Cited by 60Metabolism and Genetic DisordersClinical Nutrition and GastroenterologyLysosomal Storage Disorders Research

The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.

Treatment of carnitine deficiency

Winter, S. C.·2003·Journal of Inherited Metabolic Disease

Abstract

Summary: Carnitine deficiency is a secondary complication of many inborn errors of metabolism. Pharmacological treatment with carnitine not only corrects the deficiency, it facilitates removal of accumulating toxic acyl intermediates and the generation of mitochondrial free coenzyme A (CoA). The United States Food and Drug Administration (US FDA) approved the use of carnitine for the treatment of inborn errors of metabolism in 1992. This approval was based on retrospective chart analysis of 90 patients, with 18 in the untreated cohort and 72 in the treated cohort. Efficacy was evaluated on the basis of clinical and biochemical findings. Compelling data included increased excretion of disease‐specific acylcarnitine derivatives in a dose–response relationship, decreased levels of metabolites in the blood, and improved clinical status with decreased hospitalization frequency, improved growth and significantly lower mortality rates as compared to historical controls. Complications of carnitine treatment were few, with gastrointestinal disturbances and odour being the most frequent. No laboratory or clinical safety issues were identified. Intravenous carnitine preparations were also approved for treatment of secondary carnitine deficiency. Since only 25% of enteral carnitine is absorbed and gastrointestinal tolerance of high doses is poor, parenteral carnitine treatment is an appealing alternative therapeutic approach. In 7 patients treated long term with high‐dose weekly to daily venous boluses of parenteral carnitine through a subcutaneous venous port, benefits included decreased frequency of decompensations, improved growth, improved muscle strength and decreased reliance on medical foods with liberalization of protein intake. Port infections were the most troubling complication. Theoretical concerns continue to be voiced that carnitine might result in fatal arrhythmias in patients with long‐chain fat metabolism defects. No published clinical studies substantiate these concerns. Carnitine treatment of inborn errors of metabolism is a safe and integral part of the treatment regime for these disorders.

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Crossref · 10.1023/a:1024433100257

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Metadata

Authors
Winter, S. C.
Affiliations
University of California, San Francisco (US)
Corresponding author
Winter, S. C.
Venue
Journal of Inherited Metabolic Disease
Publisher
Wiley
Published
2003-03
Volume
26
Issue
2-3
Pages
171-180
ISSN
  • 0141-8955 (ISSN-L)
  • 1573-2665
OpenAlex
W170762119
Cited by
60
References
17
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 4 · 2016: 3 · 2015: 3 · 2014: 1 · 2013: 5 · 2012: 2
FWCI
1.33
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Inherited Metabolic Disease (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Genetics (clinical) › Lysosomal Storage Disorders Research
Keywords
carnitine deficiency, inborn errors of metabolism, pharmacotherapy, acylcarnitines, gastrointestinal tolerance, port infection, long-chain fatty acid oxidation disorders, arrhythmia risk, treatment safety, growth and mortality
MeSH terms
Carnitine, Humans, Metabolism, Inborn Errors, 3-Hydroxyacyl CoA Dehydrogenases

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