additional well-designed studies would be needed to clarify any clinical relevance.

5.3 Respiratory and Infectious Conditions

Glutathione plays an important role in pulmonary antioxidant defenses, and altered glutathione balance has been described in chronic obstructive pulmonary disease (COPD), asthma, and other inflammatory lung disorders. ^1-2,12 These mechanistic observations have contributed to scientific interest in whether exogenous glutathione might influence redox biology in respiratory settings, although they do not establish a therapeutic role for intravenous glutathione.

During the COVID-19 pandemic, intravenous glutathione was evaluated in limited human studies. A small randomized, controlled investigation assessed the feasibility and safety of IV glutathione administered as an adjunct to standard care in patients with moderate COVID-19 and respiratory compromise.¹⁴ In this exploratory trial, differences in certain clinical or laboratory parameters were reported between treatment groups, but the study was not powered to determine efficacy, and the findings should be interpreted cautiously. Case reports have also described the investigational use of glutathione in COVID-19–related respiratory illness,¹³ but such uncontrolled observations cannot establish safety or effectiveness, and additional research is needed.

5.4 Metabolic and Endocrine Conditions

Oxidative stress has been implicated in the pathogenesis of insulin resistance and type 2 diabetes mellitus.¹ Published investigations of glutathione in metabolic disorders have primarily evaluated oral supplementation or glutathione precursors, rather than intravenous administration. ¹⁵ These studies have reported changes in selected oxidative stress markers, but their findings are limited to non-IV formulations and do not establish any therapeutic role for intravenous glutathione in metabolic or endocrine conditions.

In the reproductive literature, oxidative stress has also been discussed as a factor affecting sperm function and male infertility. ^16-17 Reviews in this area describe antioxidant mechanisms, including those involving glutathione, as part of broader redox biology. However, these discussions are largely mechanistic, and no clinical studies have evaluated intravenous glutathione for infertility or reproductive disorders.

5.5 Dermatologic and Aesthetic Uses (Skin Lightening)

Glutathione has been discussed in dermatology literature because of its biochemical involvement in melanogenesis pathways and antioxidant activity. Most published evaluations of glutathione for cosmetic skin-lightening purposes involve oral or topical formulations, and the clinical evidence base remains limited.¹⁸

Intravenous glutathione has been promoted in some regions for aesthetic use; however, such use lacks support from controlled clinical studies, and has been the subject of advisories from several regulatory and professional bodies citing insufficient evidence of safety and effectiveness. At present, no well-designed clinical trials have established the safety or efficacy of IV glutathione for skin lightening, and its cosmetic use is considered investigational.

5.6 Autism Spectrum Disorder (ASD)

Glutathione plays an important role in cellular redox regulation, mitochondrial function, and antioxidant defense. Abnormalities in glutathione metabolism have been reported in individuals with autism spectrum disorder (ASD), including reduced glutathione levels, increased oxidative stress markers, and alterations in redox-related biochemical pathways.¹⁹ These observations have prompted scientific interest in glutathione-related mechanisms in ASD.

At the time of this writing, no published controlled clinical trials have evaluated intravenous glutathione as a therapeutic intervention for ASD, and available data do not define its safety or efficacy in this population.

6. SAFETY PROFILE AND ADVERSE EFFECTS

Across published IV glutathione studies in adults, treatment has generally been described as well tolerated, with most reported adverse events typically mild, transient, and nonspecific.^7-8,14 Observed reactions include:

• Erythema or irritation at the infusion site⁷
• Localized pain or induration⁸
• Thrombophlebitis ⁸

• Dizziness or lightheadedness⁷
• Headache⁷

• Nausea⁷

• Rash¹⁴

In the small clinical studies conducted to date, no clear drug-related serious adverse reactions have been identified. However, these studies were limited in sample size and duration, and the available data are insufficient to define the safety profile of repeated or long-term intravenous administration.

Regulatory agencies have also documented clusters of adverse events, such as fever and chills, associated with injectable glutathione products that were later found to contain high endotoxin levels.²⁰ These incidents reflect the consequences of contamination or inadequate manufacturing controls rather than inherent properties of glutathione itself, underscoring the importance of using products prepared with appropriate raw-material sourcing, validated sterile compounding processes, and rigorous endotoxin and sterility testing.

Any intravenous preparation should be obtained from facilities operating under suitable quality and compliance standards (e.g., current good manufacturing practice), with appropriate monitoring for adverse reactions during administration.

