Medications That May Deplete PROPIONYL-L-CARNITINE
See which medications carry a reported association, how strong the evidence is, and what to discuss with your pharmacist.
Propionyl-l-carnitine is a form of the amino acid derivative carnitine that the body uses to help turn fat into energy, and it is studied mostly for circulation problems like peripheral artery disease. Some evidence suggests it may help walking distance in people with poor leg circulation, but results are mixed and it is not a substitute for standard medical care. Talk to a pharmacist or doctor before using it, especially if you have a medical condition or take other medicines.
Commonly used for: Peripheral artery disease and leg pain, Heart and circulation support, Energy and exercise performance, Erectile dysfunction, Diabetic nerve pain.
HelloPharmacist pharmacist-reviewed education. The medication records below are licensed clinical data, shown as published.
Deep dive: Propionyl-l-carnitine — uses, safety & drug interactions
Medications associated with PROPIONYL-L-CARNITINE depletion
Each record is shown as published in our licensed clinical database. Open a medication for its full nutrient report.
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Adefovir
Insignificant DepletionBrand names include Hepsera
Adefovir pivoxil is a prodrug which is converted to adefovir and pivalate in the body. Pivalate combines with carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of propionyl-L-carnitine could also be increased. Adefovir was formerly used for HIV infection at doses of 125-500 mg daily and was associated with significant dose- and duration-related decreases in blood carnitine. After 12 weeks of therapy with 125-250 mg daily, decreases of 42% to 62% were seen, while 500 mg daily was associated with a 66% decrease in L-carnitine after 2 weeks. Some studies used a supplement of L-carnitine 500 mg daily during adefovir therapy. Adefovir is now used at a lower dose of 10 mg daily for treatment of hepatitis B. There are no reports of significant reductions in carnitine blood levels at this dose, and supplements are not necessary.
Propionyl-L-carnitine is a form of carnitine, a compound your muscles and heart use to convert fat into energy. When your body processes adefovir, it produces a byproduct called pivalate, and pivalate latches onto carnitine and pulls it out through the urine. At the low 10 mg daily dose now used for hepatitis B, though, this effect appears to be very small, and no meaningful drops in carnitine levels have been reported at this dose. Most people taking adefovir at this dose do not need to worry about or do anything about this, but feel free to mention it to your pharmacist or doctor if you have questions.
References (5)
- Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. PubMed
- Deeks SG, Collier A, Lalezari J, et al. The safety and efficacy of adefovir dipivoxil, a novel anti-human immunodeficiency virus (HIV) therapy, in HIV-infected adults: a randomized, double-blind, placebo-controlled trial. J Infect Dis 1997;176:1517-23. PubMed
- Barditch-Crovo P, Toole J, Hendrix CW, et al. Anti-human immunodeficiency virus (HIV) activitiy, safety, and pharmacokinetics of adefovir dipivoxyl (9-[2-(bis-pivaloyloxymethyl)-phosphonylmethoxyethyl]adenine) in HIV-infected patients. J Infect Dis 1997;1
- Kahn J, Lagakos S, Wulfsohn M, et al. Efficacy and safety of adefovir dipivoxil with antiretroviral therapy. J Am Med Assoc 1999;282:2305-12.
- Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479-87.
Aprobarbital, Butabarbital, Phenobarbital
Insignificant DepletionBrand names include Triple Barbital
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. Some research has looked at whether barbiturates like phenobarbital might interfere with carnitine metabolism, possibly by affecting how the body processes or retains these compounds, but the studies done so far have pointed in different directions, with some showing a modest reduction and others finding no meaningful change. Given that this is rated as insignificant depletion, most people taking one of these medications are unlikely to need to worry about it. That said, if you have questions or any concerns about your nutrition while on this medication, your pharmacist or doctor is a great person to check in with.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Aprobarbital, Butabarbital, Phenobarbital →
Aspirin, Codeine Phosphate, Phenobarbital
Insignificant DepletionBrand names include Phenaphen
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, especially in muscle tissue. The phenobarbital component of this combination has been studied for a possible effect on carnitine levels, though the research is genuinely mixed: some studies found a modest reduction in certain patients, while others found no meaningful change at all. Given the insignificant rating here, this is not something most people taking this medication need to worry about. That said, if you have any concerns about your energy levels or nutrition, it is always worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Aspirin, Codeine Phosphate, Phenobarbital →
Atropine, Hyoscyamine, Phenobarbital
Insignificant DepletionBrand names include Hypnaldyne
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fats into energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some studies as possibly affecting carnitine levels in the blood, though other studies found no real change at all. Because the evidence is genuinely mixed and the overall rating here is insignificant, most people taking this medication are not expected to need any supplementation. That said, if you have questions about your nutritional status, your pharmacist or doctor is a good person to check in with.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Atropine, Hyoscyamine, Phenobarbital →
Atropine, Hyoscyamine, Phenobarbital, Scopolamine
Insignificant DepletionBrand names include Barbidonna No. 2, Belladonna Phenobarbital
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some studies as potentially lowering carnitine levels in the blood, though the research is genuinely mixed and other studies found no meaningful change at all. Given the conflicting data and an insignificant depletion rating, most people taking this medication are not expected to need any supplementation. That said, if you have specific concerns, your pharmacist or doctor is the right person to ask.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Atropine, Hyoscyamine, Phenobarbital, Scopolamine →
