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Search Health Information    L-Carnitine

L-Carnitine

Uses

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Angina
1 gram two or three times per day
Supplementing with L-carnitine may improve heart function and ease angina symptoms.

L-carnitine is an amino acid needed to transport fats into the mitochondria (the place in the cell where fats are turned into energy). Adequate energy production is essential for normal heart function. Several studies using 1 gram of L-carnitine two to three times per day showed an improvement in heart function and a reduction in symptoms of angina.2 , 3 , 4 Coenzyme Q10 also contributes to the energy-making mechanisms of the heart. Angina patients given 150 mg of coenzyme Q10 each day have experienced greater ability to exercise without experiencing chest pain.5 This has been confirmed in independent investigations.6

3 Stars
Congestive Heart Failure
500 mg two to three times per day with a doctor's supervision
Supplementing with L-carnitine can improve heart function and exercise capacity and reduce heart muscle damage due to insufficient oxygen.

People with CHF have insufficient oxygenation of the heart, which can damage the heart muscle. Such damage may be reduced by taking L-carnitine supplements.7 L-carnitine is a natural substance made from the amino acids lysine and methionine . Levels of L-carnitine are low in people with CHF;8 therefore, many doctors recommend that those with CHF take 500 mg of L-carnitine two to three times per day.

Most L-carnitine/CHF research has used a modified form of the supplement called propionyl-L-carnitine (PC). In one double-blind trial, people using 500 mg of PC per day had a 26% increase in exercise capacity after six months.9 In double-blind research, other indices of heart function have also improved after taking 1 gram of PC twice per day.10 It remains unclear whether propionyl-L-carnitine has unique advantages over L-carnitine, as limited research in animals and humans has also shown very promising effects of the more common L-carnitine.11

3 Stars
Heart Attack
2 grams daily
Taking L-carnitine may help reduce damage and complications following a heart attack.
L-carnitine is an amino acid important for transporting fats that can be turned into energy in the heart. Clinical trials have reported that taking L-carnitine (4–6 grams per day) increases the chance of surviving a heart attack.12 , 13 , 14 In one double-blind trial, individuals with suspected heart attack were given 2 grams of L-carnitine per day for 28 days.15 At the completion of this study, infarct size, as well as the number of nonfatal heart attacks, was lower in the group receiving L-carnitine versus the placebo group. Double-blind research using L-carnitine intravenously also shows promise.16
3 Stars
Intermittent Claudication (Propionyl-L-Carnitine)
2 grams daily
In double-blind trials, supplementing with either L-carnitine or propionyl-L-carnitine (a form of L-carnitine) has increased walking distance in people with intermittent claudication.
In double-blind trials, supplementation with L-carnitine and propionyl-L-carnitine (a form of L-carnitine) has increased walking distance in people with intermitting claudication. Walking distance was 75% greater after three weeks of L-carnitine supplementation (2 grams taken twice per day), than after supplementation with a placebo, a statistically significant difference. In the study using propionyl-L-carnitine, improvement occurred on in the those who could not walk 250 meters to begin with. In that group, maximum walking distance increase by 78% with propionyl-L-carnitine supplementation compared with a 44% increase in the placebo group, also a statistically significant difference. The amount of propionyl-L-carnitine used was 1 gram per day, increasing to 2 grams per day after two months, and 3 grams per day after an additional two months, if needed. The results of this trial have been confirmed in a large European trial.
2 Stars
Attention Deficit–Hyperactivity Disorder
100 mg per 2.2 lbs (1 kg) of body weight daily, up to a maximum of 4 grams per day
In a double-blind study, supplementing with L-carnitine resulted in improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.

In a double-blind study, supplementation with L-carnitine for eight weeks resulted in clinical improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.17 The amount of L-carnitine used in this study was 100 mg per 2.2 pounds of body weight per day, with a maximum of 4 grams per day. No adverse effects were seen, although one child developed an unpleasant body odor while taking L-carnitine. Researchers have found that this uncommon side effect of L-carnitine can be prevented by supplementing with riboflavin. Although no serious side effects were seen in this study, the safety of long-term L-carnitine supplementation in children has not been well studied. This treatment should, therefore, be monitored by a physician.

