Description
Carnitine is the generic term for several compounds including L-carnitine, acetyl-L-carnitine, and propionyl-L-carnitine. It is a substance occurring naturally in humans, where it is synthesized endogenously in the liver, kidneys, and brain.
Carnitine is naturally present in many foods and most of the daily requirements of L-carnitine is provided through the diet. It is also available as a dietary supplement.
In the context of cancer, L-carnitine has been mainly investigated for alleviating adverse effects of chemo- or radiotherapy treatment.
Efficacy
Nine randomized controlled trials (RCTs) and one systematic (SR) investigated the efficacy of L-carnitine in the supportive care of cancer.
Chemotherapy-Induced Peripheral Neuropathy (CIPN)
- Prevention: 3 RCTs (n=437, n=160, n=150) found no prophylactic benefit of acetyl-L-carnitine. Largest trial reported increased risk and persistence of CIPN with prophylactic use.
- Treatment: 1 RCT (n=240) suggests possible benefit for CIPN treatment (low certainty).
Cancer-Related Fatigue
- Systematic review of 3 RCTs: No evidence supporting carnitine supplementation.
Cardiotoxicity
- Two small RCTs: Conflicting results, one showed no effect, one showed reduced cardiac events. Inconclusive evidence.
Sexual Dysfunction Post-Chemotherapy
- One RCT (n=96): Significant improvement in erectile function with L-carnitine, moderate certainty of results.
Cancer Cachexia
- One RCT (n=72): Improved BMI and nutritional status, moderate certainty of results.
Safety
The available clinical data suggest that L-carnitine is generally well tolerated and has been safely used in clinical trials at doses from 250mg to 6g per day for up to six months. Interactions with thyroid medications have been reported. See “warnings” about CIPN increase.
Description and background
L-carnitine (LC) is a naturally occurring chemical compound found in humans, most animal species, numerous microorganisms and plants. LC is a major component of carnitine stored in the human body. It is both absorbed from food and synthesised from the two amino acids lysine and methionine. Most of the body’s carnitine is located within skeletal muscles, where it is crucial for the supply of energy by the beta-oxidation of fatty acids. It also plays an important role in the stress response by modulating inflammatory and oxidative processes.
Sources of L-carnitine are animal products, particularly red meat but also poultry, fish and dairy products. (ODS 2023, NatMed 2025) For supplementation or pharmacological purposes, LC is available in capsule, tablet or powder form for oral use and as a solution for intravenous administration.
The name carnitine comes from the Latin word for meat (‘caro, carnis’), as it was first discovered in muscle tissue. (Bremer 1983) Other names include: Levocarnitine, Carnitor, Carnitene, Carnitine and Vitamin BT (obsolete term).
Ingredients and quality issues
Most carnitine supplements in Europe contain LC, but preparations containing the esterified forms acetyl-L-carnitine (ALC) and propionyl-L-carnitine (PLC) are also available over the counter. ALC is best absorbed by the intestine. As L-carnitine is not considered an essential nutrient, no recommended daily allowance or other dietary reference values have been established. (ODS 2023)
Alleged indications
Supplemental LC is mainly used to treat L-carnitine deficiency caused by certain genetic diseases or other disorders. Its role is also being investigated for Alzheimer’s disease and dementia, cardiovascular and peripheral artery disease, insulin resistance and diabetes, infertility, osteoarthritis, athletic performance enhancement, and weight loss. (ODS 2023)
In the context of cancer, supplementation with LC has been claimed to protect organs from chemo- and radiotherapy-related toxicities, to alleviate cancer-related fatigue and cancer anorexia-cachexia syndrome. However, current guidelines do not recommend L-carnitine for cancer-related fatigue (Bower 2024, S3-Leitlinie) and advise against its use for preventing chemotherapy-induced peripheral neuropathy (Loprinzi 2020, Lyman 2018).
Application and dosage
For supplementation or pharmacological purposes, LC is available in capsule, tablet or powder form for oral use and as a solution for intravenous administration. The usual dosages used in clinical studies range from 250 mg to 6 g per day (NatMed 2025).
Mechanism of action
L-Carnitine plays a central role in supporting mitochondrial energy production and reducing oxidative stress.
- Fatty acid transport: Facilitating the transfer of fatty acids (acyl groups) as acylcarnitines across the mitochondrial membrane for β-oxidation.
- Coenzyme A regulation: Maintaining adequate levels of free coenzyme A within mitochondria.
