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L-Carnitine transports long-chain fatty acids across the inner mitochondrial membrane for beta-oxidation, which is the primary energy source for cardiac and skeletal muscle. It also removes toxic acyl groups from mitochondria (as acylcarnitines), protecting mitochondrial function. Deficiency impairs energy metabolism and can lead to cardiomyopathy, muscle weakness, and fatty liver.
Commercial L-carnitine injection (Carnitor) is available but expensive. Compounding pharmacies prepare L-carnitine at more accessible price points, in combination with other IV nutrients, and in formulations optimized for IM injection at outpatient clinics.
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Carnitine deficiency is common in patients on hemodialysis (kidneys normally synthesize carnitine), valproic acid therapy, and certain metabolic disorders. Integrative medicine uses injectable carnitine for chronic fatigue, fibromyalgia, cardiac support, and weight management protocols. The acetyl-L-carnitine form (ALCAR) has additional CNS effects and is sometimes used for cognitive support.
Carnitine deficiency (dialysis, genetic, drug-induced), cardiac support and cardiomyopathy, chronic fatigue and fibromyalgia, metabolic support, athletic performance recovery, male fertility (sperm motility).
Deficiency/dialysis: 1–3g IV or IM 3 times weekly post-dialysis. Metabolic/integrative therapy: 500mg–2g IM or IV, 1–3 times weekly. Cardiac: 1–2g daily IV or IM per physician protocol.
Generally well tolerated. GI symptoms (nausea, vomiting) possible especially with higher doses. Fishy body odor from TMAO production (especially with D,L-carnitine—use L-carnitine to minimize). Seizure risk in patients with history of seizures (case reports).
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