L-Carnitine

Name	L-Carnitine
Uses	Amino acid derivative used to support fat metabolism by transporting fatty acids into mitochondria for energy production. Commonly used in wellness IVs for weight management, metabolic support, athletic performance, and recovery.
Route Of Administration	Intravenous (IV)
Frequency Of Use	Typically administered once weekly for general metabolic support. In weight management or performance protocols, may be given up to twice weekly for 4 to 6 weeks, followed by reassessment. Long-term use should be reviewed every 8 to 12 weeks.
Concentration(s)	Common compounded concentrations range from 100 mg/mL to 200 mg/mL.
Maximum Dosage (Day, Wk) (g/mL)/mL	Maximum dose per infusion: 1,000 mg (1 g). Maximum weekly dose: 2,000 mg (2 g). Higher doses are not recommended for elective wellness patients due to increased risk of side effects such as nausea and gastrointestinal upset.
Contraindications	Severe renal impairment or dialysis dependency (risk of accumulation and toxicity). Known hypersensitivity to L-carnitine or any component of the formulation. Active seizure disorder (may lower seizure threshold). Severe hepatic impairment. Pregnancy and breastfeeding unless specifically cleared by OB provider.
Possible Side Effects	Nausea, vomiting, or abdominal cramping during or after infusion. Flushing, dizziness, or unpleasant 'fishy' body odor. Headache. Injection site irritation. Rare: allergic reactions (rash, itching, hypersensitivity).
Compatibility With Other Drugs	Compatible with normal saline and D5W. Should not be mixed directly with calcium-containing solutions. Can be combined with B vitamins or amino acids in wellness IVs, but compatibility must always be verified when mixing.
Allergies	True allergy to L-carnitine is rare. Reactions are more likely related to preservatives or stabilizers in compounded formulations.
Administration Time	Typical infusion time: 30 to 45 minutes for doses up to 1,000 mg. Slower infusion may improve tolerability in sensitive patients.
IV Dosing	For metabolic support and weight management: 500 mg to 1,000 mg IV once weekly. For athletic recovery or performance enhancement: 500 mg to 1,000 mg IV once or twice weekly for 4 to 6 weeks, followed by reassessment. Long-term use requires periodic clinical review.
IM/Push	May be given as a slow IV push for doses up to 500 mg over 5 to 10 minutes. Higher doses should be given via drip for better tolerability. IM administration is possible but less preferred due to injection site pain and variability in absorption.
What To Do If Adverse Reaction Occurs	1. Stop the infusion immediately. 2. Assess vital signs (blood pressure, heart rate, oxygen saturation). 3. If nausea, flushing, or dizziness occurs, place the patient in a comfortable position and administer oral fluids if tolerated. 4. For allergic reactions (rash, itching, shortness of breath), administer antihistamines and consider epinephrine if severe. 5. If symptoms persist or worsen, arrange for emergency transfer to a higher level of care (call 911 if necessary).