部份中文左卡尼汀处方资料（仅供参考）
通用名称：左卡尼汀
英文名称：Levocarnitine
成份: 左卡尼汀
药理毒理
左卡尼汀是哺乳动物能量代谢中必需的体内天然物质,其主要功能是促进脂类代谢。在缺血、缺氧时,脂酰-CoA堆积,线粒体内的长链脂酰卡尼汀也堆积,游离卡尼汀因大量消耗而降低。缺血、缺氧导致ATP水平下降,细胞膜和亚细胞膜通透性升高,堆积的脂酰CoA可致膜结构改变,膜相崩解而导致细胞死亡。另外,缺氧时以糖无氧酵解为主,脂肪酸等堆积导致酸中毒,离子紊乱,细胞自溶死亡。足够量的游离卡尼汀可以使堆积的脂酰-CoA进入线粒体内,减少其对腺嘌呤核苷酸转位酶的抑制,使氧化磷酸化得以顺利进行。左卡尼汀是肌肉细胞尤其是心肌细胞的主要能量来源,脑、肾等许多组织器官亦主要靠脂肪酸氧化供能。卡尼汀还能增加NADH细胞色素C还原酶、细胞色素C氧化酶的活性、加速ATP的产生,参与某些药物的解毒作用。对于各种组织缺氧缺血,左卡尼汀通过增加能量产生而提高组织器官的供能。
左卡尼汀其他功能有:中等长链脂肪酸的氧化作用；脂肪酸过氧化物酶的氧化作用；对结合性辅酶A和游离辅酶A二者比率的缓冲作用；从酮类物质、丙酮酸、氨基酸(包括支链氨基酸)中产生能量,去除过高辅酶A的毒性,调节血中氨浓度。
致突变试验表明:用组胺酸缺陷型鼠伤寒沙门氏菌,啤酒酵母菌和繁殖酵母菌没有发现左卡尼汀致突变。用以评价该化合物致癌作用的长期动物试验尚未进行。
生殖力毒性研究表明,对大鼠和兔子给予人的剂量的3.8倍,本品对胎儿繁殖力无损害或毒性。
药代动力学
一次口服0.5g,健康受试者血浆最大浓度为48.5μmol/L。单一口服或静脉给予左卡尼汀0.5-2g,对健康受试者,其生物半衰期为2-15小时。左卡尼汀不与血浆蛋白结合。
左卡尼汀的排泄途径取决于给药的途径,静脉注射12小时内从尿中回收大约70%,24小时内大约80%。口服给药,尿中回收10%。
适应症
用于防治左卡尼汀缺乏。如慢性肾衰病人因血透析所致的左卡尼汀缺乏；改善心肌缺血,抗心绞痛等。临床表现如心肌病、骨骼肌病(痛)、心律失常、高脂血症,以及低血压和透析中肌痉挛等。
规格
口服溶液：10ml:1g
片剂：330mg
用法用量
口服,用餐时服用。
成人每日1-3g,分1-3次服用；
儿童起始剂量每公斤体重50mg,根据需要和耐受性缓慢加大剂量,通常剂量为每公斤体重50-100mg(最大剂量一天不超过3g)。
任何疑问，请遵医嘱!
不良反应
偶有口干、胃肠道轻度不适,停药后可自行消失。
禁忌
对本品过敏者禁用。
注意事项
用胰岛素或口服降糖药物治疗的糖尿病患者,由于改善葡萄糖的利用,在服用本品时,可能引起低血糖现象,因此,这些患者在接受治疗中血糖应当保持在经常控制的数值以内。
本品含有少量乙醇,对乙醇过敏的病人慎用。
孕妇及哺乳期妇女用药
妊娠期间,只有在明显需要时才使用本剂。尚不清楚这种药是否能进入母乳,应根据该药对母亲的重要性,决定是停止哺乳还是停止用药。
药物过量
目前尚无左卡尼汀过量毒性方面的报导,口服左卡尼汀小鼠LD50为19.2g/kg,左卡尼汀可引起腹泻,过量时可进行辅助治疗,需小心护理。
CARNITOR(levocarnitine)
INDICATIONS
CARNITOR®(levocarnitine)Tablets, Oral Solution, and Sugar-Free Oral Solution are indicated for the treatment of primary systemic carnitine deficiency.
CARNITOR®(levocarnitine)Injection is indicated for the prevention and treatment of carnitine deficiency in patients with end stage renal disease who are undergoing dialysis.