Atropine, Hyoscyamine, Scopolamine, Phenobarbital
Insignificant DepletionBrand names include Barbeloid, Donnatal #2, Donphen
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination medication has shown up in some research as a possible factor in lower carnitine levels, though the honest picture is mixed: other studies found no meaningful change at all. Given that the evidence is conflicting and the rating here is insignificant, most people taking this medication do not need to worry about supplementing. If you have any concerns, a quick conversation with your pharmacist or doctor can help you decide whether any monitoring makes sense for you personally.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Atropine, Hyoscyamine, Scopolamine, Phenobarbital →
Atropine, Phenobarbital
Insignificant DepletionBrand names include Anthrocol
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. Some research has found that phenobarbital may nudge levels slightly lower in certain patients, though the studies on this are mixed and other research found no meaningful change at all. The bottom line here is reassuring: routine supplementation is not considered necessary for most people on this medication. That said, if you have any concerns, your pharmacist or doctor is the right person to ask.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Belladona Extract, Phenobarbital
Insignificant DepletionBrand names include Chardonna-2
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your muscles and heart use to turn fat into usable energy. Some research has found that phenobarbital may be linked to lower carnitine levels in certain patients, possibly because the drug affects how the body processes these compounds, but other studies have found no real difference at all. Given those conflicting findings, routine supplementation is not considered necessary for most people on this medication. If you have any concerns, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital
Insignificant DepletionBrand names include Bellaphen-S, Spastrin, Phenarbal S
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some studies as possibly affecting carnitine levels in the blood, though other research found no meaningful change at all. Because the evidence is genuinely mixed and the overall rating here is insignificant, most people taking this medication are not expected to need any supplementation. That said, if you have concerns or take phenobarbital long-term, it is worth mentioning to your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Belladonna Alkaloids, Ergotamine Tartrate, Phenobarbital →
Belladonna Alkaloids, Phenobarbital
Insignificant DepletionBrand names include Barbidonna, Donnatal
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination has been studied for its potential effect on carnitine levels, though research has turned up mixed results: some studies found modest reductions in certain patients, while others found no meaningful change at all. Given that the evidence is conflicting and the overall rating here is insignificant, most people taking this medication do not need to worry about this or consider supplementing. If you have concerns, it is always worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Belladonna Alkaloids, Phenobarbital →
Belladonna Extract, Phenobarbital
Insignificant DepletionBrand names include Belap
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this medication has shown up in some research as possibly affecting carnitine levels in the blood, though the studies are genuinely mixed, with some finding a small reduction and others finding no change at all. Given that the evidence is conflicting and the rating here is insignificant, most people taking this medication are not expected to need any supplementation. That said, if you have questions about your nutritional status, your pharmacist or doctor is the right person to ask.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Belladonna Extract, Phenobarbital →
Belladonna, Ergotamine, Phenobarbital
Insignificant DepletionBrand names include Bellergal-S
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination may, in theory, interfere with how the body handles carnitine, though studies have gone back and forth on whether blood levels actually drop in a meaningful way. Given the insignificant rating here, most people taking this medication do not need to worry about this or consider a supplement. That said, if you have any concerns, a quick conversation with your pharmacist or doctor is always a reasonable step.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Belladonna, Ergotamine, Phenobarbital →
Belladonna, Phenobarbital
Insignificant DepletionBrand names include Bellophen, Susano
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fats into usable energy, particularly in muscle tissue. Some studies have noticed slightly lower carnitine levels in people taking phenobarbital, though other studies found no real difference at all, so the picture is genuinely mixed. Given that this is rated an insignificant depletion, routine supplementation is not considered necessary for most people. If you have been on phenobarbital long-term and have questions about your levels, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Bellafoline, Phenobarbital
Insignificant DepletionBrand names include Belladenal, Belladenal-S
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. Some research has found that phenobarbital may be linked to lower carnitine levels in certain patients, possibly because the drug affects how the body processes or clears these compounds, but other studies have found no meaningful difference at all. Given that the evidence is genuinely mixed and the rating here is insignificant, most people taking this medication do not need to worry about this or take a supplement. If you have any concerns, it is always reasonable to bring them up with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Butabarbital, Phenobarbital, Secobarbital
Insignificant DepletionBrand names include S.B.P.
