Carnitine Helps Energy, Depression, and Sleep in Cancer Patients

In this study of 27 patients with advanced cancer, carnitine was given beginning with a dose of 500 mg a day and increasing over a week to 3,000 mg a day. By the end of 1 week, fatigue and sleep improved and depression decreased. In other studies, nerve pain caused by chemotherapy also improved with acetyl L-carnitine. There were no significant side effects (though only 21 of the 27 patients finished the study).

"Safety, Tolerability and Symptom Outcomes Associated with l-Carnitine Supplementation in Patients with Cancer, Fatigue, and Carnitine Deficiency: A Phase I/II Study," Cruciani RA, Dvorkin E, et al, J Pain Symptom Manage, 2006; 32(6): 551-559. (Address: Department of Pain Medicine and Palliative Care (R.A.C., E.D., P.H., J.L., R.K.P.) and Cancer Center (S.M., B.C.), Beth Israel Medical Center, New York; Departments of Neurology and Anesthesiology (R.A.C., R.K.P.) and Pediatrics (N.E.-C.), Albert Einstein College of Medicine, Bronx; and Children's Hospital at Montefiore (N.E.-C.), Bronx, New York, USA).

In a phase I/II open-label trial designed to assess the safety and tolerability of oral supplementation with L-Carnitine, doses up to 3,000 mg/d were found to be safe, well tolerated, and reduce fatigue in patients with advanced cancer, in a dose-dependent manner. Study subjects were patients with advanced cancer, moderate to severe fatigue, carnitine deficiency (defined as levels of free carnitine <35 for males and <25 for females or acyl-free carnitine ratio of >0.4) and a score of at least 50 on the Karnofsky Performance Status. Fatigue, depressed mood, quality of sleep and KPS were assessed at baseline and after one week. 27 patients participated in the study. 21 completed the study and 17 were responders. Subjects were divided into groups and each group was given a successively higher dose of L-Carnitine for one week, starting at 250 mg/d and increasing in increments of 500 mg, up to 2750 mg/d, plus a final dose of 3000 mg/d. None of the subjects reported significant side effects or toxicities. In the 27 patients who participated in the study, levels of total carnitine and free carnitine were found to increase, fatigue was found to significantly decrease, depression was found to decrease and sleep was found to improve. Among the 17 responders, L-Carnitine was found to be associated with total carnitine, free carnitine, and fatigue in a dose-dependent manner. These results suggest that L-Carnitine may be safe and well-tolerated in doses up to 3,000 mg/d. Furthermore, supplementation with L-Carnitine may help to reduce fatigue in patients with advanced cancer. The authors conclude, "This study provides the basis for the design of future placebo-controlled studies of L-Carnitine supplementation for cancer-related fatigue."