Levocarnitine - Indications, Dosage, Side Effects and Precautions

Levocarnitine is a substance that occurs naturally in the body. It helps the body to use long chain fatty acids as a source of energy.

Levocarnitine is prescribed for the prevention and treatment of carnitine deficiency in:
• Primary carnitine deficiency, where the cause of the deficiency is not known
• Secondary carnitine deficiency, due to inborn errors of metabolism like medium chain fatty acylCoA dehydrogenase deficiency.

Other patients who may also suffer from carnitine deficiency and may benefit from levocarnitine treatment include:
• Patients on dialysis with kidney disease. The oral form should not be used in these patients.
• Individuals who take certain medicines such as zidovudine and valproic acid.

Levocarnitine is a naturally occurring substance that plays a role in the breakdown of long-chain fatty acids. This process provides energy to the body and also helps to get rid of the excess fats which could be harmful. 

Levocarnitine should not be taken by patients who develop a severe allergy to the drug.

Oral dosage:
Adults: The maximum oral dose is 990 mg administered in two or three divided doses.
Infants and children: The oral dosage to be started with 50mg/kg/day. The recommended dose is between 50 and 100mg/kg/day in divided doses. The dose should not exceed 3g/day.

Injections dosage for adults and children:
• Carnitine deficiency: The normal dose is 50mg/kg bodyweight injected into the vein.
• Patients with kidney failure undergoing hemodialysis: The usual dose is 10 to 20 mg/kg bodyweight daily after dialysis.

• Levocarnitine is available in the form of tablet, powder and injection. The oral solutions or tablets should be taken with food to avoid a stomach upset.
• If more than one dose is needed in a day, an adequate time interval should be maintained between the doses.

• In severe kidney disease, accumulation of the drug could occur in patients who consume it for long periods.
• An increase in the frequency of seizures and worsening of existing seizure disorder may occur.

•  GI Tract - Diarrhea, abdominal pain, vomiting, nausea, constipation
•  Central nervous system - Headache, dizziness, paresthesia (tingling or pricking sensation), taste perversion, seizures
•  Cardio vascular system - Fluctuations in blood pressure, palpitations, atrial fibrillation and abnormal ECG
•  Musculoskeletal - Rhabdomyolysis (breakdown of muscle)
•  Metabolic - Hypertriglyceridemia associated with high doses in dialysis patients, hypercalcemia (high blood calcium levels), hypervolemia
•  Respiratory - Increase in cough frequency, pharyngitis and breathlessness
•  Allergic reaction: Rashes, itching. A serious allergic reaction may rarely occur
•  Others - Depression, fishy body odor, fever

• Avoid excess dose.

• Levocarnitine could increase the risk of bleeding in patients taking warfarin. Therefore, the patients should be monitored through a regular blood test that measures the warfarin activity (INR or International Normalized Ration).
• Herbal supplements such as ginkgo biloba should be avoided as the combination could increase the risk of seizures.

• Store at room temperature away from light and moisture. Do not freeze.
• Keep out of reach of children.