- What other names is Propionyl-l-carnitine known by?
- What is Propionyl-l-carnitine?
- How does Propionyl-l-carnitine work?
- Are there safety concerns?
- Are there any interactions with medications?
- Dosing considerations for Propionyl-l-carnitine.
Propionyl-L-carnitine is an amino acid that is naturally produced in the body. Amino acids are the building blocks of proteins. L-carnitine and acetyl-L-carnitine are also amino acids, and they are chemically related to propionyl-L-carnitine. In fact, the body can convert L-carnitine to propionyl-L-carnitine and acetyl-L-carnitine. But, no one knows whether the benefits of carnitines are interchangeable. Until more is known, don't substitute one form of carnitine for another.
Propionyl-L-carnitine is used for treating leg pain (intermittent claudication) due to poor blood circulation (peripheral vascular disease, PVD). PVD is often caused by diabetes or “hardening of the arteries” (atherosclerosis). Propionyl-L-carnitine is also used to treat congestive heart failure (CHF).
Men with sexual performance problems (erectile dysfunction, ED) due to diabetes or poor circulation sometimes use propionyl-L-carnitine along with prescription medications. Older men who have symptoms of low testosterone levels sometimes use propionyl-L-carnitine in combination with acetyl-L-carnitine.
Healthcare providers give propionyl-L-carnitine intravenously (by IV) for treating PVD and intermittent claudication; to improve wound healing in people with PVD; and to treat heart disease, including congestive heart failure, and chest pain (angina).
Possibly Effective for...
- Poor circulation (peripheral vascular disease) that causes leg pain while walking (intermittent claudication). Propionyl-L-carnitine taken by mouth or given by IV seems to help people with severe leg pain walk farther than they otherwise could. But propionyl-L-carnitine doesn't seem to help milder peripheral vascular disease.
- Congestive heart failure (CHF). Taking propionyl-L-carnitine seems to improve heart function and exercise tolerance in people with mild to moderate congestive heart failure.
- Treating symptoms of “male menopause,” low levels of testosterone due to aging. Taking propionyl-L-carnitine by mouth in combination with acetyl-L-carnitine for six months seems to improve sexual performance, depression, and fatigue in older men. Taking this combination seems to work about as well as taking testosterone.
- Sexual performance problems (erectile dysfunction, ED) in men with diabetes. Taking propionyl-L-carnitine along with sildenafil (Viagra) may work better than taking sildenafil alone.
- An increase in fibrous tissue in the penis (Peyronie's disease). The combination of propionyl-L-carnitine and injection of a medication called verapamil seems to improve sexual performance, slow disease progression, and reduce the need for surgery.
- Chest pain (angina).
- A type of heart disease called chronic ischemic heart disease, when given by IV.
Insufficient Evidence to Rate Effectiveness for...
- Chronic fatigue syndrome (CFS). Developing research suggests that propionyl-L-carnitine might improve general fatigue in patients with CFS. Interestingly, the combination of propionyl-L-carnitine and acetyl-L-carnitine appears to be less effective than either supplement alone.
- Circulatory problems caused by diabetes.
- Other conditions.
Propionyl-L-carnitine helps the body produce energy. It is important for heart function, muscle movement, and many other body processes. It also seems to help increase circulation.
Propionyl-L-carnitine is safe for most people when taken by mouth or given intravenously by a healthcare professional. It can cause nausea, vomiting, stomach pain, weakness, and chest pain (angina). It can also cause a "fishy" odor of the urine, breath, and sweat.
Special Precautions & Warnings:Pregnancy and breast-feeding: Not enough is known about the use of propionyl-L-carnitine during pregnancy and breast-feeding. Stay on the safe side and avoid use.
“Underactive thyroid” (hypothyroidism): There is a concern that propionyl-L-carnitine might make hypothyroidism worse or thyroid hormone treatment less effective. This is because a related chemical, L-carnitine, seems to interfere with thyroid hormone. If you have hypothyroidism, don't take propionyl-L-carnitine.