7. FORMULATION, STABILITY, AND HANDLING (SCIENTIFIC OVERVIEW)

Reduced glutathione in aqueous solution is sensitive to oxidative and temperature-dependent degradation. Because intravenous preparations must also meet stringent sterility and endotoxin requirements, these properties have several implications for formulation and handling:

• Oxidation: Dissolved GSH can oxidize to GSSG and other degradation products when exposed to oxygen or trace catalytic impurities. Formulation approaches may therefore include strategies to limit oxygen exposure during preparation and storage.
• Temperature: Elevated temperatures accelerate both oxidative and hydrolytic degradation processes. As a result, glutathione-containing injectable solutions are often stored under refrigerated conditions, as supported by product-specific stability data, to help maintain potency and quality throughout their assigned shelf life.
• Sterility and endotoxin control: Glutathione solutions are typically sterilized by filtration rather than terminal heat sterilization due to the compound’s thermal sensitivity. Consequently, validated aseptic processing, container–closure integrity, and stringent microbial and endotoxin controls are essential considerations for producing a parenteral-grade preparation.

8. REGULATORY AND QUALITY CONSIDERATIONS (HIGH LEVEL SUMMARY)

Regulatory agencies in several jurisdictions have issued communications regarding the compounding and use of glutathione for injection. Common themes in these statements include:

• Raw material quality: Concerns about the use of dietary-grade or non-pharmaceutical-grade glutathione as a starting material for sterile injectable preparations, due to risks of microbial contamination and elevated endotoxin levels.
• Compliance with sterile manufacturing standards: Emphasis on adherence to applicable Good Manufacturing Practice (GMP) requirements when producing sterile glutathione formulations. These expectations include validated sterilization or sterile filtration processes, appropriate environmental monitoring, and robust quality control testing.

Healthcare practitioners should be aware of federal, state, and local regulations governing the sourcing, compounding, and distribution of intravenous glutathione, including any requirements specific to 503B outsourcing facilities and compounding pharmacies. Intravenous preparations should be used only if they are manufactured under appropriate sterile-processing and quality-assurance standards.

9. SUMMARY

Reduced L-glutathione is a central component of human antioxidant defense and cellular redox regulation. Intravenous formulations have been explored in a variety of clinical and investigational contexts where oxidative stress and inflammation are thought to contribute to disease processes.

Pharmacokinetic evaluations show that IV glutathione produces a rapid but transient increase in circulating levels, followed by quick clearance through oxidation and metabolism. Clinical research across neurodegenerative, vascular, respiratory, metabolic, and dermatologic settings has yielded heterogeneous and generally preliminary findings, with most studies limited by small sample sizes, short durations, and variability in design.

Short-term controlled studies have described IV glutathione as generally well tolerated, but the available evidence base remains limited, and longer-term safety has not been defined. Existing reports underscore the importance of using appropriately manufactured sterile preparations and maintaining routine monitoring during administration.

Further research is needed to clarify the pharmacologic behavior, safety characteristics, and scientific relevance of intravenous glutathione in different investigational settings.