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into energy, particularly in muscle tissue. Some research has found that phenobarbital (one of the barbiturates in this class) might nudge blood levels of carnitines a little lower, though the honest picture from the studies is mixed, with other research showing no meaningful change at all. Given the conflicting data and the insignificant rating here, most people taking these medications do not need to worry about supplementing this nutrient. If you have concerns, it is always worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Butabarbital, Phenobarbital, Secobarbital →
Butalbital, Phenobarbital, Secobarbital
Insignificant DepletionBrand names include Tribarb
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, especially in muscle tissue. Some research has looked at whether phenobarbital (one of the barbiturates in this group) might nudge carnitine levels downward, possibly by affecting how the body processes or holds onto it, but study results have gone back and forth with no clear answer. Given the insignificant rating, most people taking these medications are unlikely to have a meaningful concern here. If you are curious or have symptoms like unusual fatigue, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Butalbital, Phenobarbital, Secobarbital →
Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian
Insignificant DepletionBrand names include Nevrotose #3
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your muscles and heart use to convert fat into usable energy. The phenobarbital in this combination has shown up in some research as possibly linked to lower carnitine levels, though the studies on this are split, with others finding no real change at all. Given that the evidence is conflicting and the overall rating here is insignificant, most people taking this medication do not need to worry or make any changes. If you have specific concerns, a quick conversation with your pharmacist or doctor can help you sort out whether anything applies to your situation.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Camphor, Hyoscyamine, Passif, Phenobarbital, Scopolamine, Valerian →
Carbamazepine
Insignificant DepletionBrand names include Tegretol, Tegretol XR, Equetro
Data on the effect of carbamazepine on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients on the drug, while others have found no effect. Routine L-carnitine or propionyl-L-carnitine supplementation is not necessary. Preliminary data in patients treated with the related drug oxcarbazepine (Trileptal) suggest that it does not affect levels of carnitines.
Propionyl-L-carnitine is a compound your body uses to help convert fat into energy, and some research has looked at whether carbamazepine might interfere with how the body handles it. The studies are genuinely mixed, with some finding slightly lower levels in people on the drug and others finding no difference at all. Given that the evidence is conflicting and the rating is insignificant, most people taking carbamazepine do not need to worry about this or take a supplement. That said, if you have any concerns, your pharmacist or doctor is the right person to ask.
References (6)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25.
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
- Kurul S, Dirik E, Iscan A. Serum carnitine levels during oxcarbazepine and carbamazepine monotherapies in children with epilepsy. J Child Neurol 2003;18:552-4. PubMed
Cisplatin
Insignificant DepletionBrand names include Platinol-AQ
Increased urinary losses of L-carnitine can occur during cisplatin therapy. Cisplatin might increase L-carnitine mobilization due to tissue injury and reduce renal tubular reabsorption due to kidney injury. Theoretically, cisplatin may also increase losses of propionyl-L-carnitine. Deficiency of carnitines is unlikely in people who can maintain adequate dietary intake.
Propionyl-L-carnitine is a compound your muscles and heart use to turn fat into usable energy. Cisplatin can damage the kidneys, and because the kidneys normally recapture carnitine from urine, that injury may allow more of it to slip out of the body than usual. That said, this is listed as an insignificant depletion, meaning it is considered theoretical and most patients eating a normal diet are not expected to run low. No action is needed for most people, but if you have concerns about your diet or kidney function during cisplatin therapy, it is worth raising with your care team.
References (1)
- Heuberger W, Berardi S, Jacky E, et al. Increased urinary excretion of carnitine in patients treated with cisplatin. Eur J Clin Pharmacol 1998;54:503-8. PubMed
Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital
Insignificant DepletionBrand names include G.B.S.
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fats into usable energy, particularly in muscle tissue. Some research has found that phenobarbital, the anticonvulsant in this combination, may be linked to lower carnitine levels in certain patients, though the studies on this are genuinely mixed and no clear mechanism has been pinned down. Because the evidence is conflicting and the rating here is insignificant, most people taking this medication do not need to worry or add a supplement. If you have any concerns, your pharmacist or doctor is the right person to ask.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Dehydrocholic Acid, Homatropine Methylbromide, Phenobarbital →
Dicyclomine, Phenobarbital
Insignificant DepletionBrand names include Bentyl w/ Pb
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some studies as possibly affecting carnitine levels in the blood, though other studies found no real change at all, and the overall picture is conflicting. Given that rating of insignificant depletion, this is not something most people taking this medication need to worry about or act on. If you have any lingering concerns, a quick conversation with your pharmacist or doctor can give you peace of mind.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Dyphylline, Ephedrine, Guaifenesin, Phenobarbital
Insignificant DepletionBrand names include Lufyllin-EPG
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, particularly in muscle tissue. The phenobarbital in this combination has been looked at in a handful of studies to see whether it might interfere with how the body handles carnitines, though the results have been mixed, with some studies finding modest reductions and others finding no real change at all. Given that the evidence is conflicting and the rating is insignificant, most people taking this medication do not need to worry or do anything extra. If you have concerns, a quick chat with your pharmacist or doctor can put your mind at ease.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Dyphylline, Ephedrine, Guaifenesin, Phenobarbital →
Ephedrine, Guaifenesin, Phenobarbital, Theophylline
Insignificant DepletionBrand names include Mudrane GG
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some research as potentially affecting carnitine levels in the blood, though the studies are genuinely mixed, with some finding a small reduction and others finding no effect at all. Given that this is rated as an insignificant depletion, most people taking this medication are unlikely to have a real concern here, and routine supplementation is not considered necessary. If you are curious or have symptoms that worry you, it is always worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Ephedrine, Guaifenesin, Phenobarbital, Theophylline →