2 Stars
Chronic Fatigue Syndrome
1 gram three times daily
L-carnitine is an important nutrient for energy production. Supplementation can make up for a possible deficiency.

L-carnitine is required for energy production in the powerhouses of cells (the mitochondria). There may be a problem in the mitochondria in people with CFS. Deficiency of carnitine has been seen in some CFS sufferers.19 One gram of carnitine taken three times daily for eight weeks led to improvement in CFS symptoms in one preliminary trial.20 Supplementation with 6 grams of L-carnitine per day for four weeks also improved fatigue in a preliminary study of patients with advanced cancer.21 Similar improvements were seen in another study of patients with advanced cancer given up to 3 grams of L-carnitine per day for one week.22

2 Stars
Chronic Obstructive Pulmonary Disease
2 grams taken twice per day
Studies have shown that when L-carnitine is given to people with chronic lung disease, breathing during exercise improves.

L-carnitine has been given to people with chronic lung disease in trials investigating how the body responds to exercise.23 , 24 In these double-blind trials, 2 grams of L-carnitine, taken twice daily for two to four weeks, led to positive changes in breathing response to exercise.

2 Stars
Erectile Dysfunction (Acetyl-L-Carnitine)
2 grams of each daily
In one study, supplementing with the combination of propionyl-L-carnitine (a form of L-carnitine) and acetyl-L-carnitine significantly improved erectile function in elderly men.

In a double-blind study, supplementing with the combination of propionyl-L-carnitine (a form of L-carnitine ) and acetyl-L-carnitine (2 grams of each per day) for six months significantly improved erectile function in elderly men with erectile dysfunction associated with low testosterone levels. Propionyl-L-carnitine and acetyl-L-carnitine were significantly more effective than testosterone treatment.25

2 Stars
High Triglycerides
1 to 3 grams daily
Supplementing with L-carnitine may help normalize triglyceride levels.

L-carnitine is another supplement that has lowered TGs in several clinical trials.26 , 27 However, the effect of carnitine is unpredictable, and some individuals have experienced an increase in triglyceride levels after receiving this supplement.28 Some doctors recommend 1–3 grams of carnitine per day, in the form known as L-carnitine.

2 Stars
Intermittent Claudication
2 grams a day of proprionyl-L-carnitine
In double-blind trials, supplementation with either L-carnitine or propionyl-L-carnitine (a form of L-carnitine) has increased walking distance in people with intermittent claudication.

In double-blind trials, supplementation with either L-carnitine and propionyl-L-carnitine (a form of L-carnitine) has increased walking distance in people with intermittent claudication. Walking distance was 75% greater after three weeks of L-carnitine supplementation (2 grams taken twice per day), than after supplementation with a placebo, a statistically significant difference.29 In the study using propionyl-L-carnitine, improvement occurred only in those who could not walk 250 meters to begin with. In that group, maximum walking distance increased by 78% with propionyl-L-carnitine supplementation compared with a 44% increase in the placebo group, also a statistically significant difference.30 The amount of propionyl-L-carnitine used was 1 gram per day, increasing to 2 grams per day after two months, and 3 grams per day after an additional two months, if needed. The results of this trial have been confirmed in a large European trial.31

2 Stars
Male Infertility
3 grams daily
L-carnitine appears to be necessary for normal functioning of sperm cells. Supplementing with it may improve sperm motility.

L-carnitine is a substance made in the body and also found in supplements and some foods (such as meat). It appears to be necessary for normal functioning of sperm cells. In preliminary studies, supplementing with 3–4 grams per day for four months helped to normalize sperm motility in men with low sperm quality.32 , 33 While the majority of clinical trials have used L-carnitine, one preliminary trial found that acetylcarnitine (4 grams per day) may also prove useful for treatment of male infertility caused by low quantities of immobile sperm.34

2 Stars
Multiple Sclerosis and Drug-Induced Fatigue
3 to 6 grams daily
Some drugs that are used to treat MS appear to deplete carnitine. In one trial, supplementing with L-carnitine significantly improved fatigue in 63% of drug-treated MS patients.