10. SELECTED REFERENCES

1. Ballatori N, et al. Glutathione dysregulation and the etiology and progression of human diseases. Biol Chem. 2009;390(3):191-214.
2. Espinosa-Díaz C, et al. Antioxidant responses and cellular adjustments to oxidative stress. Redox Biol. 2015;6:183-197.
3. Lu S. Regulation of Glutathione Synthesis. Mol Aspects Med. 2009;30(1-2):42-59.
4. Witschi A, et al. The systemic availability of oral glutathione. Eur J Clin Pharmacol. 1992;43:667-669.
5. Vaskova J, et al. Glutathione-Related Enzymes and Proteins: A Review. Molecules. 2023 Feb 2;28(3):1447.
6. Hong SY, et al. Pharmacokinetics of glutathione and its metabolites in normal subjects. J Korean Med Sci. 2005 Oct;20(5):721-6.
7. Hauser RA, et al. Randomized, double-blind, pilot evaluation of intravenous glutathione in Parkinson’s disease. Mov Disord. 2009;24:979-983.
8. Sechi G, et al. Reduced intravenous glutathione in the treatment of early Parkinson’s disease. Prog Neuro-Psychopharmacol & Biol Psychiat. 1996;20:1159-70.
9. Wang H, et al. Potential use of glutathione as a treatment for Parkinson’s disease. Exp Ther Med. 2021 Feb;21(2):125. doi: 10.3892/etm.2020.9557.
10. Otto M. et al. The use of intravenous glutathione for symptom management of Parkinson’s disease: A case report. Altern Ther Health Med. Jul 2018;24(4):56-60.
11. Arosio E, et al. Effect of glutathione infusion on leg arterial circulation, cutaneous microcirculation, and pain-free walking distance in patients with peripheral obstructive arterial disease. Mayo Clin Proc. 2002;77:754-759.
12. Rahman I, MacNee W. Oxidative stress and regulation of glutathione in lung inflammation. Eur Respir J. 2000;16(3):534-554.
13. Horowitz R., Freeman P., Bruzzese J. Respiratory Med Case Reports. 2020:30:101063. doi: 10.1016/j.rmcr.2020.101063.
14. Dewan B, Shinde S. Glutathione as an adjuvant therapy for acute respiratory distress syndrome associated with COVID-19 infection. J Adv Med Med Res. 2022;34(22):100-113.
15. Kalamkar S. et al. Randomized clinical trial of how long-term glutathione supplementation offers protection from oxidative damage and improves HbA1c in elderly Type 2 diabetic patients. Antioxidants. 2022;11,1026.
16. Adeoye O. et al. Review on the role of glutathione on oxidative stress and infertility. JBRA Assist Repro. 2018;22(1):61-66.
17. Majzoub A.; Agarwal A. Antioxidant therapy in idiopathic oligoasthenoteratozoospermia. Ind J Urol. Jul/Sept 2017;33(3):207-214.
18. Davids LM, et al. Intravenous glutathione for skin lightening: a review of the evidence and safety concerns. S Afr Med J. 2016;106(8):782-786.
19. Kern J, et al. Evidence of neurodegeneration in autism spectrum disorder. Transl Neurodegener. 2013 Aug 8;2:17. doi: 10.1186/2047-9158-2-17.
20. U.S. Food and Drug Administration. FDA highlights concerns with using dietary ingredient glutathione to compound sterile injectables. Safety communication, 2019.

COMPOSITION & GENERAL CHARACTERISTICS

• Active Ingredient: Reduced L-Glutathione
• Excipients: Sodium bicarbonate, sodium hydroxide, benzyl alcohol, and water for injection
• Appearance: Clear, colorless sterile solution
• Typical pH Range: Approximately 4.8 – 6.5

All quality attributes, acceptance criteria, and analytical testing results are verified in the lot-specific CoA.

INTENDED USE & REGULATORY CONTEXT

This sterile preparation is produced by an FDA-registered 503B outsourcing facility and may be provided to licensed healthcare professionals for office-use administration, hospitals, clinics, pharmacies, and other healthcare entities in accordance with applicable federal and state requirements.

This document does not:

• Provide dosing or therapeutic guidance
• Replace product labeling or the CoA
• Substitute for practitioner medical judgment
• Establish indications – this is not an FDA-approved drug; no clinical indications are established for this compounded preparation

KEY SAFETY CONSIDERATIONS (Non-Exhaustive)

CONTRAINDICATIONS

• Known hypersensitivity to glutathione or any component of the formulation (including benzyl alcohol)
• History of hypersensitivity reactions to sulfhydryl or thiol-containing compounds
• Neonates or infants due to the presence of benzyl alcohol (risk of “gasping syndrome”)

HYPERSENSITIVITY & ALLERGY CONSIDERATIONS

• Hypersensitivity reactions to glutathione or thiol-containing compounds have been reported and may include rash, pruritus, flushing, or mild bronchospasm
• Although rare, more significant reactions such as dyspnea or hypotension have been described in susceptible individuals
• Products containing benzyl alcohol may cause allergic-type reactions, including anaphylactoid responses in sensitive individuals
• Patients with asthma may be at increased risk of bronchospasm due to sulfhydryl reactivity

ADVERSE EFFECTS

Potential adverse effects may include but are not limited to:

• Local reactions: injection site discomfort, irritation, erythema, or thrombophlebitis
• Neurologic: dizziness, lightheadedness, or headache
• Gastrointestinal: nausea or abdominal discomfort
• Respiratory: transient shortness of breath or throat tightness in sensitive individuals
• Dermatologic: rash, flushing, or pruritus
• Allergic reactions: from mild hypersensitivity to rare anaphylactoid responses

ROUTE-SPECIFIC WARNINGS

• For intravenous use only.

