Nurses Compass
Drug Guide
Levocarnitine
Classification
Therapeutic: Nutritional supplement / Amino acid metabolism modifier
Pharmacological: Carnitine analog, Acyl-CoA dehydrogenase substrate
FDA Approved Indications
- Treatment of primary systemic carnitine deficiency
- Secondary carnitine deficiency (e.g., resulting from inborn errors of metabolism, dialysis, or certain medications)
Mechanism of Action
Levocarnitine facilitates the transport of long-chain fatty acids into mitochondria for beta-oxidation, thus aiding in energy production, and helps to remove accumulated acyl groups in cases of deficiency or toxicity.
Dosage and Administration
Adult: Typically 50-100 mg/kg/day divided into 2-4 doses; doses may vary based on indication and clinical response.
Pediatric: Dose is usually 50-100 mg/kg/day divided into 2-4 doses, adjusted based on weight and response.
Geriatric: No specific dose adjustment unless renal or hepatic impairment is present.
Renal Impairment: Adjust dose based on severity of renal impairment; cautious use recommended.
Hepatic Impairment: Use with caution; no specific guidelines established.
Pharmacokinetics
Absorption: Good oral absorption.
Distribution: Widely distributed in tissues, especially muscle and heart.
Metabolism: Minimal hepatic metabolism.
Excretion: Renal excretion of unchanged drug.
Half Life: Approximately 17 hours in healthy individuals.
Contraindications
- Hypersensitivity to levocarnitine.
Precautions
- Caution in patients with renal impairment, as clearance may be reduced.
- Use with caution in hepatic impairment.
- Monitor for potential hypersensitivity reactions.
Adverse Reactions - Common
- Gastrointestinal disturbances (nausea, vomiting, diarrhea) (Common)
- Body odor and skin odor (Less common)
Adverse Reactions - Serious
- Allergic reactions including rash, urticaria, and anaphylaxis (Rare)
- Seizures (in overdose or when administered with other medications lowering seizure threshold) (Rare)
Drug-Drug Interactions
- Valproic acid – may enhance risk of seizures or alter levocarnitine levels
Drug-Food Interactions
- No significant interactions reported
Drug-Herb Interactions
- Limited data; consult clinical guidance
Nursing Implications
Assessment: Monitor for signs of deficiency, adverse reactions, and efficacy (improvement in symptoms).
Diagnoses:
- Impaired nutritional status
- Risk for hypersensitivity reactions
Implementation: Administer as prescribed; monitor serum levels if indicated; monitor renal function.
Evaluation: Assess for improvement in energy metabolism and reduction of symptoms related to deficiency.
Patient/Family Teaching
- Take levocarnitine exactly as prescribed.
- Report any signs of allergic reactions or unusual body odor.
- Maintain regular follow-up appointments to monitor treatment response.
Special Considerations
Black Box Warnings: N/A
Genetic Factors: Consider genetic testing in cases of suspected primary carnitine deficiency.
Lab Test Interference: May alter serum lipid profiles; interpret with clinical context.
Overdose Management
Signs/Symptoms: Nausea, vomiting, diarrhea, hypoglycemia, potential seizures
Treatment: Supportive care; dialysis in severe cases; no specific antidote.
Storage and Handling
Storage: Store at room temperature between 20-25°C (68-77°F), protected from light.
Stability: Stable for the duration of the labeled shelf life when stored properly.