GSH Sample Protocol

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NOTE: GSH use should not be attempted in CF patients who culture Burkholderia

cepacia, who have a history of hemoptysis/pneumothorax, or whose FEV1 is less

than 30% predicted until such time as research has been performed to decide

whether use under such conditions is safe.

The following protocol was recommended by Dr. Bishop, M.D. and

board-certified pulmonologist. You or your doctor can reach him at

gshtreatment@...

1. When the patient wakes in the morning, have them take a cysteine donor such

as NAC, 250-500 mg. This is the only time during the day that they will do this.

2. Have them follow that in a half hour by the first dose of GSH.

3. Have them continue to take their GSH dose every 3-4 hours.

4. We recommend a mix of oral GSH dosing and inhaled GSH dosing during the

patient's waking hours, and further recommend that the patient have at least one

oral dose and one inhaled dose every day. The specific mix of doses over the

course of the day, e.g., 3 oral, 1 inhaled; 2 oral, 2 inhaled, etc. is up to

you.

5. We recommend that the patient *not* take both an oral dose and an inhaled

dose during the same 3-4 hour period.

6. We recommend that CF persons start out at a very low dose, about one half

gram or less *total* per day (less for children), and *gradually* increase that

dose until the desired total daily dose is achieved. We recommend at least a two

to three week period at one dose before increasing to the next step. The patient

may not reach the desired level for months, but this should allow for maximum

safety.

7. GSH that is inhaled should be both buffered and isotonic when in solution. We

recommend the product GSHPlus by Theranaturals, Inc. ( theranat@...

) and their website is

http://www.theranaturals.com <http://www.theranaturals.com/> Each capsule of

GSHPlus contains about 210 mg of buffered GSH, and when dissolved in 3-4 ml of

sterile or distilled water (not saline!), this will yield a roughly isotonic

solution of pH 6, suitable for nebulizing. How many capsules to use will vary

by weight of the patient, see #10 below. If using more than one capsule or less

than one capsule, the amount of water should be adjusted proportionately to

maintain approximate isotonicity.

8. GSH to be taken orally should ideally have ascorbic acid with it. We

recommend the formulation by Theranaturals called " GSH Caps " which each contain

500 mg of pharmaceutical grade glutathione. Their email is theranat@...

and their website is http://www.theranaturals.com

<http://www.theranaturals.com/> There is also another company called HMP,

Inc., which sells oral glutathione mixed with ascorbic acid called

Ultrathione-250 and Ultrathione-500. ( http://www.hmpscience.com or

1-), though we have received a few complaints about HMP's shipping

and billing. No member of UVICF has any financial connection to any company

selling glutathione.

9. There may be some initial slightly negative side effects, such as transitory

sulphur-smelling flatulence, lightheadedness, transitory slight aggravation of

asthma. These effects will disappear in 7-10 days. However, if the patient

notices any negative side effects that you feel are harmful, have them cease

taking GSH! Remember that GSH is a vasodilator, so if a patient is prone to

bleeds, be very careful when you are using GSH with them.

10. Desired total daily dose is currently an art, not a science. Dr. Bishop used

the following formula in his 2002 clinical trial: the formula for total daily

dose is

30 mg/pound body weight/day.

This formula yields a total daily dose, and must be divided by the number of

times that GSH is given during the day to get the dose per dosing period. Most

persons take 4 doses per day, so, for example, if the formula yields 2000 mg per

day as the total dose, then each of the 4 daily doses would be 500 mg. Remember

that a CF person must work up to these doses gradually over time!

11. Make sure the patient does not take acetaminophen or drink alcohol when on

glutathione augmentation therapy, as these will strip GSH from the body. Other

substances, such as morphine, will do the same.