L-Carnitine

How it works

It facilitates transport of long-chain fatty acids across the inner mitochondrial membrane for beta-oxidation and helps remove accumulated acyl groups as acylcarnitines, supporting energy production and detoxification.

Prescribing in practice

• Treatment of inherited metabolic carnitine deficiency should be directed by a specialist metabolic team, as inappropriate use without confirmed deficiency offers no benefit.
• Available in oral and intravenous formulations; gastrointestinal upset and a fishy body odour can occur, more commonly with oral therapy.
• Dose adjustment may be required in renal impairment and in dialysis-associated deficiency; consult the SPC.

Monitoring

Monitor plasma carnitine levels and clinical and biochemical response under specialist supervision, particularly in metabolic disorders.

Counselling the patient

• This replaces a substance your body needs to use fats for energy.
• Some people notice a fishy body odour or stomach upset, which can improve with dose adjustment.
• Do not stop treatment without discussing it with your metabolic team.

Evidence & guidelines

Levocarnitine is an established treatment for primary carnitine deficiency and recognised carnitine-deficiency states, with use guided by specialist metabolic medicine practice.