DRUG INTERACTIONS

• Oxidizing agents: may reduce glutathione activity due to chemical incompatibility
• Chemotherapeutic agents: glutathione may theoretically alter the redox balance of certain drugs (e.g., platinum-based compounds); relevance depends on clinical context
• Nitroglycerin and similar agents: co-administration may influence nitric oxide signaling pathways
• Other thiol-containing product: may have additive effects related to sulfur-based reactivity

PRECAUTIONARY CONSIDERATIONS

• Administer only by, or under the supervision of, licensed healthcare professionals
• Use caution in patients with a history of asthma, atopy, or sensitivity to thiol-containing compounds
• Monitoring during infusion is recommended to identify any signs of hypersensitivity or intolerance
• Facilities should have immediate access to resuscitation equipment in the event of an adverse reaction

STORAGE, HANDLING & DISPOSAL

• Store at controlled cold temperature (35.6–46.4°F / 2–8°C)
• Inspect visually; do not use if discolored or particulate matter is present
• Handle using aseptic technique appropriate for sterile injectable products
• Contains benzyl alcohol; do not use in neonates or infants.
• Dispose in accordance with federal, state, and institutional requirements

STABILITY & EXPIRATION

Expiration dating is assigned based on validated stability studies, storage conditions, and compounding controls.

• Product label provides official expiration date for the lot
• CoA documents release testing and quality attributes
• Multi-dose vial (MDV): In-use period of up to 28 days post puncture when maintained under recommended storage and aseptic handling conditions.
• MOS does not recommend using the product beyond the labeled expiration date or the established in-use period, whichever comes first.

REGULATORY STATEMENT

• Produced by an FDA-registered 503B outsourcing facility
• Manufactured in compliance with applicable cGMP requirements
• Not an FDA-approved drug product
• Country of Origin: United States of America

EMERGENCY INFORMATION

• If a patient exhibits signs of hypersensitivity, systemic toxicity, or unexpected adverse reaction, discontinue administration immediately.
• Seek prompt medical evaluation or emergency care according to institutional procedures.
• Healthcare professionals should follow their facility’s established protocols for the management of infusion-related or hypersensitivity reactions.
• Report serious adverse events through appropriate institutional, state, or federal reporting channels.

DISCLAIMER

This Product Safety Summary is provided as general information for licensed healthcare professionals. It does not replace product labeling, CoA, institutional policy, or clinical decision-making. The CoA supersedes all information contained herein.

Reduced L-Glutathione Injection | 200 mg/mL | 6000 mg/30 mL MDV | NDC 67157-135-30 | For IV Use Only

3. PHARMACOLOGY AND MECHANISM OF ACTION

The pharmacological effects of exogenous glutathione largely derive from its capacity to participate in redox reactions and conjugation pathways. Key mechanisms described in the literature include:

• Antioxidant activity: GSH donates electrons to reactive oxygen and nitrogen species, limiting oxidative damage to lipids, proteins, and nucleic acids. In doing so, it is converted to GSSG, which can be reduced back to GSH by glutathione reductase using NADPH.^2,3,5
• Detoxification: Through glutathione S-transferases, GSH conjugates electrophilic metabolites and xenobiotics, facilitating their excretion via bile or urine.^3,5
• Redox signaling and enzyme regulation: GSH helps maintain the redox state of cysteine residues within proteins, influencing the activity of various enzymes and transcription factors involved in inflammation, apoptosis, and cell stress response.^2,5
• Support of other antioxidant systems: Adequate GSH stores are required to maintain the function of other antioxidant defenses, including the detoxification of hydrogen peroxide via glutathione peroxidase.⁵

Because endogenous glutathione levels are tightly regulated, intravenous administration leads to a transient rise in circulating GSH that may influence these biochemical pathways for a limited period following infusion.

4. PHARMACOKINETICS OF INTRAVENOUS GLUTATHIONE

Pharmacokinetic studies in humans indicate that intravenous glutathione is rapidly distributed and cleared from the circulation. In evaluations involving both healthy volunteers and patients receiving high-dose IV GSH, plasma glutathione concentrations increased sharply during infusion and declined quickly once administration ceased, with a reported plasma half-life on the order of minutes to tens of minutes.⁶ These studies also demonstrated rapid oxidation of reduced GSH to GSSG and other downstream metabolites.

Urinary excretion of glutathione-related metabolites, including GSH and cysteine, increases significantly after high-dose IV administration, reflecting renal handling and elimination of these compounds.⁶

Because endogenous glutathione levels are tightly regulated, IV administration produces only a transient rise in circulating GSH. As a result, IV glutathione is typically administered intermittently in investigational clinical settings rather than as a continuous infusion. The short duration of plasma elevation is an important consideration when interpreting the time course of any pharmacodynamic effects reported in clinical studies.