Some drugs that are used to treat MS appear to deplete carnitine. In a preliminary trial, supplementation with 3 to 6 grams of L-carnitine per day significantly improved fatigue in 63% of drug-treated MS patients.35

2 Stars
Sickle Cell Anemia
50 mg per 2.2 lbs (1 kg) of body weight daily
In a study of children with sickle cell anemia, supplementing with L-carnitine reduced the number of painful crises and improved abnormal heart function and pulmonary hypertension.

In a preliminary study of children with sickle cell anemia, supplementing with L-carnitine (50 mg per 2.2 pounds of body weight per day for six months) significantly reduced the number of painful crises and significantly improved the abnormal heart function (diastolic dysfunction) that was present in most of the children. L-carnitine supplementation also significantly improved pulmonary hypertension in the children who had this abnormality prior to treatment.36

2 Stars
Sprains and Strains and Exercise-Related Muscle Injury
3 grams per day
One trial showed that people who take L-carnitine for three weeks before engaging in an exercise regimen are less likely to experience muscle soreness.

One controlled trial showed that people who supplement with 3 grams per day L-carnitine for three weeks before engaging in an exercise regimen are less likely to experience muscle soreness.37

2 Stars
Thalassemia
50 to 100 mg per 2.2 lbs (1 kg) of body weight daily
Studies have shown that propionyl-L-carnitine (a form of L-carnitine) protects red blood cells of people with thalassemia against free radical damage. Supplementing with it may reduce the need for blood transfusions.

Test tube studies have shown that propionyl-L-carnitine (a form of L-carnitine ) protects red blood cells of people with thalassemia against free radical damage.38 In a preliminary study, children with beta thalassemia major who took 100 mg of L-carnitine per 2.2 pounds of body weight per day for three months had a significantly decreased need for blood transfusions.39 Some studies have found people with thalassemia to be frequently deficient in folic acid , vitamin B12 ,40 and zinc .41 , 42 Researchers have reported improved growth rates in zinc-deficient thalassemic children who were given zinc supplements of 22.5 to 90 mg per day, depending on age.43 , 44 Magnesium has been reported to be low in thalassemia patients in some,45 , 46 but not all,47 studies. A small, preliminary study reported that oral supplements of magnesium, 7.2 mg per 2.2 pounds of body weight per day, improved some red blood cell abnormalities in thalassemia patients.48

2 Stars
Type 1 Diabetes
0.25 mg per 2.2 lbs (1 kg) of body weight
Supplementing with L-carnitine may reduce cholesterol and triglyceride levels in people with diabetes.
L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given L-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides —dropped 25 to 39% in just ten days in one trial.49
2 Stars
Type 2 Diabetes
0.25 mg per 2.2 lbs (1 kg) of body weight
Supplementing with L-carnitine may reduce cholesterol and triglyceride levels in people with diabetes.

L-carnitine is an amino acid needed to properly utilize fat for energy. When people with diabetes were given DL-carnitine (0.5 mg per 2.2 pounds of body weight), high blood levels of fats—both cholesterol and triglycerides —dropped 25 to 39% in just ten days in one trial.50

 

1 Star
Asthma
Refer to label instructions
In a double-blind trial, supplementing with L-carnitine improved lung function and overall asthma control, compared with a placebo, in children with asthma.
In a double-blind trial, supplementing with L-carnitine (1,050 mg each morning for six months) improved lung function and overall asthma control, compared with a placebo, in Egyptian children with asthma.51
1 Star
Athletic Performance
Refer to label instructions
L-carnitine has been popular as a potential aid in improving athletic performance because of its role in converting fat to energy. Some studies have found that it improves certain measures of muscle physiology.