Seizures: Some people who have a history of seizures have reported an increase in the number and severity of seizures after taking L-carnitine by mouth or intravenously (by IV). There is a concern that this might also occur with propionyl-L-carnitine, because it is a similar chemical.
Acenocoumarol (Sintrom)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Acenocoumarol (Sintrom) is used to slow blood clotting. Propionyl-L-carnitine might increase the effects of acenocoumarol (Sintrom). Increasing the effects of acenocoumarol (Sintrom) might slow blood clotting too much and cause bruising and bleeding. The dose of your acenocoumarol (Sintrom) might need to be changed.
Warfarin (Coumadin)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Warfarin (Coumadin) is used to slow blood clotting. Propionyl-L-carnitine might increase the effects of warfarin (Coumadin) and increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.
The following doses have been studied in scientific research:
- For disorders of the blood vessels: 500-1500 mg propionyl-L-carnitine twice daily.
- For congestive heart failure and chest pain due to blood circulation problems (chronic angina): A dose of 500 mg of propionyl-L-carnitine three times daily.
- For symptoms in older men caused by insufficient levels of testosterone: A dose of 2 grams of acetyl-L-carnitine plus 2 grams of propionyl-L-carnitine daily has been used.
- For ED (erectile dysfunction): A daily dose of 2 grams of propionyl-L-carnitine has been used in combination with 50 mg of sildenafil (Viagra) given twice weekly.
- For Peyronie's disease: 2 grams of propionyl-L-carnitine daily has been used in combination with injections of a medication called verapamil.
- For blood vessel disorders and heart disease: Healthcare providers give propionyl-L-carnitine intravenously (by IV).
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Health Solutions From Our Sponsors
12761 Benvenga S, Amato A, Calvani M, Trimarchi F. Effects of carnitine on thyroid hormone action. Ann N Y Acad Sci 2004;1033:158-67. View abstract.
Amico-Roxas M, Caruso A, Cutuli VM, et al. Inhibitory effects of propionyl-L-carnitine on plasma extravasation induced by irritants in rodents. Drugs Exp Clin Res 1993;19:213-7. View abstract.
Anand I, Chandrashekhan Y, De Giuli F, et al. Acute and chronic effects of propionyl-L-carnitine on the hemodynamics, exercise capacity, and hormones in patients with congestive heart failure. Cardiovasc Drugs Ther 1998;12:291-9. View abstract.
Anon. Carnitor (levocarnitine) package insert. Sigma-Tau Pharmaceuticals Inc, Gaithersburg, MD. December 1999.
Bachmann HU, Hoffmann A. Interaction of food supplement L-carnitine with oral anticoagulant acenocoumarol. Swiss Med Wkly 2004;134:385.
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;176:406-13. View abstract.
Bartels GL, Remme WJ, den Hartog FR, et al. Additional anti-ischemic effects of long-term L-propionylcarnitine in anginal patients treated with conventional antianginal therapy. Cardiovasc Drugs Ther 1995;9:749-53. View abstract.
Bartels GL, Remme WJ, Holwerda KJ, Kruijssen DA. Anti-ischaemic efficacy of L-propionylcarnitine - a promising novel metabolic approach to ischaemia? Eur Heart J 1996;17:414-20. View abstract.
Bartels GL, Remme WJ, Pillay M, et al. Acute improvement of cardiac function with intravenous L-propionylcarnitine in humans. J Cardiovasc Pharmacol 1992;20:157-64. View abstract.
Bartels GL, Remme WJ, Pillay M, et al. Effects of L-propionylcarnitine on ischemia-induced myocardial dysfunction in men with angina pectoris. Am J Cardiol 1994;74:125-30. View abstract.
Brass EP. Pivalate-generating prodrugs and carnitine homeostasis in man. Pharmacol Rev 2002;54:589-98. View abstract.
Brevetti G, Diehm C, Lambert D, et al. European multicenter study on propionyl-L-carnitine in intermittent claudication. J Am Coll Cardiol 1999;34:1618-24. View abstract.