5. HISTORICAL AND INVESTIGATIONAL CLINICAL USES OF IV GLUTATHIONE

Intravenous glutathione has been investigated across a variety of conditions where oxidative stress and inflammation are believed to contribute to pathophysiology. The following subsections summarize selected areas of study. Inclusion of a condition indicates published investigation, not established therapeutic benefit.

5.1 Neurodegenerative Disorders (e.g., Parkinson’s Disease)

Intravenous glutathione has been explored as an adjunct in Parkinson’s disease in several small clinical and observational studies. A commonly cited randomized, double-blind, placebo-controlled pilot trial evaluated IV glutathione 1,400 mg administered three times weekly for 4 weeks in patients with idiopathic Parkinson’s disease whose symptoms were not fully controlled by standard therapy.⁷ The primary objectives of this study were to assess feasibility, safety, and tolerability, with exploratory analyses of motor outcomes.

Earlier open-label evaluations used IV glutathione doses ranging from approximately 600 to 1,400 mg several times per week.^8-10 However, these studies were generally small, of short duration, and not powered to draw definitive conclusions. Current literature views IV glutathione in Parkinson’s disease as investigational rather than established therapy.

5.2 Peripheral Obstructive Arterial Disease

A randomized, double-blind, placebo-controlled trial evaluated intravenous glutathione administered twice daily for 5 days in patients with peripheral obstructive arterial disease.¹¹ In this study, the glutathione group demonstrated statistically significant changes in pain-free walking distance and selected macro- and microcirculatory parameters compared with placebo. Because the trial included a limited number of participants and was of short duration, the findings are considered preliminary and exploratory.

These results have been interpreted as hypothesis-generating with respect to redox modulation in peripheral arterial disease, but they have not led to broader clinical adoption. Intravenous glutathione remains an investigational adjunct in this setting, and additional well-designed studies would be needed to clarify any clinical relevance.

5.3 Respiratory and Infectious Conditions

Glutathione plays an important role in pulmonary antioxidant defenses, and altered glutathione balance has been described in chronic obstructive pulmonary disease (COPD), asthma, and other inflammatory lung disorders. ^1-2,12 These mechanistic observations have contributed to scientific interest in whether exogenous glutathione might influence redox biology in respiratory settings, although they do not establish a therapeutic role for intravenous glutathione.

During the COVID-19 pandemic, intravenous glutathione was evaluated in limited human studies. A small randomized, controlled investigation assessed the feasibility and safety of IV glutathione administered as an adjunct to standard care in patients with moderate COVID-19 and respiratory compromise.¹⁴ In this exploratory trial, differences in certain clinical or laboratory parameters were reported between treatment groups, but the study was not powered to determine efficacy, and the findings should be interpreted cautiously. Case reports have also described the investigational use of glutathione in COVID-19–related respiratory illness,¹³ but such uncontrolled observations cannot establish safety or effectiveness, and additional research is needed.

5.4 Metabolic and Endocrine Conditions

Oxidative stress has been implicated in the pathogenesis of insulin resistance and type 2 diabetes mellitus.¹ Published investigations of glutathione in metabolic disorders have primarily evaluated oral supplementation or glutathione precursors, rather than intravenous administration. ¹⁵ These studies have reported changes in selected oxidative stress markers, but their findings are limited to non-IV formulations and do not establish any therapeutic role for intravenous glutathione in metabolic or endocrine conditions.

In the reproductive literature, oxidative stress has also been discussed as a factor affecting sperm function and male infertility. ^16-17 Reviews in this area describe antioxidant mechanisms, including those involving glutathione, as part of broader redox biology. However, these discussions are largely mechanistic, and no clinical studies have evaluated intravenous glutathione for infertility or reproductive disorders.

5.5 Dermatologic and Aesthetic Uses (Skin Lightening)

Glutathione has been discussed in dermatology literature because of its biochemical involvement in melanogenesis pathways and antioxidant activity. Most published evaluations of glutathione for cosmetic skin-lightening purposes involve oral or topical formulations, and the clinical evidence base remains limited.¹⁸

Intravenous glutathione has been promoted in some regions for aesthetic use; however, such use lacks support from controlled clinical studies, and has been the subject of advisories from several regulatory and professional bodies citing insufficient evidence of safety and effectiveness. At present, no well-designed clinical trials have established the safety or efficacy of IV glutathione for skin lightening, and its cosmetic use is considered investigational.

