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levocarnitine (Rx)Brand and Other Names:Carnitor, carnitine

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablets

  • 330mg
  • 500mg

capsule

  • 250mg

oral solution

  • 1g/10mL

injectable solution

  • 200mg/mL
more...

Carnitine Deficiency

990 mg PO q8-12hr, up to 3 g/day

50 mg/kg IV bolus, THEN 50 mg/kg over next 24 hr (divided q3-6hr)

End-Stage Renal Disease

Indicated for ESRD in patients on hemodialysis

Initial dose: 10-20 mg/kg IV bolus infused over 2-3 minutes; administer into venous return line after dialysis session 

Adjust doses by predialysis levocarnitine concentrations

Downward dose titration may begin as within 3-4 weeks after initiating

Valproic Acid Overdose (Orphan)

For the prevention or treatment of secondary carnitine deficiency in valproic acid toxicity

100 mg/kg IV (not to exceed 6 g/dose) once 

May give additional doses of 15 mg/kg IV q4hr infused over 30 min

Recommendations vary; some sources advocate limiting total dose to 3 g/day

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Myopathy (Orphan)

Treatment of zidovudine-induced mitochondrial myopathy

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Rett Syndrome (Orphan)

Acetyl-L-carniticine designated orphan indication for treatment Rett syndrome

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Administration

Consume oral solution slowly, may be mixed with drinks and space doses evenly throughout the day (q3-4hr) preferably during or after meals (may decrease GI distress)

Administer IV bolus slowly over at least 2-3 min

Also sold as a non-pharmacologic health supplement (L-carnitine)

Dosage Forms & Strengths

tablets

  • 330mg
  • 500mg

capsule

  • 250mg

oral solution

  • 1g/10mL

injectable solution

  • 200mg/mL
more...

Carnitine Deficiency

50 mg/kg/day PO divided q8-12hr initially 

May increase to 100 mg/kg/day PO divided q8-12hr; not to exceed 3 g/day

IV: 50 mg/kg IV bolus; may repeat 50 mg/kg IV daily if indicated; not to exceed 300 mg/kg

End-Stage Renal Disease

Indicated for ESRD in patients on hemodialysis

Initial dose: 10-20 mg/kg IV bolus infused over 2-3 minutes; administer into venous return line after dialysis session 

Adjust doses by predialysis levocarnitine concentrations

Downward dose titration may begin as within 3-4 weeks after initiating

Valproic Acid Overdose (Orphan)

For the prevention or treatment of secondary carnitine deficiency in valproic acid toxicity

Overdose or hyperammonemia: 150-500 mg/kg/day IV; not to exceed 3 g/day or until clinical improvement observed 

100 mg/kg/day PO; not to exceed 2 g/day in divided doses

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Rett Syndrome (Orphan)

Acetyl-L-carnitine designated orphan indication for treatment Rett syndrome

Orphan indication sponsor

  • sigma-tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd; Gaithersburg, MD 20878

Cardiomyopathy (Orphan)

Treatment of pediatric cardiomyopathy

Orphan indication sponsor

  • Sigma-Tau Pharmaceuticals, Inc; 9841 Washingtonian Blvd, Suite 500; Gaithersburg, MD 20878

Administration

Consume oral solution slowly, may be mixed with drinks and space doses evenly throughout the day (q3-4hr) preferably during or after meals (may decrease GI distress)

Administer IV bolus slowly over at least 2-3 min

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Interactions

Interaction Checker

levocarnitine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            GI distress

            Mild myasthenia in patients with uremia

            Hypertension

            Headache

            Dizziness

            Fever

            Vomiting

            Hypercalcemia

            Anemia

            Paresthesia

            Cough

            Tachycardia

            Palpitation

            Peripheral edema

            Vertigo

            Rash

            Bronchitis

            Gastritis

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            Warnings

            Contraindications

            None listed by the manufacturer

            Cautions

            Monitor blood chemistries, plasma carnitine concentration, vital signs

            INR may increase in patients receiving warfarin therapy; monitor INR levels following initiation of levocarnitine therapy and after dose adjustments

            GI reactions may occur from too rapid consumption of carnitine

            Carcinogenic potential unknown

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: not studied, weigh risk/benefit

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Quaternary ammonium compound found in all mammalian tissue (particularly striated muscle)

            Important for lipid catabolism; essential for FFA transport from cytosol to mitochondria where they are oxidized

            Pharmacokinetics

            Bioavailability: 10-20%

            Distribution half-life: 0.585 hr

            Half-life elimination : 17.4 hr

            Peak plasma time: (PO) 3.3 hr

            Peak plasma concentration: (PO) 80 umol/L

            Protein Bound: None

            Total Body Clearance: 4 L/hr

            Metabolism: Metabolized to trimethylamine-N-oxide and gamma-butyrobetaine

            Excretion: Urine (76%); feces (<1%)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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