Ephedrine, Phenobarbital, Potassium Iodide, Theophylline
Insignificant DepletionBrand names include Quadrinal, Mudrane
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, particularly in muscle tissue. Phenobarbital has shown up in some research as possibly lowering carnitine levels, though the studies on this are genuinely mixed, with some finding a small reduction and others finding no real difference at all. Given that rating of insignificant depletion, the current thinking is that routine supplementation is not necessary for most people on this medication. That said, if you have any concerns, it is always worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Ephedrine, Phenobarbital, Potassium Iodide, Theophylline →
Ephedrine, Phenobarbital, Theophylline
Insignificant DepletionBrand names include Tedral
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, and some research has looked at whether phenobarbital might nudge levels of it downward, possibly by affecting how the body processes carnitines over time. Honestly, the studies on this are a mixed bag: some found modest reductions in certain patients, while others found no meaningful change at all. Given that this is rated as insignificant depletion, most people taking phenobarbital are not expected to need any supplementation. That said, if you have questions specific to your situation, a quick conversation with your pharmacist or doctor can put your mind at ease.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Ephedrine, Phenobarbital, Theophylline →
Ergotamine, Belladonna, Phenobarbital
Insignificant DepletionBrand names include Bellaspas, Bellamine, Eperbel-S
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, especially in muscle cells. The phenobarbital component of this combination has shown up in some research as possibly affecting carnitine levels in the blood, though other studies found no meaningful change at all. The evidence here is genuinely mixed and the overall rating is insignificant, so routine supplementation is not considered necessary for most people. If you have any concerns, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Full nutrient report for Ergotamine, Belladonna, Phenobarbital →
Hyoscyamine, Phenobarbital
Insignificant DepletionBrand names include Levsin Pb, Levsinex Pb Timecaps
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fats into energy, particularly in muscle tissue. The phenobarbital component of this combination has shown up in some research as potentially lowering carnitine levels, though other studies found no meaningful change at all. Because the evidence is genuinely mixed and the overall rating here is insignificant, most people taking this medication do not need to worry about or act on this. If you take phenobarbital long-term and have concerns, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Isotretinoin
Insignificant DepletionBrand names include Accutane, Amnesteem, Claravis
Data on the effects of isotretinoin on carnitine levels are conflicting. Reduced carnitine blood levels have been reported, sometimes with symptoms of carnitine deficiency, such as myalgia and muscle stiffness. However, other studies have found no significant effect of isotretinoin on carnitine blood levels. There is not enough information to recommend routine use of L-carnitine or propionyl-L-carnitine supplements with isotretinoin.
Propionyl-L-carnitine is a compound your muscles use for energy, and some research has found that isotretinoin may be associated with lower carnitine levels in the blood, occasionally with muscle aches or stiffness. That said, other studies found no real change, and the evidence overall is conflicting and rated insignificant. For most people taking isotretinoin, this is not a practical concern, but if you develop unexplained muscle soreness during treatment, it is worth mentioning to your pharmacist or doctor.
References (2)
- Georgala S, Schulpis KH, Georgala C, Michas T. L-carnitine supplementation in patients with cystic acne on isotretinoin therapy. J Eur Acad Dermatol Venereol 1999;13:205-9. DOI
- Laker MF, Green C, Bhuiyan AK, Shuster S. Isotretinoin and serum lipids: studies on fatty acid, apolipoprotein and intermediary metabolism. Br J Dermatol 1987;117:203-6. PubMed
Mephenytoin
Insignificant DepletionBrand names include Mesantoin
Data on the effect of phenytoin on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients on phenytoin. However, other studies have found no effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your muscles and heart use to turn fatty acids into energy, and mephenytoin is closely related to phenytoin, so researchers have looked at whether it might affect carnitine levels in a similar way. The honest answer is that the studies are mixed: some found modest reductions in certain patients, others found no change at all. Given that the evidence is conflicting and the rating here is insignificant, most people taking this medication do not need to worry about supplementing. If you have any concerns, a quick conversation with your pharmacist or doctor is the right place to start.
References (3)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25.
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Phenobarbital
Insignificant DepletionBrand names include Solfoton, Luminal
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. Some research has suggested phenobarbital might interfere with how the body handles carnitines, possibly by affecting metabolism in the liver, but other studies found no meaningful difference at all. The evidence here is genuinely mixed and the overall rating is insignificant, meaning most people on phenobarbital do not need to worry about this or take a supplement. If you have been on phenobarbital long-term and have concerns, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Phenobarbital, Phenytoin
Insignificant DepletionBrand names include Dilantin with PB
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body makes naturally that helps cells convert fat into usable energy, particularly in muscle tissue. Some early studies noticed that phenobarbital users occasionally had lower carnitine levels, possibly because the drug affects how the liver processes certain compounds, but other studies found no difference at all. Given how mixed the evidence is, this is considered an insignificant concern for most people, and routine supplementation is not recommended. If you have been on phenobarbital long-term and are curious, it is worth a quick conversation with your pharmacist or doctor.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Phenobarbital, Sodium Nitrate
Insignificant DepletionBrand names include Soniphen
Data on the effect of phenobarbital on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients taking phenobarbital. However, other studies have found no significant effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help convert fat into usable energy, particularly in muscle tissue. Some early research suggested phenobarbital might interfere with how the body handles carnitine compounds, possibly by affecting how they are processed in the liver, but other studies found no real difference at all. Because the evidence is genuinely mixed and the rating here is insignificant, most people taking phenobarbital do not need to worry about this or take any supplement for it. If you have concerns, a quick conversation with your pharmacist or doctor can put your mind at ease.