5.6 Autism Spectrum Disorder (ASD)

Glutathione plays an important role in cellular redox regulation, mitochondrial function, and antioxidant defense. Abnormalities in glutathione metabolism have been reported in individuals with autism spectrum disorder (ASD), including reduced glutathione levels, increased oxidative stress markers, and alterations in redox-related biochemical pathways.¹⁹ These observations have prompted scientific interest in glutathione-related mechanisms in ASD.

At the time of this writing, no published controlled clinical trials have evaluated intravenous glutathione as a therapeutic intervention for ASD, and available data do not define its safety or efficacy in this population.

6. SAFETY PROFILE AND ADVERSE EFFECTS

Across published IV glutathione studies in adults, treatment has generally been described as well tolerated, with most reported adverse events typically mild, transient, and nonspecific.^7-8,14 Observed reactions include:

• Erythema or irritation at the infusion site⁷
• Localized pain or induration⁸
• Thrombophlebitis ⁸

• Dizziness or lightheadedness⁷
• Headache⁷

• Nausea⁷

• Rash¹⁴

In the small clinical studies conducted to date, no clear drug-related serious adverse reactions have been identified. However, these studies were limited in sample size and duration, and the available data are insufficient to define the safety profile of repeated or long-term intravenous administration.

Regulatory agencies have also documented clusters of adverse events, such as fever and chills, associated with injectable glutathione products that were later found to contain high endotoxin levels.²⁰ These incidents reflect the consequences of contamination or inadequate manufacturing controls rather than inherent properties of glutathione itself, underscoring the importance of using products prepared with appropriate raw-material sourcing, validated sterile compounding processes, and rigorous endotoxin and sterility testing.

Any intravenous preparation should be obtained from facilities operating under suitable quality and compliance standards (e.g., current good manufacturing practice), with appropriate monitoring for adverse reactions during administration.

7. FORMULATION, STABILITY, AND HANDLING (SCIENTIFIC OVERVIEW)

Reduced glutathione in aqueous solution is sensitive to oxidative and temperature-dependent degradation. Because intravenous preparations must also meet stringent sterility and endotoxin requirements, these properties have several implications for formulation and handling:

• Oxidation: Dissolved GSH can oxidize to GSSG and other degradation products when exposed to oxygen or trace catalytic impurities. Formulation approaches may therefore include strategies to limit oxygen exposure during preparation and storage.
• Temperature: Elevated temperatures accelerate both oxidative and hydrolytic degradation processes. As a result, glutathione-containing injectable solutions are often stored under refrigerated conditions, as supported by product-specific stability data, to help maintain potency and quality throughout their assigned shelf life.
• Sterility and endotoxin control: Glutathione solutions are typically sterilized by filtration rather than terminal heat sterilization due to the compound’s thermal sensitivity. Consequently, validated aseptic processing, container–closure integrity, and stringent microbial and endotoxin controls are essential considerations for producing a parenteral-grade preparation.

8. REGULATORY AND QUALITY CONSIDERATIONS (HIGH LEVEL SUMMARY)

Regulatory agencies in several jurisdictions have issued communications regarding the compounding and use of glutathione for injection. Common themes in these statements include:

• Raw material quality: Concerns about the use of dietary-grade or non-pharmaceutical-grade glutathione as a starting material for sterile injectable preparations, due to risks of microbial contamination and elevated endotoxin levels.
• Compliance with sterile manufacturing standards: Emphasis on adherence to applicable Good Manufacturing Practice (GMP) requirements when producing sterile glutathione formulations. These expectations include validated sterilization or sterile filtration processes, appropriate environmental monitoring, and robust quality control testing.

Healthcare practitioners should be aware of federal, state, and local regulations governing the sourcing, compounding, and distribution of intravenous glutathione, including any requirements specific to 503B outsourcing facilities and compounding pharmacies. Intravenous preparations should be used only if they are manufactured under appropriate sterile-processing and quality-assurance standards.

9. SUMMARY

Reduced L-glutathione is a central component of human antioxidant defense and cellular redox regulation. Intravenous formulations have been explored in a variety of clinical and investigational contexts where oxidative stress and inflammation are thought to contribute to disease processes.

