Levocarnitine (L-3-hydroxy-4-N-trimethylaminobutyrate)

Levocarnitine Brand Names- ACTICARNITINE | Carnitor

What is Levocarnitine

Levocarnitine is synthesized in the liver from the amino acids methionine and lysine. This naturally occurring substance is found in all mammalian tissues, especially striated muscle, and is required in energy metabolism, such as the oxidation of fatty acids, facilitating the aerobic metabolism of carbohydrates, and enhancing the excretion of certain organic acids.

Only the L isomer of carnitine is naturally present in the biologic systemCommercially, carnitine is available as both a prescription and non-prescription product.

The prescription version is levocarnitine, while most dietary supplements contain D,L-carnitine which is commonly sold in health food stores.

Levocarnitine has been used in the treatment of primary and secondary carnitine deficiency in adults and pediatric patients, including neonates.  Other uses have included  dilated cardiomyopathy in adults and children, valproic acid-induced hepatotoxicity in children, and hyperlipoproteinemia.

It has been designated an orphan drug for a variety of conditions. Its use in alcohol induced fatty liver, Down’s syndrome, and chronic fatigue syndrome has shown varying results. Some athletes use carnitine supplements to increase exercise performance, however, the concept of carnitine loading does not appear to be very effective.

Further, D,L-carnitine competitively inhibits levocarnitine.

This inhibition may lead to a deficiency.

Oral prescription forms of levocarnitine were first approved by the FDA in 1985 and an injection was FDA-approved in 1992.

Indications

  1. acute myocardial infarction
  2. Alzheimer’s disease
  3. cardiomyopathy
  4. carnitine deficiency
  5. ergogenesis
  6. heart failure
  7. hyperlipoproteinemia
  8. infertility
  9. nutritional supplementation
  10. renal impairment
  11. type 2 diabetes mellitus
  12. valproate-induced hepatotoxicity

For the treatment of primary or secondary carnitine deficiency

Side Effects

  1. abdominal pain
  2. amblyopia
  3. anaphylactoid reactions
  4. anemia
  5. anorexia
  6. anxiety
  7. asthenia
  8. atrial fibrillation
  9. back pain
  10. bleeding
  11. bronchospasm
  12. chest pain (unspecified)
  13. constipation
  14. cough
  15. depression
  16. diarrhea
  17. dizziness
  18. drug-induced body odor
  19. dysgeusia
  20. dyspepsia
  21. dyspnea
  22. edema
  23. fever
  24. gastritis
  25. headache
  26. hypercalcemia
  27. hyperkalemia
  28. hypertension
  29. hypertonia
  30. hypervolemia
  31. hypotension
  32. infection
  33. injection site reaction
  34. insomnia
  35. laryngeal edema
  36. melena
  37. nausea
  38. palpitations
  39. paresthesias
  40. peripheral edema
  41. pharyngitis
  42. pruritus
  43. rash
  44. rhinitis
  45. seizures
  46. sinus tachycardia
  47. sinusitis
  48. urticaria
  49. vertigo
  50. vomiting
  51. weakness
  52. weight gain
  53. weight loss

Monitoring Parameters

  • serum carnitine concentrations

Contraindications

  • breast-feeding
  • cardiac disease
  • dialysis
  • diarrhea
  • hepatic disease
  • hypertension
  • peripheral neuropathy
  • pregnancy
  • renal failure
  • renal impairment
  • seizure disorder
  • ventricular arrhythmias

Interactions

There are no drug interactions associated with Levocarnitine products.