References (5)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Phenytoin
Insignificant DepletionBrand names include Dilantin Kapseals, Dilantin, Di-Phen
Data on the effect of phenytoin on blood levels of carnitines are conflicting. Some studies have found reduced levels in some patients on phenytoin. However, other studies have found no effect. Routine L-carnitine or propionyl-L-carnitine supplementation does not seem to be necessary.
Propionyl-L-carnitine is a compound your body uses to help turn fat into energy, particularly in muscle tissue. The research on whether phenytoin actually lowers it is genuinely mixed, with some studies showing a small reduction and others finding no change at all. Given that the evidence is conflicting and the rating here is insignificant, most people on phenytoin do not need to worry about this or take any extra supplement. If you have questions about your carnitine levels or your diet while on phenytoin, your pharmacist or doctor is a good place to start.
References (3)
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25.
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
Cefditoren Pivoxil
Moderate DepletionBrand names include Spectracef
Cefditoren pivoxil is a prodrug which is converted to cefditoren and pivalate in the body. Pivalate combines with L-carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of propionyl-L-carnitine could also be increased. Short courses of cefditoren can decrease blood concentrations of L-carnitine, but tissue levels are unlikely to be affected. Treatment for 1-2 months may cause a decrease in muscle L-carnitine, and treatment for 6 months or longer may cause symptoms of L-carnitine deficiency. Routine L-carnitine or propionyl-L-carnitine supplementation is not necessary unless therapy is prolonged or the patient has other factors contributing to low L-carnitine stores.
Here is something worth knowing about this antibiotic: cefditoren pivoxil is what pharmacists call a prodrug, meaning your body has to convert it into its active form. That conversion releases a byproduct called pivalate, which latches onto carnitine and pulls it out through the urine. Propionyl-L-carnitine is a form of carnitine your muscles and heart use for energy. A short course of this medication is unlikely to cause any real problem, but if you end up taking it for many weeks or months, it may be worth asking your pharmacist whether your carnitine levels should be watched.
References (1)
- Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. PubMed
Pivampicillin
Moderate DepletionBrand names include Pondicillin
This antibiotic is a prodrug which liberates the active antibiotic and pivalate in the body. Pivalate combines with L-carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of propionyl-L-carnitine could also be increased. Short courses of pivampicillin decrease blood concentrations of L-carnitine, but tissue levels appear to be unaffected. Treatment for 1-2 months causes decreases in muscle L-carnitine, and treatment for 6 months or longer may cause symptoms of L-carnitine deficiency. Routine L-carnitine or propionyl-L-carnitine supplementation is not necessary unless therapy is prolonged or the patient has other factors contributing to low L-carnitine stores.
Propionyl-L-carnitine is a compound your muscles rely on to produce energy efficiently. Here is the tricky part with pivampicillin: as your body processes this antibiotic, it releases a byproduct called pivalate, which latches onto L-carnitine and gets flushed out through the urine, pulling carnitine along with it. Short courses are generally not a concern, but patients on several months of treatment may see muscle carnitine levels drop enough to cause real symptoms. If your therapy is expected to be prolonged, that is worth a conversation with your pharmacist or doctor about whether any monitoring or supplementation makes sense for you.
References (2)
Pivmecillinam
Moderate DepletionBrand names include Selexid
This antibiotic is a prodrug which liberates the active antibiotic and pivalate in the body. Pivalate combines with L-carnitine and is excreted in the urine, which increases L-carnitine losses from the body. Theoretically, losses of propionyl-L-carnitine could also be increased. Short courses of pivmecillinam decrease blood concentrations of L-carnitine, but tissue levels appear to be unaffected. Treatment for 1-2 months causes decreases in muscle L-carnitine, and treatment for 6 months or longer may cause symptoms of carnitine deficiency. Routine L-carnitine or propionyl-L-carnitine supplementation is not necessary unless therapy is prolonged or the patient has other factors contributing to low L-carnitine stores.
Propionyl-L-carnitine is a compound your muscles and heart use to turn fat into usable energy. Here is the catch with pivmecillinam: as your body breaks this antibiotic down, it releases a byproduct called pivalate, which latches onto carnitine and gets flushed out in the urine, pulling carnitine along with it. A short course is unlikely to cause any real problem, but longer treatment (think months, not days) has been linked to falling carnitine levels in muscle tissue. If your doctor is considering extended pivmecillinam therapy, it is worth asking them or your pharmacist whether your carnitine stores should be monitored.
References (2)
Sodium valproate
Moderate DepletionBrand names include Epilim
Valproic acid can reduce blood and tissue carnitine levels. Valproic acid interferes with L-carnitine biosynthesis in the liver and forms a valproylcarnitine ester, which is excreted in the urine, reducing tubular reabsorption of free carnitine. Reduced L-carnitine levels are not clinically significant in most people taking valproic acid. However, some patients may be at increased risk for L-carnitine deficiency with valproic acid, and this may contribute to the development of hyperammonemia and hepatotoxicity associated with the drug. Risk factors for symptomatic L-carnitine deficiency with valproic acid include age less than 2 years, severe neurological problems including mental retardation, taking multiple antiepileptic drugs, poor nutrition, and use of the ketogenic diet. Some experts recommend L-carnitine supplements for people with these risk factors who need to take valproic acid. There is no data on the use of propionyl-L-carnitine supplements in people taking valproic acid. Supplements of carnitines aren't necessary for most people taking valproic acid who are otherwise healthy and consuming a diet adequate in L-carnitine.