Pharmacokinetic evaluations show that IV glutathione produces a rapid but transient increase in circulating levels, followed by quick clearance through oxidation and metabolism. Clinical research across neurodegenerative, vascular, respiratory, metabolic, and dermatologic settings has yielded heterogeneous and generally preliminary findings, with most studies limited by small sample sizes, short durations, and variability in design.

Short-term controlled studies have described IV glutathione as generally well tolerated, but the available evidence base remains limited, and longer-term safety has not been defined. Existing reports underscore the importance of using appropriately manufactured sterile preparations and maintaining routine monitoring during administration.

Further research is needed to clarify the pharmacologic behavior, safety characteristics, and scientific relevance of intravenous glutathione in different investigational settings.

10. SELECTED REFERENCES

1. Ballatori N, et al. Glutathione dysregulation and the etiology and progression of human diseases. Biol Chem. 2009;390(3):191-214.
2. Espinosa-Díaz C, et al. Antioxidant responses and cellular adjustments to oxidative stress. Redox Biol. 2015;6:183-197.
3. Lu S. Regulation of Glutathione Synthesis. Mol Aspects Med. 2009;30(1-2):42-59.
4. Witschi A, et al. The systemic availability of oral glutathione. Eur J Clin Pharmacol. 1992;43:667-669.
5. Vaskova J, et al. Glutathione-Related Enzymes and Proteins: A Review. Molecules. 2023 Feb 2;28(3):1447.
6. Hong SY, et al. Pharmacokinetics of glutathione and its metabolites in normal subjects. J Korean Med Sci. 2005 Oct;20(5):721-6.
7. Hauser RA, et al. Randomized, double-blind, pilot evaluation of intravenous glutathione in Parkinson’s disease. Mov Disord. 2009;24:979-983.
8. Sechi G, et al. Reduced intravenous glutathione in the treatment of early Parkinson’s disease. Prog Neuro-Psychopharmacol & Biol Psychiat. 1996;20:1159-70.
9. Wang H, et al. Potential use of glutathione as a treatment for Parkinson’s disease. Exp Ther Med. 2021 Feb;21(2):125. doi: 10.3892/etm.2020.9557.
10. Otto M. et al. The use of intravenous glutathione for symptom management of Parkinson’s disease: A case report. Altern Ther Health Med. Jul 2018;24(4):56-60.
11. Arosio E, et al. Effect of glutathione infusion on leg arterial circulation, cutaneous microcirculation, and pain-free walking distance in patients with peripheral obstructive arterial disease. Mayo Clin Proc. 2002;77:754-759.
12. Rahman I, MacNee W. Oxidative stress and regulation of glutathione in lung inflammation. Eur Respir J. 2000;16(3):534-554.
13. Horowitz R., Freeman P., Bruzzese J. Respiratory Med Case Reports. 2020:30:101063. doi: 10.1016/j.rmcr.2020.101063.
14. Dewan B, Shinde S. Glutathione as an adjuvant therapy for acute respiratory distress syndrome associated with COVID-19 infection. J Adv Med Med Res. 2022;34(22):100-113.
15. Kalamkar S. et al. Randomized clinical trial of how long-term glutathione supplementation offers protection from oxidative damage and improves HbA1c in elderly Type 2 diabetic patients. Antioxidants. 2022;11,1026.
16. Adeoye O. et al. Review on the role of glutathione on oxidative stress and infertility. JBRA Assist Repro. 2018;22(1):61-66.
17. Majzoub A.; Agarwal A. Antioxidant therapy in idiopathic oligoasthenoteratozoospermia. Ind J Urol. Jul/Sept 2017;33(3):207-214.
18. Davids LM, et al. Intravenous glutathione for skin lightening: a review of the evidence and safety concerns. S Afr Med J. 2016;106(8):782-786.
19. Kern J, et al. Evidence of neurodegeneration in autism spectrum disorder. Transl Neurodegener. 2013 Aug 8;2:17. doi: 10.1186/2047-9158-2-17.
20. U.S. Food and Drug Administration. FDA highlights concerns with using dietary ingredient glutathione to compound sterile injectables. Safety communication, 2019.

COMPOSITION & GENERAL CHARACTERISTICS

• Active Ingredient: Reduced L-Glutathione
• Excipients: Sodium bicarbonate, sodium hydroxide, benzyl alcohol, and water for injection
• Appearance: Clear, colorless sterile solution
• Typical pH Range: Approximately 4.8 – 6.5

All quality attributes, acceptance criteria, and analytical testing results are verified in the lot-specific CoA.