L-carnitine , which is normally manufactured by the human body, has been popular as a potential ergogenic aid (i.e., having the ability to increase work capacity), because of its role in the conversion of fat to energy.52 However, while some studies have found that L-carnitine improves certain measures of muscle physiology, research on the effects of 2 to 4 grams of L-carnitine per day on performance have produced inconsistent results.53 L-carnitine may be effective in certain intense exercise activities leading to exhaustion,54 but recent studies have reported that L-carnitine supplementation does not benefit non-exhaustive or even marathon-level endurance exercise,55 , 56 anaerobic performance,57 or lean body mass in weight lifters.58

1 Star
Cardiomyopathy
Refer to label instructions
Inherited forms of cardiomyopathy seen in children may be responsive to L-carnitine.

Deficiency of L-carnitine , an amino acid , is associated with the development of some forms of cardiomyopathy.59 Inherited forms of cardiomyopathy seen in children may be the most responsive to therapy with L-carnitine.60 , 61 Whether carnitine supplementation helps the average person with cardiomyopathy remains unknown. Nonetheless, some doctors recommend 1 to 3 grams of carnitine per day for adults of average weight.

1 Star
High Cholesterol
Refer to label instructions
Some preliminary trials report that L-carnitine reduces serum cholesterol and raises HDL cholesterol.
L-carnitine is needed by heart muscle to utilize fat for energy. Some,62 , 63 but not all, preliminary trials report that carnitine reduces serum cholesterol.64 HDL cholesterol has also increased in response to carnitine supplementation.65 , 66 People have been reported in controlled research to stand a greater chance of surviving a heart attack if they are given L-carnitine supplements.67 Most trials have used 1 to 4 grams of carnitine per day.
1 Star
Liver Cirrhosis
Refer to label instructions
L-carnitine injections have been used to improve circulation to the liver in people with cirrhosis.

L-carnitine injections have been used to improve circulation to the liver in people with cirrhosis,68 but trials of the oral supplement are lacking.

1 Star
Mitral Valve Prolapse
Refer to label instructions
In one report, deficient levels of L-carnitine were found in five people with MVP. One person was given L-carnitine and experienced a complete resolution of MVP symptoms.

In one report, deficient levels of L-carnitine were found in five consecutive people with MVP.69 One of these people was given L-carnitine (1 gram three times per day for four months) and experienced a complete resolution of the symptoms associated with MVP.

1 Star
Obesity
Refer to label instructions
The amino acid L-carnitine is thought to be potentially helpful for weight loss because of its role in fat metabolism.
The amino acid L-carnitine is thought to be potentially helpful for weight loss because of its role in fat metabolism. In a preliminary study of overweight adolescents participating in a diet and exercise program, those who took 1,000mg of L-carnitine per day for three months lost significantly more weight than those who took a placebo.70 A weakness of this trial, however, was the fact that the average starting body weight differed considerably between the two groups. A double-blind trial found that adding 4,000 mg of L-carnitine per day to an exercise program did not result in weight loss in overweight women.71
1 Star
Raynaud’s Disease
Refer to label instructions
In one study, people with Raynaud’s disease who were given L-carnitine showed less blood-vessel spasm in their fingers in response to cold exposure.

In one study, 12 people with Raynaud’s disease were given L-carnitine (1 gram three times a day) for 20 days.72 After receiving L-carnitine, these people showed less blood-vessel spasm in their fingers in response to cold exposure.

How It Works

How to Use It

Most people do not need carnitine supplements. For therapeutic use, typical amounts are 1–3 grams per day.

It remains unclear whether the propionyl-L-carnitine form of carnitine used in congestive heart failure research has greater benefits than the L-carnitine form, since limited research in both animals and humans with the more common L-carnitine has also shown very promising effects.73

Where to Find It

Dairy and red meat contain the greatest amounts of carnitine. Therefore, people who have a limited intake of meat and dairy products tend to have lower L-carnitine intakes.

Possible Deficiencies

Carnitine deficiencies are rare, even in strict vegetarians, because the body produces carnitine relatively easily.

Rare genetic diseases can cause a carnitine deficiency. Also, deficiencies are occasionally associated with other diseases, such as diabetes and cirrhosis .74 , 75 Among people with diabetes, carnitine deficiency is more likely to be found in persons experiencing complications of diabetes (such as retinopathy , hyperlipidemia, or neuropathy), suggesting that carnitine deficiency may play a role in the development of these complications.76 A carnitine deficiency can also result from oxygen deprivation which can occur in some heart conditions . In Italy, L-carnitine is prescribed for heart failure , heart arrhythmias , angina , and lack of oxygen to the heart.77

Interactions

Interactions with Supplements, Foods, & Other Compounds

The body needs lysine , methionine , vitamin C , iron , niacin , and vitamin B6 to produce carnitine.