Propionyl-L-carnitine is a form of carnitine, a compound your body uses to move fatty acids into cells for energy production. Sodium valproate can gradually pull down carnitine levels in two ways: it interferes with the liver's ability to make carnitine, and it binds to carnitine to form a byproduct that gets flushed out through the kidneys rather than recycled. For most adults on valproate, this does not cause a meaningful problem, but certain patients, including very young children, those on multiple seizure medications, or those with poor nutrition, may be at higher risk. If any of those situations apply to you or someone you care for, it is worth bringing up with your pharmacist or doctor.
References (16)
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Riva R, Albani F, Gobbi G, et al. Carnitine disposition before and during valproate therapy in patients with epilepsy. Epilepsia 1993;34:184-7. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25.
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Shapira Y, Gutman A. Muscle carnitine deficiency in patients using valproic acid. J Pediatrics 1991;118:646-9. PubMed
- Winter SC, Szabo-Aczel S, Curry CJR, et al. Plasma carnitine deficiency: Clinical observations in 51 pediatric patients. Am J Dis Child 1987;141:660-5. PubMed
- Coulter DL. Carnitine, valproate, and toxicity. J Child Neurol 1991;6:7-14.
- Raskind JY, El-Chaar GM. The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 2000;34:630-8. PubMed
- Coulter DL. Prevention of hepatotoxicity recurrence with valproate monotherapy and carnitine. Ann Neurol 1988;24:301.
- Vance CK, Vance H, Winter SC, et al. Control of valproate-induced hepatotoxicity with carnitine. Ann Neurol 1989;26:456.
- Hirose S, Mitsudome A, Yasumoto S, et al. Valproate therapy does not deplete carnitine levels in otherwise healthy children. Pediatrics 1998;101:E9 (abstract). PubMed
- Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211-4.
- Freeman JM, Vining EPG, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications? A double-blinded, crossover study. Pediatrics 1994;93:893-5. DOI
Valproic Acid
Moderate DepletionBrand names include Depakene, Depacon, Valproate
Valproic acid can reduce blood and tissue carnitine levels. Valproic acid interferes with L-carnitine biosynthesis in the liver and forms a valproylcarnitine ester, which is excreted in the urine, reducing tubular reabsorption of free carnitine. Reduced L-carnitine levels are not clinically significant in most people taking valproic acid. However, some patients may be at increased risk for L-carnitine deficiency with valproic acid, and this may contribute to the development of hyperammonemia and hepatotoxicity associated with the drug. Risk factors for symptomatic L-carnitine deficiency with valproic acid include age less than 2 years, severe neurological problems including mental retardation, taking multiple antiepileptic drugs, poor nutrition, and use of the ketogenic diet. Some experts recommend L-carnitine supplements for people with these risk factors who need to take valproic acid. There is no data on the use of propionyl-L-carnitine supplements in people taking valproic acid. Supplements of carnitines aren't necessary for most people taking valproic acid who are otherwise healthy and consuming a diet adequate in L-carnitine.
Propionyl-L-carnitine is a form of carnitine, a compound your body needs to help convert fat into usable energy, particularly in muscle and nerve tissue. Valproic acid can chip away at carnitine levels through two routes: it interferes with the liver's ability to make carnitine on its own, and it bonds with carnitine to form a byproduct that gets flushed out through the kidneys rather than recycled. For most people on valproic acid this does not cause a real problem, but certain patients, such as young children, those on multiple seizure medications, or those with poor nutrition, may be at higher risk. If any of those situations apply to you or someone you care for, it is worth bringing up carnitine levels with your doctor or pharmacist.
References (16)
- Thom H, Carter PE, Cole GF, et al. Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant drugs. Dev Med Child Neurol 1991;33:795-802. PubMed
- Hug G, McGraw CA, Bates SR, et al. Reduction of serum carnitine concentrations during anticonvulsant therapy with phenobarbital, valproic acid, phenytoin, and carbamazepine in children. J Pediatr 1991;119:799-802. PubMed
- Riva R, Albani F, Gobbi G, et al. Carnitine disposition before and during valproate therapy in patients with epilepsy. Epilepsia 1993;34:184-7. PubMed
- Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. PubMed
- Opala G, Winter S, Vance C, et al. The effect of valproic acid on plasma carnitine levels. Am J Dis Child 1991;145:999-1001. PubMed
- De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25.
- Castro-Gago M, Eiris-Punal J, Novo-Rodriguez MI, et al. Serum carnitine levels in epileptic children before and during treatment with valproic acid, carbamazepine, and phenobarbital. J Child Neurol 1998;13:546-9. PubMed
- Shapira Y, Gutman A. Muscle carnitine deficiency in patients using valproic acid. J Pediatrics 1991;118:646-9. PubMed
- Winter SC, Szabo-Aczel S, Curry CJR, et al. Plasma carnitine deficiency: Clinical observations in 51 pediatric patients. Am J Dis Child 1987;141:660-5. PubMed
- Coulter DL. Carnitine, valproate, and toxicity. J Child Neurol 1991;6:7-14.
