Levocarnitine
Administration
- Type: amino-acid derivative, Antidote
- Dosage Forms: Capsule 250mg, 330mg; Solution (PO) 1g/10mL; Solution (IV) 200mg/mL
- Routes of Administration: IV, oral
- Common Trade Names: Carnitor
Adult Dosing
- Valproic acid toxicity: 100mg/kg IV bolus, followed by 50mg/kg Q8h or alternatively 50mg/kg/day IV in 3 divided doses
- Primary carnitine deficiency: 990mg tablet or 1g solution PO 1-3 times per day
- Carnitine deficiency due to inborn error of metabolism
- Initial: 50 mg/kg (max 300mg) IV bolus, repeat daily PRN
- Severe metabolic crisis: 50 mg/kg IV (max 300mg) IV bolus, then repeat 50mg/kg IV over 24h in divided doses. Repeat 50mg/kg IV daily PRN.
- 990mg tablet or 1g solution PO 1-3 times per day
- Carnitine deficiency due to ESRD: 10 to 20 mg/kg (dry weight) after HD, subsequent dosing determent by pre-HD levels of levocarnitine
Pediatric Dosing
- IV dosing: same as adult dosing
- PO dosing: 50 mg/kg PO
Special Populations
- Pregnancy Rating: B
- Lactation risk: Infant risk cannot be ruled out
- Renal dosing: dosing not established, may be more prone to accumulation of toxic metabolites
- Hepatic dosing: no adjustment
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Seizure
Common
- Nausea/vomiting, diarrhea, stomach cramps
Pharmacology
- Half-life: 17.4h
- Metabolism: Hepatic
- Excretion: Mostly renal
Mechanism of Action
- Amino-acid found normally in humans: facilitates entry of long-chain fatty acids into cellular mitochondria
- Increases valproate metabolism