Levocarnitine

Administration

• Type: amino-acid derivative, Antidote
• Dosage Forms: IV, tablet, oral solution
• Routes of Administration: IV, oral
• Common Trade Names:

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:
• 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

See Also

• Antidotes
• Valproic acid toxicity
• Inborn errors of metabolism

References

Authors

Claire