- Raskind JY, El-Chaar GM. The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 2000;34:630-8. PubMed
- Coulter DL. Prevention of hepatotoxicity recurrence with valproate monotherapy and carnitine. Ann Neurol 1988;24:301.
- Vance CK, Vance H, Winter SC, et al. Control of valproate-induced hepatotoxicity with carnitine. Ann Neurol 1989;26:456.
- Hirose S, Mitsudome A, Yasumoto S, et al. Valproate therapy does not deplete carnitine levels in otherwise healthy children. Pediatrics 1998;101:E9 (abstract). PubMed
- Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211-4.
- Freeman JM, Vining EPG, Cost S, Singhi P. Does carnitine administration improve the symptoms attributed to anticonvulsant medications? A double-blinded, crossover study. Pediatrics 1994;93:893-5. DOI
Ifosfamide
Insufficient EvidenceBrand names include Ifex
Increased urinary losses of L-carnitine can occur during ifosfamide therapy. This might be due to binding of L-carnitine with a metabolite of ifosfamide. Theoretically, ifosfamide may also increase losses of propionyl-L-carnitine. The clinical significance of this and the role of carnitine supplements in people treated with ifosfamide are unknown.
Propionyl-L-carnitine is a compound your muscles and heart use to convert fat into usable energy. Ifosfamide may cause the kidneys to spill more L-carnitine into the urine, possibly because one of the drug's breakdown products binds to carnitine and carries it out of the body. Whether this also affects propionyl-L-carnitine in a meaningful way is genuinely unknown right now, so there is no clear action to take. If you are on ifosfamide long-term and are curious about carnitine levels, it is worth bringing up with your oncologist or pharmacist.
References (2)
- Marthaler NP, Visarius T, Kupfer A, Lauterburg BH. Increased urinary losses of carnitine during ifosfamide chemotherapy. Cancer Chemother Pharmacol 1999;44:170-2. PubMed
- Schlenzig JS, Charpentier C, Rabier D, et al. L-carnitine: a way to decrease cellular toxicity of ifosfamide? Eur J Pediatr 1995;154:686-7. DOI
Lamivudine, Zidovudine
Insufficient EvidenceBrand names include Combivir
Low L-carnitine blood levels are found in some people with HIV infection. Zidovudine seems to exacerbate this, and can also lower muscle carnitine levels, which is linked to symptoms of myopathy. Zidovudine interferes with mitochondrial transport of L-carnitine into muscle cells. In vitro data suggest L-carnitine supplements might improve functioning of muscle cells affected by zidovudine, but there is not enough data to recommend routine use of L-carnitine or propionyl-L-carnitine supplements for patients taking zidovudine.
Propionyl-L-carnitine is a compound your muscles rely on for energy, and there is some theoretical concern that zidovudine (one of the two drugs in this combination) may interfere with how carnitine gets transported into muscle cells, potentially lowering muscle levels over time. HIV infection itself can also reduce carnitine levels, so the two factors may compound each other. That said, the evidence here is rated insufficient, meaning researchers do not yet have enough data to know how clinically meaningful this really is. If you have been on this regimen long-term and have muscle-related concerns, it is worth raising with your doctor or pharmacist.
References (4)
- Mintz M. Carnitine in human immunodeficiency virus type 1 infection/acquired immune deficiency syndrome. J Child Neurol 1995;10:S40-4. DOI
- Dalakas MC, Leon-Monzon ME, Bernardini I, et al. Zidovudine-induced mitochondrial myopathy is associated with muscle carnitine deficiency and lipid storage. Ann Neurol 1994;35:482-7. PubMed
- Campos Y, Arenas J. Muscle carnitine deficiency associated with zidovudine-induced mitochondrial myopathy. Ann Neurol 1994;36:680-1. PubMed
- Georges B, Galland S, Rigault C, et al. Beneficial effects of L-carnitine in myoblastic C2C12 cells. Interaction with zidovudine. Biochem Pharmacol 2003;65:1483-8.. PubMed
Pyrimethamine
Insufficient EvidenceBrand names include Daraprim
A single case report describes symptomatic L-carnitine deficiency in a patient treated with pyrimethamine plus sulfadiazine which reversed when both drugs were stopped. The mechanism of this effect is not known and further data is needed before L-carnitine or propionyl-L-carnitine depletion can be linked to these drugs.
Propionyl-L-carnitine is a compound your body uses to help convert fat into energy, particularly in muscle tissue. There is one old case report suggesting that pyrimethamine, possibly in combination with another antibiotic, may have played a role in lowering carnitine levels, though how or why that might happen is genuinely not understood. The evidence here is quite thin, so this is more of an open question than an established concern. If you are on long-term pyrimethamine and are curious about this, it is worth a quick conversation with your pharmacist or doctor.
References (1)
- Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. PubMed
Pyrimethamine, Sulfadoxine
Insufficient EvidenceBrand names include Fansidar
A single case report describes symptomatic L-carnitine deficiency in a patient treated with pyrimethamine plus sulfadiazine which reversed when both drugs were stopped. The mechanism of this effect is not known and further data is needed before L-carnitine or propionyl-L-carnitine depletion can be linked to these drugs.
