L - CARNITINE 1 GM / 5 ML ( L-CARNITINE ) 5 X 5 ML IV USE AMPOULES

Uses
Carnitine has been commercially advertised to improve exercise performance, enhance a sense of well-being, and to aid weight loss; however, clinical trials have not consistently supported these uses. The US Food and Drug Administration (FDA) has approved oral and intravenous (IV) L-carnitine for the treatment of primary and secondary carnitine deficiency as a result of inborn errors of metabolism. IV L-carnitine is also approved for the treatment of carnitine deficiency resulting from dialysis in patients with end-stage renal disease. Administration of L-carnitine in combination with orlistat or sibutramine has been shown to improve anthropomorphic, glycemic, and insulin parameters compared with L-carnitine monotherapy in patients with type 2 diabetes mellitus. Some lipid parameters as well as diabetic peripheral neuropathy have improved in diabetic patients whose diet was supplemented with L-carnitine. Limited clinical data support L-carnitine as an effective therapy for improving sperm quality for men with oligoasthenozoospermia. Limited data support the use of propionyl-L-carnitine for treatment of intermittent claudication in patients with peripheral artery disease, and data do not support its use in the treatment of congestive heart failure. Higher doses of propionyl-L-carnitine may increase the risk of atherogenesis and cardiovascular disease (CVD). Data do not support use of acetyl-L-carnitine in patients with cerebral ischemia.

Limited clinical data exist supporting L-carnitine's use in the management of mitochondrial dysfunction related to aging and apoptosis, AIDS-related dementia complex, drug-induced anemia, bipolar depression, cachexia, cardiovascular disease, dyslipidemia, dysthymic disorder, fatigue, drug-induced hepatotoxicity, intermittent claudication, migraine prophylaxis, muscle cramps, and drug-induced peripheral neuropathy.

Dosing
Because it increases adenosine triphosphate (ATP) generation and cellular oxidative respiratory processes, L-carnitine is often given with an antioxidant such as alpha-lipoic acid.

• AIDS-related dementia complex: An IV dose of acetyl-L-carnitine 3 g/day for 4 weeks.
• Athletic performance: Limited data support the use of L-carnitine 3 or 4g in prolonged time to exhaustion.
• Cachexia: Liquid L-carnitine 4 g/day for 12 weeks administered orally.
• Cardiovascular disease, secondary prevention: Oral maintenance doses of L-carnitine 2 to 6 g/day for up to 12 months have been used in clinical studies; some trials used oral or IV loading doses of 6 or 9 g/day for 5 to 7 days.
• Diabetes mellitus, type 2: L-carnitine 2 g once daily for 1 year as a combination therapy with either orlistat or sibutramine. Other treatment options include an IV dose of acetyl-L-carnitine 5 mg/kg bolus loading dose followed by 0.025, 0.1, or 1 mg/kg constant infusion.
• Diabetic peripheral neuropathy: acetyl-L-carnitine 1 g, 3 times daily administered over 1 year in adults with type 1 and 2 diabetes.
• Dyslipidemia: A combination therapy of L-carnitine 2 g once daily with orlistat in adults with type 2 diabetes. A regimen of 500 mg twice daily was given for 12 weeks for dyslipidemia in patients with coronary artery disease without comorbid diabetes, liver disease, or renal disease.
• Dysthymic disorder: Oral acetyl-L-carnitine1 g, 3 times daily for 7 weeks in elderly patients.
• Hepatotoxicity induced by interferon/ribavirin therapy: L-carnitine 2 g administered orally twice daily for 12 months.
• Hepatotoxicity induced by tuberculosis regimen: Carnitine 1 g administered orally twice daily for 4 weeks.
• Hepatotoxicity induced by valproic acid overdose: IV loading dose of L-carnitine 100 mg/kg; a maintenance dose of 50 mg/kg (to a maximum of 3 g/dose) administered every 8 hours may be used.
• Infertility, male: Carnitine 2 g/day, L-carnitine 2 to 3 g/day, acetyl-L-carnitine 0.5 to 3 g/day for up to 26 weeks is recommended.
• Intermittent claudication: Propionyl-L-carnitine (PLC) 2 g once daily in patients with peripheral artery disease, combined with exercise training and other strategies.
• Migraine prophylaxis: L-carnitine 500 mg/day administered orally for 12 weeks.
• Mitochondrialmyopathy: L-carnitine 3 g/day for 2 months.
• Muscle cramps: L-carnitine 300 mg administered 3 to 4 times daily for 8 weeks in patients with cirrhosis.

Contraindications
Contraindications have not been identified.

Pregnancy/ Lactation
Avoid use. L-carnitine is assigned the pregnancy Category B by the US Food and Drug Association (FDA); L-carnitine supplementation in breast-feeding mothers has not been clinically studied.

Interactions

Blood carnitine concentrations may be decreased in children who are concomitantly taking the anticonvulsants carbamazepine, phenobarbital, phenytoin, or valproic acid. Children concomitantly taking pivampicillin and other pivalate-conjugated antibiotics may also have reduced blood carnitine concentration levels.

Adverse Reactions
Nausea, vomiting, abdominal cramps, diarrhea, and a "fishy" body odor can occur with doses of about 3 g/day. Less common adverse effects have included pruritic rash, muscle weakness in uremic patients, and seizures in patients with seizure disorders. In patients with cardiovascular disease, oral doses of L-carnitine more than 3 g/day have resulted in a higher risk of atherogenesis and CVD.

Toxicology

There have been no reports of toxicity from levocarnitine overdosage. Large doses of levocarnitine may cause diarrhea.

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