Interactions with Medicines

Certain medicines interact with this supplement.

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • AZT

    Preliminary information suggests that muscle damage sometimes caused by AZT is at least partially due to depletion of carnitine in the muscles by the drug.78 It has been reported that most patients taking AZT have depleted carnitine levels that can be restored with carnitine supplementation (6 grams per day).79

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Carbamazepine

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.80 , 81 , 82 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.83 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.84 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Felbamate

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.86 , 87 , 88 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.89 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.90 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Levetiracetam

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.94 , 95 , 96 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.97 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.98 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Oxcarbazepine

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.99 , 100 , 101 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.102 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.103 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Phenytoin

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.106 , 107 , 108 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.109 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.110 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Primidone

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.111 , 112 , 113 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.114 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.115 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Topiramate

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.117 , 118 , 119 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.120 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.121 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

  • Zonisamide

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.122 , 123 , 124 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.125 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.126 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

Reduce Side Effects

  • Doxorubicin

    Animal research suggests carnitine may prevent doxorubicin’s toxicity.85

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Interferon Alfa-2a
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.91
  • Interferon Alfa-2B
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.92
  • Interferon Alfacon-1
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.93
  • Peginterferon Alfa-2a
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.104
  • Peginterferon Alfa-2b
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.105
  • Ribavirin
    In a randomized trial, patients with chronic hepatitis C who were being treated with Peg-interferon-alpha 2b and ribavirin were randomly assigned to receive L-carnitine (2 grams twice a day) or no L-carnitine (control group). Compared with the control group, fewer patients in the L-carnitine group had to reduce the medication dosage or discontinue treatment because of side effects such as anemia or a decline in the white blood cell count.116

Support Medicine

  • none

Reduces Effectiveness

  • none

Potential Negative Interaction

  • none

Explanation Required

  • Allopurinol

    People who have Duchenne muscular dystrophy have low levels of L-carnitine in their muscles. Allopurinol restores L-carnitine to normal levels, resulting in improved muscle strength.127 Whether L-carnitine supplementation might improve this effect of allopurinol has not been investigated.

  • Gabapentin

    Several controlled and preliminary studies showed that multiple drug therapy for seizures results in dramatic reductions in blood carnitine levels.128 , 129 , 130 Further controlled research is needed to determine whether children taking anticonvulsants might benefit by supplementing with L-carnitine, since current studies yield conflicting results. For example, one controlled study indicated that children taking valproic acid and carbamazepine received no benefit from supplementing with L-carnitine.131 However, another small study revealed that children taking valproic acid experienced less fatigue and excessive sleepiness following L-carnitine supplementation.132 Despite the lack of well-controlled studies, individuals who are taking anticonvulsants and experiencing side effects might benefit from supplementing with L-carnitine.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Phenobarbital

    One controlled study showed that taking phenobarbital resulted in reduced blood levels of L-carnitine.133 Further research is needed to determine whether people taking phenobarbital might benefit from supplemental L-carnitine. Based on the currently available information, some healthcare practitioners may recommend monitoring L-carnitine blood levels or supplementing with L-carnitine.

  • Valproate

    Valproic acid causes depletion of carnitine in children,134 and blood carnitine levels are often low in people taking valproic acid for long periods of time. While there have been several case reports of valproic acid-related carnitine deficiency causing abdominal pain in children, there is controversy about the need for carnitine supplements in children taking valproic acid.135 , 136 , 137

