L-tryptophan

General

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

Pronunciation:
el trip-tuh-fan


Trade Name(s)

  • tryptophan

Ther. Class.

mood stabilizers

smoking deterrents

sedative/hypnotics

antidepressants

Common Uses

  • Premenstrual dysphoric disorder (PMDD)
  • Depression.
  • Smoking cessation.
  • Insomnia.

Action

L-tryptophan is an essential amino acid that is converted by the body to 5–hydroxytryptophan (5–HTP) and then to serotonin. Both L-tryptophan and 5–HTP cross the blood-brain barrier and have sedative effects. Depletion of endogenous tryptophan can cause a relapse in depression symptoms.

Therapeutic Effect(s):

  • Improved symptoms of depression.
  • Improved sleep.

Pharmacokinetics

Absorption: Unknown

Distribution: Unknown

Metabolism and Excretion: Unknown

Half-life: Unknown

TIME/ACTION PROFILE

ONSETPEAKDURATION
POunknownunknownunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity.
  • Pregnancy and lactation.

Use Cautiously in:

  • Eosinophilia.
  • Kidney disease.
  • Liver disease.

Adverse Reactions/Side Effects

EENT: visual blurring

GI: abdominal pain, dry mouth, heartburn, nausea

Hemat: eosinophilia-myalgia syndrome

Neuro: ataxia, drowsiness, headache, lightheadedness

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Natural Drug Interaction

  • Increased risk of serotonergic effects and serotonin syndrome with  SSRIs,  dextromethorphan,  meperidine,  tricyclic antidepressants,  monoamine oxidase inhibitors, and  tramadol.
  • Increased sedation with  CNS depressants.

Natural-Natural:

  • Additive sedation with herbs or supplements that have sedative properties such as  kava St. John's wort valerian 5–HTP and others.
  • Increased risk of serotonin syndrome with  St. John's wort. .

Route/Dosage

PO (Adults): Insomnia: 1 gram 20 minutes before bedtime;  Depression: 300 mg/day;  Prementrual syndrome: 6 grams/day;  Smoking cessation: 50 mg/kg/day.

Availability

Capsules:
Tablets: 500 mg

Assessment

  • Assess sleep patterns prior to and periodically during therapy.
  • Monitor for signs and symptoms of esosinophilia-myalgia sydrome (severe myalgia, arthralgia, intense eosinophilia) Less common symptoms include respiratory prodrome (cough, dyspnea, pulmonary infiltrates), limb edema, scleroderma, mononeuritis, evanescent skin rash, mild LFT elevations, and leukocytosis. If these symptoms occur, discontinue l-tryptophan.

Implementation

  • PO Administer without regard to food.

Patient/Family Teaching

  • Instruct patient to take as directed; do not take more than directed.
  • Advise patient to notify health care professional of symptoms of esosinophilia-myalgia sydrome occur.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Improvement in insomnia and premenstrual disorder.