l O F O S T I N (Levocarnitine)

Levocarnitine is used to address disorders of carnitine metabolism and to support fatty‑acid oxidation.

• Primary carnitine deficiency: restores intracellular carnitine levels to improve energy production.
• Secondary carnitine deficiency: compensates for loss of carnitine due to renal disease, dialysis, or certain medications.
• Support of fatty acid metabolism: enhances β‑oxidation in conditions where fatty‑acid utilization is impaired.
• Metabolic disorders with impaired fatty‑acid oxidation: assists in maintaining normal metabolic function.

• Levocarnitine acts as a carrier molecule that transports long‑chain fatty acids across the inner mitochondrial membrane. By forming acyl‑carnitine esters, it enables the fatty acids to enter the mitochondrial matrix where they undergo β‑oxidation, producing acetyl‑CoA for the citric acid cycle and ATP generation. This facilitates efficient energy production, particularly in tissues reliant on fatty‑acid metabolism such as heart and skeletal muscle.

Oral levocarnitine is generally well tolerated, but some users may experience adverse reactions.

Common Side Effects

• Nausea: mild stomach upset.
• Diarrhea: loose stools.
• Headache: mild headache.
• Metallic taste: temporary taste change.

Serious or Rare Side Effects

• Hypersensitivity reaction: rash, itching, or swelling.
• Muscle weakness: unexplained loss of strength.
• Cardiac arrhythmia: abnormal heart rhythm.

When considering levocarnitine therapy, several precautions should be observed to ensure safe use.

• Assess renal function: dosage may need adjustment in patients with impaired kidney function.
• Monitor carnitine levels: periodic measurement helps guide therapy effectiveness.
• Evaluate for metabolic disorders: confirm diagnosis of primary or secondary deficiency before initiating.
• Use with caution in pregnancy: limited data, weigh potential benefits against risks.
• Avoid in known hypersensitivity: discontinue if allergic reaction occurs.
• Store at ambient temperature: keep below 25 °C, in the original packaging, protected from moisture.

Levocarnitine may interact with certain medicines, affecting its absorption or activity.

Major Interactions (Avoid)

• Valproic acid: can reduce plasma carnitine concentrations, potentially diminishing efficacy.
• Certain antibiotics (e.g., cefoperazone): may increase risk of carnitine depletion.

Moderate Interactions (Monitor Closely)

• Dialysis fluids: may remove levocarnitine, requiring supplemental dosing.
• Anticonvulsants (e.g., phenobarbital): may enhance carnitine metabolism.
• High‑dose zinc supplements: can interfere with carnitine absorption.