    Complete disappearance of severe valproic acid-induced abdominal pain was achieved in one child with intractable epilepsy immediately following the introduction of 300 mg per day of L-carnitine .138 Carnitine supplementation (50 mg per 2.2 pounds of body weight) has protected children from valproic acid-induced increases in blood ammonia levels in some research,139 though other published work has questioned whether the depletion of carnitine and the increase in blood ammonia levels (both caused by valproic acid) are actually related to each other.140 This last report found that the depletion of carnitine was significantly more severe when epileptics were taking valproic acid together with other anti-seizure medications. A double-blind, crossover study found that carnitine supplementation (100 mg per 2.2 pounds of body weight) was no more effective than placebo in improving the sense of well-being in children treated with valproic acid.141 To date, the question of whether carnitine supplementation is beneficial for people taking valproic acid remains unresolved.142 However, a panel of pediatric neurologists and experts on L-carnitine supplementation strongly recommended oral L-carnitine supplementation for all infants and children taking valproic acid, as well as for adults with carnitine deficiency syndromes, people with valproic acid-induced liver and kidney toxicity, people on kidney dialysis, and premature infants on total parenteral nutrition (intravenous feeding). The panel recommended an amount of 100 mg per 2.2 pounds of body weight per day, up to a maximum of 2 grams per day.143

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Side Effects

At the time of writing, there were no well-known side effects caused by this supplement.

References

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82. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

83. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

84. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

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86. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

87. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

88. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

89. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

90. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

91. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

92. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

93. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

94. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

95. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

96. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

97. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

98. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

99. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

100. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

101. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

102. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

103. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

104. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

105. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

106. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

107. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

108. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

109. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

110. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

111. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

112. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

113. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

114. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

115. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

116. Malaguarnera M, Vacante M, Giordano M, et al. L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-alpha 2b plus ribavirin. World J Gastroenterol 2011;17:4414–20.

117. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

118. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

119. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

120. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

121. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

122. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

123. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

124. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

125. Freeman JM, Vining EP, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

126. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

127. Camina F, Novo-Rodriguez MI, Rodriguez-Segade S, Castro-Gago M. Purine and carnitine metabolism in muscle of patients with Duchenne muscular dystrophy. Clin Chim Acta 1995;243:151–64.

128. Hiraoka A, Arato T, Tominaga I. Reduction in blood free carnitine levels in association with changes in sodium valproate (VPA) disposition in epileptic patients treated with VPA and other anti-epileptic drugs. Biol Pharm Bull 1997;20:91–3.

129. Morita J, Yuge K, Yoshino M. Hypocarnitinemia in the handicapped individuals who receive a polypharmacy of antiepileptic drugs. Neuropediatrics 1986;17:203–5.

130. Hug G, McGraw CA, Bates SR, Landrigan EA. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbitol, valproic acid, phenytoin and carbamazepine in children. J Pedr 1991;119:799–802.

131. Freeman JM, Vining EPG, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications?: A double-blinded, crossover study. Pediatrics 1994;93:893–5.

132. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

133. Castro-Gago M, Eiris-Punal J, Novo-Rodriquez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546–9.

134. Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211–4.

135. Castro-Gago M, Camina F, Rodriguezx-Segade S. Carnitine deficiency caused by valproic acid. J Pediatr 1992;120:496 [letter].

136. Hirose S, Mitsudome A, Yasumoto S, et al. Valproate therapy does not deplete carnitine levels in otherwise healthy children. Pediatrics 1998;101:E9.

137. Stanley CA. Carnitine disorders. Adv Pediatr 1995;42:209–42.

138. Shuper A, Gutman A, Mimouni M. Intractable epilepsy. Lancet 1999;353:1238.

139. Gidal BE, Inglese CM, Meyer JF, et al. Diet-and valproate-induced transient hyperammonemia: Effect of L-carnitine. Pediatr Neurol 1997;16:301–5.

140. Verotti A, Greco R, Morgese G, Chiarelli F. Carnitine deficiency and hyperammonemia in children receiving valproic acid with and without other anticonvulsant drugs. Int J Clin Lab Res 1999;29:36–40.

141. Freeman JM, Vining EPG, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications? A double-blinded, crossover study. Pediatrics 1994;93:893–5.

142. Kelley RI. The role of carnitine supplementation in valproic acid therapy. Pediatrics 1994;93:891–2 [editorial].

143. De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: current perspectives. Epilepsia 1998;39:1216–25.

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