L-carnitine

What it is and how it works

Levocarnitine is an endogenous amino-acid derivative required for transport of long-chain fatty acids into mitochondria for beta-oxidation and energy production. It also binds and removes toxic acyl groups as acylcarnitines, which are excreted in urine.

Indications

Primary systemic carnitine deficiency; secondary carnitine deficiency due to inborn errors of metabolism (e.g. organic acidurias) or haemodialysis in end-stage renal disease.

Dosage and administration (summary)

Oral: adults commonly 1–3 g daily in divided doses with meals, adjusted to response. Intravenous: for dialysis-related deficiency, typically 10–20 mg/kg slowly after each dialysis session; higher doses in metabolic disorders are individualised by the specialist.

Contraindications

Hypersensitivity to levocarnitine or excipients.

Warnings and precautions

Seizures have been reported in patients with or without a history of seizures. Gastrointestinal upset and a fishy body odour may occur; high oral doses in severe renal impairment should be avoided because of accumulation of metabolites. Plasma carnitine levels and clinical status should guide therapy; in diabetic patients, glucose-lowering requirements may change.

Pregnancy

Use only if clearly needed; carnitine is a normal physiological substance.

Storage and supply

Store below 25 °C; protect oral solution from light once opened.

Source: reference summary prepared from the EU SmPC/EPAR, BNF and WHO Model Formulary. The approved product information in Iran governs.