CARNITOR®(levocarnitine) Injection, Tablets, Oral Solution, and Sugar-Free Oral Solution are also indicated for the acute and chronic treatment of patients with an inborn error of metabolism which results in secondary carnitine deficiency.
IMPORTANT SAFETY INFORMATION
Contraindications
None known.
Warnings
CARNITOR®(levocarnitine)Tablets, Oral Solution, and Sugar-Free Oral Solution
Hypersensitivity Reactions
Serious hypersensitivity reactions, including rash, urticaria, and facial edema have been reported with oral CARNITOR®. Other serious hypersensitivity reactions, including anaphylaxis, laryngeal edema, and bronchospasm have been reported following intravenous levocarnitine administration, mostly in patients with end stage renal disease undergoing dialysis.
Discontinue use of CARNITOR® and instruct patients to seek medical attention if they experience symptoms suggestive of a hypersensitivity reaction.
CARNITOR® (levocarnitine) Injection
Hypersensitivity Reactions
Serious hypersensitivity reactions, including anaphylaxis, laryngeal edema, and bronchospasm have been reported following CARNITOR® administration, mostly in patients with end stage renal disease who are undergoing dialysis. Some reactions occurred within minutes after intravenous administration of CARNITOR®.
If a severe hypersensitivity reaction occurs, discontinue CARNITOR® treatment and initiate appropriate medical treatment. Consider the risks and benefits of re-administering CARNITOR® to individual patients following a severe reaction. If the decision is made to re-administer the product, monitor patients for a reoccurrence of signs and symptoms of a severe hypersensitivity reaction.
Precautions
General
The safety and efficacy of oral levocarnitine has not been eva luated in patients with renal insufficiency. Chronic administration of high doses of oral levocarnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine (TMA) and trimethylamine-N-oxide (TMAO), since these metabolites are normally excreted in the urine.
CARNITOR® (levocarnitine) Oral Solution and CARNITOR® SF (levocarnitine) Sugar-Free Oral Solution are for oral/internal use only.
Drug Interactions
Reports of INR increase with the use of warfarin have been observed. It is recommended that INR levels be monitored in patients on warfarin therapy after the initiation of treatment with levocarnitine or after dose adjustments.
Carnitor®(levocarnitine) Tablets, Oral Solution, and Sugar-Free Oral Solution - Not for parenteral use
Gastrointestinal reactions may result from a too rapid consumption of carnitine. CARNITOR® (levocarnitine) Oral Solution and CARNITOR® SF (levocarnitine) Sugar-Free Oral Solution may be consumed alone, or dissolved in drinks or other liquid foods to reduce taste fatigue. They should be consumed slowly and doses should be spaced evenly throughout the day to maximize tolerance.
ADVERSE REACTIONS
Neurologic Reactions:Seizures have been reported to occur in patients, with or without pre-existing seizure activity, receiving either oral or intravenous levocarnitine. In patients with pre-existing seizure activity, an increase in seizure frequency and/or severity has been reported.
Carnitor® (levocarnitine) Tablets, Oral Solution, and Sugar-Free Oral Solution
The following adverse reactions associated with the use of oral formulations of levocarnitine were identified in clinical trials or postmarketing reports. Because these reactions were reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency, reliability, or to establish a causal relationship to drug exposure.
Gastrointestinal Reactions:Various mild gastrointestinal complaints have been reported during the long-term administration of oral L- or D,L-carnitine; these include transient nausea and vomiting, abdominal cramps, and diarrhea. Gastrointestinal adverse reactions with CARNITOR® (levocarnitine) Oral Solution or CARNITOR® SF (levocarnitine) Sugar-Free Oral Solution dissolved in liquids might be avoided by a slow consumption of the solution or by a greater dilution. Decreasing the dosage often diminishes or eliminates drug-related patient body odor or gastrointestinal symptoms when present. Tolerance should be monitored very closely during the first week of administration, and after any dosage increases.
Musculoskeletal Reactions:Mild myasthenia has been described only in uremic patients receiving D,L-carnitine.
Hypersensitivity Reactions:Rash, urticaria, and facial edema have been reported with oral CARNITOR® (see WARNINGS).
Carnitor® (levocarnitine) Injection
Gastrointestinal Reactions:Transient nausea and vomiting have been observed. Less frequent adverse reactions are body odor, nausea, and gastritis. An incidence for these reactions is difficult to estimate due to the confounding effects of the underlying pathology.
Hypersensitivity Reactions:Anaphylaxis, laryngeal edema and bronchospasm (see WARNINGS).
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cf801cc4-775e-433d-9d32-e5d9a98981d3