Citrulline

Name	Citrulline
Uses	Amino acid used to support nitric oxide production, improving circulation and vascular function. May enhance exercise performance, support detoxification via the urea cycle, and assist in muscle recovery. Commonly used in wellness IV protocols for performance enhancement, circulation support, and metabolic optimization.
Route Of Administration	Intravenous (IV)
Frequency Of Use	Typically administered once weekly for general wellness and circulation support. In performance-focused protocols, may be given up to twice weekly for 4 to 6 weeks, followed by reassessment. Long-term use should be reviewed every 8 to 12 weeks.
Concentration(s)	Common compounded concentrations range from 50 mg/mL to 100 mg/mL.
Maximum Dosage (Day, Wk) (g/mL)/mL	Maximum dose per infusion: 1,500 mg (1.5 g). Maximum weekly dose: 3,000 mg (3 g). Higher doses are not recommended for elective wellness patients due to potential risk of hypotension and electrolyte imbalances.
Contraindications	Severe renal impairment or dialysis dependency (due to potential accumulation of nitrogenous waste). Severe hepatic impairment. Active hypotension. Known hypersensitivity to citrulline or any component of the formulation. Pregnancy and breastfeeding unless cleared by OB provider.
Possible Side Effects	Nausea, flushing, headache, or dizziness during infusion. Mild hypotension, especially if infused too rapidly. Injection site discomfort. Rare: allergic reactions (rash, itching, hypersensitivity).
Compatibility With Other Drugs	Compatible with normal saline and D5W. Should not be mixed directly with calcium-containing solutions. May be combined with other amino acids or vitamins in metabolic or performance IVs, but always verify compatibility before combining.
Allergies	True allergic reactions to citrulline are rare. Reactions are more likely related to preservatives or stabilizers in compounded formulations.
Administration Time	Typical infusion time: 30 to 45 minutes for doses up to 1,500 mg. Faster infusions increase risk of side effects like flushing and dizziness.
IV Dosing	For general wellness and circulation support: 500 mg to 1,000 mg IV once weekly. For performance optimization: 1,000 mg to 1,500 mg IV once or twice weekly for up to 6 weeks, followed by reassessment. Long-term use requires periodic clinical review.
IM/Push	May be given as a slow IV push for doses up to 500 mg over 5 to 10 minutes. Higher doses should be given via drip to reduce risk of side effects. IM administration is not recommended due to potential muscle irritation and pain.
What To Do If Adverse Reaction Occurs	1. Stop the infusion immediately. 2. Assess vital signs (blood pressure, heart rate, oxygen saturation). 3. If hypotension occurs, place the patient in a supine position and elevate legs. Administer fluids (normal saline) if needed to support blood pressure. 4. For allergic reactions (rash, itching, shortness of breath), administer antihistamines and consider epinephrine for severe reactions. 5. If symptoms do not resolve promptly, arrange for transfer to a higher level of care (call 911 if necessary).