Propionyl-L-carnitine is a compound your body uses to help produce energy inside cells, particularly in heart and muscle tissue. There is one reported case of a patient on pyrimethamine developing low carnitine levels, though we do not fully understand why it happened or whether pyrimethamine was truly responsible. The evidence here is too limited to draw firm conclusions, so most people taking this medication do not need to act on this. That said, if you have concerns or notice unusual muscle fatigue while on treatment, it is worth bringing up with your doctor or pharmacist.
References (1)
- Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. PubMed
Sulfadiazine
Insufficient EvidenceA single case report describes symptomatic L-carnitine deficiency in a patient treated with pyrimethamine plus sulfadiazine which reversed when both drugs were stopped. The mechanism of this effect is not known and further data is needed before L-carnitine or propionyl-L-carnitine depletion can be linked to these drugs.
Propionyl-L-carnitine is a compound your body uses to help turn fats into energy, particularly in muscle tissue. There is one old case report of a patient developing carnitine deficiency while taking a combination of sulfadiazine and another antibiotic, but the exact reason it happened is still not understood, and we have no solid evidence linking sulfadiazine alone to this effect. The current evidence is simply too thin to draw firm conclusions, so most people taking this antibiotic do not need to act on this. That said, if you have any concerns or are taking sulfadiazine long-term, it is worth a quick conversation with your pharmacist or doctor.
References (1)
- Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. PubMed
Sulfadiazine, Sulfamerazine, Sulfamethazine
Insufficient EvidenceBrand names include Triple Sulfoid, Terfonyl
A single case report describes symptomatic L-carnitine deficiency in a patient treated with pyrimethamine plus sulfadiazine which reversed when both drugs were stopped. The mechanism of this effect is not known and further data is needed before L-carnitine or propionyl-L-carnitine depletion can be linked to these drugs.
Propionyl-L-carnitine is a compound your body uses to help convert fat into energy, particularly in muscle and heart tissue. There is one older case report of a patient on both pyrimethamine and sulfadiazine who developed carnitine deficiency, though it is not clear which drug was responsible or exactly how it happened. The evidence here is really just a single data point, so this is considered theoretical at best. If you are on long-term sulfonamide therapy and have concerns, it is worth mentioning to your pharmacist or doctor.
References (1)
- Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. PubMed
Full nutrient report for Sulfadiazine, Sulfamerazine, Sulfamethazine →
Sulfadiazine, Trimethoprim
Insufficient EvidenceBrand names include Coptin
A single case report describes symptomatic L-carnitine deficiency in a patient treated with pyrimethamine plus sulfadiazine which reversed when both drugs were stopped. The mechanism of this effect is not known and further data is needed before L-carnitine or propionyl-L-carnitine depletion can be linked to these drugs.
Propionyl-L-carnitine is a compound your body uses to help turn fat into usable energy, especially in muscle tissue. There is one old case report linking a related antibiotic combination to low carnitine levels, but how sulfadiazine or trimethoprim might cause this is simply not understood yet. The evidence here is really too thin to draw any firm conclusions, so most people taking these antibiotics do not need to worry about this. If you have any concerns, it is worth mentioning to your pharmacist or doctor.
References (1)
- Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. PubMed
Zidovudine
Insufficient EvidenceBrand names include Retrovir, Retrovir Injection
Low L-carnitine blood levels are found in some people with HIV infection. Zidovudine seems to exacerbate this, and can also lower muscle carnitine levels, which is linked to symptoms of myopathy. Zidovudine interferes with mitochondrial transport of L-carnitine into muscle cells. In vitro data suggest L-carnitine supplements might improve functioning of muscle cells affected by zidovudine, but there is not enough data to recommend routine use of L-carnitine or propionyl-L-carnitine supplements for patients taking zidovudine.
Propionyl-L-carnitine is a compound your muscles use for energy, and there is some early research suggesting zidovudine may interfere with how carnitine gets transported into muscle cells, potentially lowering levels there. People living with HIV can already have lower carnitine levels, and zidovudine may add to that. That said, the evidence here is still quite limited, so this is firmly in the 'we need more research' category rather than a reason to worry. If you have questions about muscle symptoms or supplements while taking zidovudine, bring them up with your pharmacist or doctor.
References (4)
- Mintz M. Carnitine in human immunodeficiency virus type 1 infection/acquired immune deficiency syndrome. J Child Neurol 1995;10:S40-4. DOI
- Dalakas MC, Leon-Monzon ME, Bernardini I, et al. Zidovudine-induced mitochondrial myopathy is associated with muscle carnitine deficiency and lipid storage. Ann Neurol 1994;35:482-7. PubMed
- Campos Y, Arenas J. Muscle carnitine deficiency associated with zidovudine-induced mitochondrial myopathy. Ann Neurol 1994;36:680-1. PubMed
- Georges B, Galland S, Rigault C, et al. Beneficial effects of L-carnitine in myoblastic C2C12 cells. Interaction with zidovudine. Biochem Pharmacol 2003;65:1483-8.. PubMed
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
PROPIONYL-L-CARNITINE & medications: FAQs
Which medications can lower PROPIONYL-L-CARNITINE?
I take one of these medications — am I deficient in PROPIONYL-L-CARNITINE?
Should I start a PROPIONYL-L-CARNITINE supplement?
Where does this information come from?
Other commonly implicated nutrients
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Sources & How We Checked
Medication associations with PROPIONYL-L-CARNITINE are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.