Adult Dosing
Secondary carnitine deficiency
- 50 mg/kg slow IV as a 2-3 mins bolus injection or infusion
Severe metabolic carnitine crisis
- Loading dose: 50 mg/kg as a 2-3 mins bolus injection or infusion
- Maintenance dose: 50 mg/kg IV div q3-4 hrs
- Max: 300 mg/kg/day
Note: Obtain plasma carnitine levels before the initiation of parenteral therapy
ESRD Patients on Hemodialysis
- Start: 10-20 mg/kg dry body wt as a 2-3 min bolus injection after each dialysis session
- Give IV therapy if plasma levocarnitine concentrations are <40-50 micromol/L (below normal); reduction in dose is made as early as the third or fourth week of therapy
Pediatric Dosing
Secondary carnitine deficiency
- 50 mg/kg slow IV as a 2-3 mins bolus injection or infusion
Severe metabolic carnitine crisis
- Loading dose: 50 mg/kg as a 2-3 mins bolus injection or infusion
- Maintenance dose: 50 mg/kg IV div q3-4 hrs
- Max: 300 mg/kg/day
Note: Obtain plasma carnitine levels before the initiation of parenteral therapy. May add 10-20 mg/kg/day IV to TPN for premature and term neonates
ESRD Patients on Hemodialysis
- Start: 10-20 mg/kg dry body wt; 2-3 min bolus injection after each dialysis session
- Give IV therapy if plasma levocarnitine concentrations are <40-50 micromol/L (below normal); reduction in dose is made as early as the third or fourth week of therapy
[Outline]
Renal Dose Adjustment
ESRD Patients on Hemodialysis
- Start: 10-20 mg/kg dry body wt as a 2-3 min bolus injection after each dialysis session
- Give IV therapy if plasma levocarnitine concentrations are <40-50 micromol/L (below normal); reduction in dose is made as early as the third or fourth week of therapy
Hepatic Dose Adjustment
- Hepatic dose adjustments not defined
- Chronic administration of high doses in patients with ESRD/severely compromised renal function may result in accumulation of the potentially toxic metabolites
- Obtain plasma carnitine level prior to start of treatment
- Closely monitor for hematologic changes, vital signs, plasma carnitine concentrations and overall clinical condition during the treatment
Cautions: Use cautiously in
- Renal insufficiency
- Hx of seizures
Pregnancy Category:B
Breastfeeding: Safety unknown, use with caution. The concentration of levocarnitine increases in the breastmilk of cows following administration. Any risks to the child due to excess carnitine intake should be weighed against the benefits of supplementation to the mother. Manufacturer recommends discontinuation of breastfeeding, or postponing of treatment (based on risk benefit assessment)