INTENDED USE & REGULATORY CONTEXT

This sterile preparation is produced by an FDA-registered 503B outsourcing facility and may be provided to licensed healthcare professionals for office-use administration, hospitals, clinics, pharmacies, and other healthcare entities in accordance with applicable federal and state requirements.

This document does not:

• Provide dosing or therapeutic guidance
• Replace product labeling or the CoA
• Substitute for practitioner medical judgment
• Establish indications – this is not an FDA-approved drug; no clinical indications are established for this compounded preparation

KEY SAFETY CONSIDERATIONS (Non-Exhaustive)

CONTRAINDICATIONS

• Known hypersensitivity to glutathione or any component of the formulation (including benzyl alcohol)
• History of hypersensitivity reactions to sulfhydryl or thiol-containing compounds
• Neonates or infants due to the presence of benzyl alcohol (risk of “gasping syndrome”)

HYPERSENSITIVITY & ALLERGY CONSIDERATIONS

• Hypersensitivity reactions to glutathione or thiol-containing compounds have been reported and may include rash, pruritus, flushing, or mild bronchospasm
• Although rare, more significant reactions such as dyspnea or hypotension have been described in susceptible individuals
• Products containing benzyl alcohol may cause allergic-type reactions, including anaphylactoid responses in sensitive individuals
• Patients with asthma may be at increased risk of bronchospasm due to sulfhydryl reactivity

ADVERSE EFFECTS

Potential adverse effects may include but are not limited to:

• Local reactions: injection site discomfort, irritation, erythema, or thrombophlebitis
• Neurologic: dizziness, lightheadedness, or headache
• Gastrointestinal: nausea or abdominal discomfort
• Respiratory: transient shortness of breath or throat tightness in sensitive individuals
• Dermatologic: rash, flushing, or pruritus
• Allergic reactions: from mild hypersensitivity to rare anaphylactoid responses

ROUTE-SPECIFIC WARNINGS

• For intravenous use only.

DRUG INTERACTIONS

• Oxidizing agents: may reduce glutathione activity due to chemical incompatibility
• Chemotherapeutic agents: glutathione may theoretically alter the redox balance of certain drugs (e.g., platinum-based compounds); relevance depends on clinical context
• Nitroglycerin and similar agents: co-administration may influence nitric oxide signaling pathways
• Other thiol-containing product: may have additive effects related to sulfur-based reactivity

PRECAUTIONARY CONSIDERATIONS

• Administer only by, or under the supervision of, licensed healthcare professionals
• Use caution in patients with a history of asthma, atopy, or sensitivity to thiol-containing compounds
• Monitoring during infusion is recommended to identify any signs of hypersensitivity or intolerance
• Facilities should have immediate access to resuscitation equipment in the event of an adverse reaction

STORAGE, HANDLING & DISPOSAL

• Store at controlled cold temperature (35.6–46.4°F / 2–8°C)
• Inspect visually; do not use if discolored or particulate matter is present
• Handle using aseptic technique appropriate for sterile injectable products
• Contains benzyl alcohol; do not use in neonates or infants.
• Dispose in accordance with federal, state, and institutional requirements

STABILITY & EXPIRATION

Expiration dating is assigned based on validated stability studies, storage conditions, and compounding controls.

• Product label provides official expiration date for the lot
• CoA documents release testing and quality attributes
• Multi-dose vial (MDV): In-use period of up to 28 days post puncture when maintained under recommended storage and aseptic handling conditions.
• MOS does not recommend using the product beyond the labeled expiration date or the established in-use period, whichever comes first.

REGULATORY STATEMENT

• Produced by an FDA-registered 503B outsourcing facility
• Manufactured in compliance with applicable cGMP requirements
• Not an FDA-approved drug product
• Country of Origin: United States of America

EMERGENCY INFORMATION

• If a patient exhibits signs of hypersensitivity, systemic toxicity, or unexpected adverse reaction, discontinue administration immediately.
• Seek prompt medical evaluation or emergency care according to institutional procedures.
• Healthcare professionals should follow their facility’s established protocols for the management of infusion-related or hypersensitivity reactions.
• Report serious adverse events through appropriate institutional, state, or federal reporting channels.

DISCLAIMER

This Product Safety Summary is provided as general information for licensed healthcare professionals. It does not replace product labeling, CoA, institutional policy, or clinical decision-making. The CoA supersedes all information contained herein.

Reduced L-Glutathione Injection | 200 mg/mL | 6000 mg/30 mL MDV | NDC 67157-135-30 | For IV Use Only