- Acetyl-CoA buffering: Modulating excess acetyl coenzyme A to support metabolic balance (Bremer, 1990).
- Anti-inflammatory effects have been reported in humans (Farahzadi, 2023b) and in vivo and in vitro studies (Famularo, 2004; Jones, 2010).
- Anti-tumour effects via apoptosis or anti-angiogenesis are preclinical with both pro-apoptotic effects reported in vitro in certain cancer cell lines (Fan, 2009; Farahzadi, 2023; Donisi, 2025; NatMed 2025) and anti-apoptotic effects demonstrated in vivo in cardiac failure models and in vitro under stress conditions (Chapela, 2009; NatMed 2025).
Legal issues
In the EU, dietary supplements containing L-carnitine are regulated as foods; as an food additive it is regulated for specific uses, such as in baby foods and other products for particular nutritional needs. (Anton 2003). In the USA, LC is approved by the US Food and Drug Administration (FDA) for the treatment of carnitine deficiency. (Drugs 2024)
Nine randomized controlled trials (RCTs) and one systematic review (SR) investigated the efficacy of L-carnitine in the supportive care of cancer:
A full description of the RCTs can be found in Table 1.
Chemotherapy-induced peripheral neuropathy
Four randomized controlled trials (RCTs) have evaluated the use of acetyl-L-carnitine (LC) for the prevention of chemotherapy-induced peripheral neuropathy (CIPN). The findings consistently indicate no benefit and, in some cases, a worsening of CIPN with LC use.
- In a 4-arm RCT (n=160), LC was compared with vitamin E, glutamine, and vitamin B12. LC and glutamine were less effective at reducing CIPN symptoms than vitamin E or B12. (Mondal 2014).
- A double-blind RCT (n=150) in patients receiving sagopilone chemotherapy showed no reduction in CIPN incidence with LC, although a slight decrease in severity was observed in ovarian cancer patients (not in prostate cancer patients). (Campone 2013)
- A large double-blind RCT (n=409) found no benefit of LC for CIPN prevention in breast cancer patients receiving taxanes. In fact, LC worsened CIPN severity over time. (Hershman 2013)
- Two-year follow-up confirmed persistent and worsening CIPN in the LC group without recovery, suggesting long-term harm. (Hershman (2018):
- As a result of this evidence, current clinical guidelines advise against the use of acetyl-L-carnitine for CIPN prevention. (Loprinzi 2020, Lyman 2018).
One double-blind, placebo-controlled RCT by investigated the use of ALC for the treatment of established CIPN (grade ≥2 or 3, NCI-CTC v3.0) in 240 patients with various solid tumours.
- Results showed a significant improvement in neuropathy symptoms, defined as a ≥1 grade reduction on NCI-CTC.
- Additionally, nerve conduction velocities improved in the ALC group.
- However, due to limitations in methodology and potential bias, the certainty of the evidence is low.
Cancer-related fatigue
A systematic review and meta-analysis by Marx (2017) evaluating the efficacy of L-carnitine supplementation for the treatment of cancer-related fatigue included three RCTs (Hershman 2013, Cruciani 2012/2018, Kraft 2012).
- Despite some individual studies reporting small benefits, more methodologically rigorous trials failed to show meaningful effects.
Prevention of chemotherapy-associated cardiotoxicity
Two small RCTs have assessed the use of L-carnitine for the prevention of cardiotoxicity in cancer patients. While one small study suggests a potential benefit in reducing IL-2-associated cardiac events, another showed no protective effect against anthracycline-induced cardiotoxicity.
- A double-blind RCT (n=40) in patients with non-Hodgkin's lymphoma receiving anthracyclines found no significant differences in echocardiographic parameters between the L-carnitine and placebo groups. (Waldner 2006)
- A double-blind RCT (n=30) in patients receiving high-dose interleukin-2 therapy reported a reduction in serious cardiac events (e.g., arrhythmias and acute heart failure) with L-carnitine use compared to no therapy, but the small sample size and heterogeneity of the cancer types limit generalizability. (Lissoni 1993)
Sexual dysfunction
One placebo-controlled RCT evaluated the efficacy of propionyl-L-carnitine in 96 men with erectile dysfunction following bilateral, nerve-sparing prostatectomy. (Cavallini 2005)
- Patients receiving L-carnitine in addition to sildenafil 100mg (as needed) reported significantly less erectile dysfunction, as measured by the International Index of Erectile Function questionnaire.
