The therapy with valproic acid, the nuceloside analogues and pivapicillin, pivmecillinam., pivcephalexin, didanosine, zalcitabine and stavudine may produce secondary L-carnitine deficiencies.

Choline supplementation may lead to increased L-carnitine retension. Vitamin C deficiency may lead to secondary L-carnitine deficiency.

CHF Diabetic cardiomyopathy Sytemic carnitine deficiency

Mild gastrointestinal symptoms have been reported in those taking oral L-carnitine, including transcient nausea and vomiting, abdominal cramps, and diarrhea. Mild myasthenia has ben reported in uremic patients taking racemic mixture D,L-carnitine.

There are no reports of mild myasthnia inuremic patients receiving L-carnitine. Supplemental L-carnitine is generally welltolerated. Although the incidence is low seizures have been reported to occur in those with with or without pre-existning seizure disorders receiving either oral or interavenous L-carnitine. In those with pre-existing seizure activity, an incrase in seizure frequency and/or severity has been reported.

None reported Special precautions- There are no adequate and studies in pregnant woman. It is not known whether L-carnitine is excreted in human milk.

Those with seizure disorders should only use L-carnitine under medical advice and supervision.

Sytemic carnitine deficiency

Dosage-

50mg/kg given in slow , 2-3 minutes bolus injection or infusion

LEVOCARNITINE-

1.Allergy- Tell your doctor ifyouare allergic to any substances, such as food, presrvatve,dyestuff

2. Pregnancy- Not studied in humans. Levocarnitine has not shown to cause birth defects or other problems in animal studies

3. Breast feeding- Not known whether levocarnitine passes into breast milk. Carnitine is present in breast milk even in women not taking supplements because it is obtained from diet.

4. Children- No specific information comparing useoflevocarnitine with use inoterage groups . The dietary supplement not expected to cause different side effects or problems in children than it does in adults.

5. Older adults- Nospecific information ofuse of levecarnitine in elderly. Not expected to cause differn side effects or problems in older people than it does in younger adults

6. Other medicines- Tell your doctor if you are taking any other prescription or OTC drugs

7. Missed dose- If you miss of this medicine take it as soon as possible. However, it is almost time for the next dose, skip the missed dose and go back to normal schedule. Do not double doses.

8. Storage- Keep the medicines our of reach of children Store the medicines away heat and direct light Do not store tablets or capsules in the bath room, in damp places near the kitchen sink Heat and moisture cause the medicines to break down Store the oral solution form of thismedicine from freezing. Do not refrigerate Do not store out dated medicines or medicines no longer needed. Make sure that all discared medicines are kept out of reach of children

Pharmacology-

L-Carnitine is a naturally occuring substance required in mamamalian energy metabolism. it has been shown to facilitate long- chain fatty acid entry into cellular mitochondria, thereby delivering substrate for oxidation and subsuquent enery production. The functions of L-carnitine include transport of long chain fatty acids across the mitochondrial membranes into the mitochondia and transport of small chain and medium chain fatty acids out of mitrochonria. In order to, among other things maintain normal coenzyme carnitine/acylcarnitine translocase (CT) transports acylcarnitine across the inner mitochondrial membranes.

Pharmacokinetics

About 60 to 75% of L-carnitine from food is absorbed. Percentage absorbed from supplements appears to be lower The biovailability of oral L-carnitine is about 15%. L-carnitine is not bound to plasma protein or albumin.

About 60 to 75% of L-carnitine from food is absorbed.

There are no adequate and studies in pregnant woman. It is not known whether L-carnitine is excreted in human milk. Those with seizure disorders should only use L-carnitine under medical advice and supervision.