Levocarnitine

How it works

It is the physiological form of carnitine that facilitates transport of long-chain fatty acids across the inner mitochondrial membrane for beta-oxidation and energy production, and helps remove accumulated acyl groups.

Prescribing in practice

• Use the levo-isomer only, as the D-isomer can cause a myasthenia-like syndrome; ensure the correct preparation is prescribed.
• Oral dosing may cause gastrointestinal upset and a fishy body odour, which can be reduced by spreading doses through the day.
• It is available in oral and intravenous forms, with the route chosen according to indication and the ability to absorb oral therapy.

Monitoring

Monitor plasma carnitine concentrations and clinical response, adjusting therapy to maintain adequate levels.

Counselling the patient

• Take oral doses spread through the day, with or after food, to improve tolerance.
• A fishy body odour can occur and tends to lessen with dose adjustment.
• Continue treatment as directed for your metabolic condition.

Evidence & guidelines

Carnitine supplementation is the established treatment for primary carnitine deficiency and recognised carnitine-depletion states.