Brevetti G, Perna S, Sabba C, et al. Effect of propionyl-L-carnitine on quality of life in intermittent claudication. Am J Cardiol 1997;79:777-80. View abstract.
Brevetti G, Perna S, Sabba C, et al. Propionyl-L-carnitine in intermittent claudication: double-blind, placebo-controlled, dose titration, multicenter study. J Am Coll Cardiol 1995;26:1411-6. View abstract.
Brevetti G, Perna S, Sabba C, et al. Superiority of L-propionylcarnitine vs L-carnitine in improving walking capacity in patients with peripheral vascular disease: an acute, intravenous, double-blind, cross-over study. Eur Heart J 1992;13:251-5. View abstract.
Campos Y, Arenas J. Muscle carnitine deficiency associated with zidovudine-induced mitochondrial myopathy. Ann Neurol 1994;36:680-1. View abstract.
Caponnetto S, Canale C, Masperone MA, et al. Efficacy of L-propionylcarnitine treatment in patients with left ventricular dysfunction. Eur Heart J 1994;15:1267-73. View abstract.
Caruso A, Cutuli VM, De Bernardis E, et al. Protective effect of propionyl-L-carnitine against PAF-induced rat paw oedema. Pharmacol Res 1995;31:67-72. View abstract.
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. View abstract.
Cavallini G, Biagiotti G, Koverech A, Vitali G. Oral propionyl-l-carnitine and intraplaque verapamil in the therapy of advanced and resistant Peyronie's disease. BJU Int 2002;89:895-900. View abstract.
Cavallini G, Caracciolo S, Vitali G, et al. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology 2004;63:641-6. View abstract.
Cherchi A, Lai C, Onnis E, et al. Propionyl carnitine in stable effort angina. Cardiovasc Drugs Ther 1990;4:481-6. View abstract.
Chiddo A, Gaglione A, Musci S, et al. Hemodynamic study of intravenous propionyl-L-carnitine in patients with ischemic heart disease and normal left ventricular function. Cardiovasc Drugs Ther 1991;5 Suppl 1:107-11. View abstract.
Coulter DL. Carnitine, valproate, and toxicity. J Child Neurol 1991;6:7-14. View abstract.
Coulter DL. Prevention of hepatotoxicity recurrence with valproate monotherapy and carnitine. Ann Neurol 1988;24:301.
Dal Lago A, De Martini D, Flore R, et al. Effects of propionyl-L-carnitine on peripheral arterial obliterative disease of the lower limbs: a double-blind clinical trial. Drugs Exp Clin Res 1999;25:29-36. View abstract.
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. View abstract.
De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: Current perspectives. Epilepsia 1998;39:1216-25. View abstract.
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. View abstract.
Evans AM, Fornasini G. Pharmacokinetics of L-carnitine. Clin Pharmacokinet 2003;42:941-67. View abstract.
Ferrari R, De Giuli F. The propionyl-L-carnitine hypothesis: an alternative approach to treating heart failure. J Card Fail 1997;3:217-24. View abstract.
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. View abstract.
Gentile V, Vicini P, Prigiotti G, et al. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. Curr Med Res Opin 2004;20:1377-84. View abstract.
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. View abstract.
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.. View abstract.
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. View abstract.
Hiatt WR, Regensteiner JG, Creager MA, et al. Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication. Am J Med 2001;110:616-22.. View abstract.
Hirose S, Mitsudome A, Yasumoto S, et al. Valproate therapy does not deplete carnitine levels in otherwise healthy children. Pediatrics 1998;101:E9 (abstract). View abstract.
Holme E, Greter J, Jacobson CE, et al. Carnitine deficiency induced by pivampicillin and pivmecillinam therapy. Lancet 1989;2:469-73. View abstract.
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. View abstract.
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. View abstract.
Krahenbuhl S, Reichen J. Carnitine metabolism in patients with chronic liver disease. Hepatology 1997;25:148-53. View abstract.
