Parenteral Manual

Levocarnitine (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Carnitor
Classification: 
Carnitine replenisher
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • Treatment of primary systemic carnitine deficiency.
  • Acute and chronic treatments of patients with an inborn error of metabolism, which results in a secondary carnitine deficiency.
  • Prevention and treatment of carnitine deficiency in hemodialysis patients.
  • TPN supplementation in neonates/infants with little or no enteral intake.
  • Prophylaxis and treatment of valproate-associated hepatotoxicity.
Reconstitution and Stability: 
  • Available as 200 mg/mL vials.  Store at room temperature
  • Stable in TPN for up to 24 hours in PVC plastic bags at room temperature
Compatibility: 

- Solution Compatible:  NS, lactated ringer's up to a concentration of 8 mg/mL

- Additive/Above Cassette Compatible: TPN (amino acids/dextrose)

- Y-site Compatible: TPN (amino acids/dextrose)

- Incompatible: no information

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct YES
Usual dilution: 200 mg/mL
Infusion time: 2-3 minutes
IV Intermittent Infusion

YES
Usual dilution: 5 mg/mL
Infusion time: 10-15 minutes
IV Continuous Infusion YES: may be added to TPN and infused as per TPN rate
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatrics: 
- Carnitine deficiency (metabolic aciduria):

  • 50 mg/kg bolus followed by:
    - 50 mg/kg/day as a continuous infusion  OR
    -     50 mg/kg/day divided Q4-6H.  Increase as needed to 300 mg/kg/day

- Hemodialysis: 5-20 mg/kg/dose following dialysis

- TPN supplementation: 10-20 mg/kg/day

- Valproate-associated hepatotoxicity:

  • Treatment: 150-500 mg/kg/day (Maximum: 3 g/day)
  • Prophylaxis:  15-100 mg/kg/day (Maximum: 100 mg/kg/day)

Adults:
- Carnitine deficiency:

  • Initial dose: 50 mg/kg given IV push or by infusion followed by a daily dose
  • Daily dose:  50 mg/kg given in divided doses Q 3-4 hours
  • Maximum dose:  300 mg/kg

- Hemodialysis patients :

  • 5-20 mg/kg after each dialysis session
Potential hazards of parenteral administration: 
  • Seizures
  • Transient nausea and vomiting, gastritis, body odor
Notes: 
  • Plasma carnitine concentration should be obtained prior to beginning therapy; weekly and monthly monitoring of blood chemistries, vital signs and plasma carnitine concentrations is recommended

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