- The certainty of results is moderate, suggesting a potential benefit of L-carnitine as an adjunct to PDE5 inhibitors in this population.
Tumour cachexia
One placebo-controlled RCT (n=72), investigated the use of L-carnitine in patients with advanced pancreatic cancer and tumour cachexia Kraft (2012).
- The study showed a significant increase in body mass index (BMI) and improvement in nutritional status in the L-carnitine group receiving 4 g/day for 12 weeks compared to placebo.
- The certainty of results is moderate, indicating a possible benefit of L-carnitine in this context.
Adverse effects
LC is generally well-tolerated. It has been safely used orally in children for up to 6 months (NatMed 2025). A systematic review including clinical trials and animal studies defined LC as safe, and identified the upper level for supplements at 200 mg/day (Hathcock 2006). Similarly, individual clinical trials reported minimal or no AEs (Sato 2020; Sawicka 2020)
Common, mild to moderate AEs
A 10-year follow-up (n=83) evaluation reported common AEs including fish odour, abdominal pain, diarrhoea, reflux, flatulence, low stamina (ungraded; Abrahmsen 2023).
Rare, mild to moderate AEs
Nausea, epigastric discomfort, vomiting (unclear; unknown grading; NatMed 2025); loose stool which resolved upon dose reduction (unknown grading; NatMed 2025), headache (NatMed 2025; unknown grading, unclear).
Single case reports
Tachyarrhythmias and palpitation (unknown grading; Bakalov 2020), skin rash (NatMed 2025, unclear, unknown grading), hypophosphatemia resolved after discontinuation (NatMed2025).
Contraindications
- Pregnancy and lactation: individual case reports suggest safety during pregnancy (de Bruyn 2015), however data which mainly include in vivo studies (Xi 2008) are insufficient. Regarding lactation, studies are lacking.
- Children: mild to moderate side effects were reported in children in a small pilot study, although authors defined 200mg/kg/day as a well-tolerated dose among children of mean age 5 years (Goin-Kochel 2019). More compelling evidence is lacking.
- Preclinical risk based on known effects: a Mendelian randomization study of cohorts and large consortia established increased risk of coronary artery disease with increased intake of L-carnitine (Zhao 2022). In a single clinical study and in vitro, L-carnitine was reported to reverse hyperthyroidism, and to regulate T3 and T4 hormones. Supplementation may be contraindicated in hypothyroidism patients (Benvenga 2005).
Interactions
- CYP: In vivo, one study reported increased or decreased expression of different isoforms (Olsozowy 2006). Hypothesized: drug-drug interaction (unknown);
- P-glycoprotein: data reporting interactions not available;
- Oxidant chemotherapy: in vivo, L-carnitine did not interfere with doxorubicin cytotoxic effects (Sayed-Ahmed 1999); acetyl-L-carnitine did not interfere with paclitaxel, and cisplatin (Pisano 2003). However, data are limited to preclinical studies.
- Immune checkpoint inhibitors (ICI): a single case report showed that combined therapy (L-carnitine + pembrolizumab; unclear) showed a beneficial effect against myasthenia gravis in a thymoma patient. No mention of ICI dose adjustment, or possible negative interaction. Data are insufficient.
- Monoclonal antibody (mAb): in vivo, L-carnitine was reported to ameliorate the immune response (Famularo 1993). Hypothesized: improved mAb therapy, or reduced efficacy (unknown).
- Others: Anti-coagulants: acenocumarol (single case report, unclear) (Bachmann 2004); in vivo, hypercoagulation decreased upon LC treatment (ElGendy 2014): hypothesized; risk of bleeding;
Warnings
Acetyl-L-carnitine was reported to increase chemotherapy-induced peripheral neuropathy in breast-cancer patients undergoing taxane-based chemotherapy, however the underlying mechanism was not clear (Hershman 2018).
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Citation
CAM Cancer Collaboration. L-Carnitine, October 2025.
Document history
Updated in August 2025 by Lisa Dal Pozzo (“Mechanism of Action” and “Safety”) and the CAM Cancer Collaboration. Literature search in August 2025. Assessed as up to date in November 2024 by Tessy Boedt. Updated in July 2023 by Ali Behzad. Assessed as up to date in January 2015 by Barbara Wider. Summary updated in July 2014 by Peter Renner and Markus Horneber. Summary first published in September 2012, authored by Peter Renner and Markus Horneber.
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