Krahenbuhl S. Carnitine metabolism in chronic liver disease. Life Sci 1996;59:1579-99. View abstract.
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. View abstract.
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. View abstract.
Mancini M, Rengo F, Lingetti M, et al. Controlled study on the therapeutic efficacy of propionyl-L-carnitine in patients with congestive heart failure. Arzneimittelforschung 1992;42:1101-4. View abstract.
Marthaler NP, Visarius T, Kupfer A, Lauterburg BH. Increased urinary losses of carnitine during ifosfamide chemotherapy. Cancer Chemother Pharmacol 1999;44:170-2. View abstract.
Martinez E, Domingo P, Roca-Cusachs A. Potentiation of acenocoumarol action by L-carnitine. J Intern Med 1993;233:94.
Mintz M. Carnitine in human immunodeficiency virus type 1 infection/acquired immune deficiency syndrome. J Child Neurol 1995;10:S40-4. View abstract.
Noble S, Goa KL. Adefovir dipivoxil. Drugs 1999;58:479-87. View abstract.
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. View abstract.
Persico G, Amato B, Aprea G, et al. The early effects of intravenous L-propionyl carnitine on ulcerative trophic lesions of the lower limbs in arteriopathic patients: a controlled randomized study. Drugs Exp Clin Res 1995;21:187-98. View abstract.
Raskind JY, El-Chaar GM. The role of carnitine supplementation during valproic acid therapy. Ann Pharmacother 2000;34:630-8. View abstract.
Rebouche CJ. Kinetics, pharmacokinetics, and regulation of L-carnitine and acetyl-L-carnitine metabolism. Ann N Y Acad Sci 2004;1033:30-41. View abstract.
Riva R, Albani F, Gobbi G, et al. Carnitine disposition before and during valproate therapy in patients with epilepsy. Epilepsia 1993;34:184-7. View abstract.
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. View abstract.
Sekas G, Paul HS. Hyperammonemia and carnitine deficiency in a patient receiving sulfadiazine and pyrimethamine. Am J Med 1993;95:112-3. View abstract.
Shapira Y, Gutman A. Muscle carnitine deficiency in patients using valproic acid. J Pediatrics 1991;118:646-9. View abstract.
Siliprandi N, Di Lisa F, Menabo R. Propionyl-L-carnitine: biochemical significance and possible role in cardiac metabolism. Cardiovasc Drugs Ther 1991;5 Suppl 1:11-5. View abstract.
Stanley CA. Carnitine deficiency disorders in children. Ann N Y Acad Sci 2004;1033:42-51. View abstract.
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. View abstract.
Tsoko M, Beauseigneur F, Gresti J, et al. Enhancement of activities relative to fatty acid oxidation in the liver of rats depleted of L-carnitine by D-carnitine and a gamma- butyrobetaine hydroxylase inhibitor. Biochem Pharmacol 1995;49:1403-10. View abstract.
Van Wouwe JP. Carnitine deficiency during valproic acid treatment. Int J Vitam Nutr Res 1995;65:211-4. View abstract.
Vance CK, Vance H, Winter SC, et al. Control of valproate-induced hepatotoxicity with carnitine. Ann Neurol 1989;26:456.
Vermeulen RC, Scholte HR. Exploratory open label, randomized study of acetyl- and propionylcarnitine in chronic fatigue syndrome. Psychosom Med 2004;66:276-82. View abstract.
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. View abstract.
Wiseman LR, Brogden RN. Propionyl-L-carnitine. Drugs Aging 1998;12:243-8; discussion 249-50. View abstract.
Wu X, Huang W, Prasad PD, et al. Functional characteristics and tissue distribution pattern of organic cation transporter 2 (OCTN2), an organic cation/carnitine transporter. J Pharmacol Exp Ther 1999;290:1482-92. View abstract.
Zelnik N, Fridkis I, Gruener N. Reduced carnitine and antiepileptic drugs: cause relationship or co-existence? Acta Paediatr 1995;84:93-5. View abstract.