Acetyl-l-carnitine (ALC)
CAM (antioxidant, neuroprotective, transports long-chain fatty acids into the mitochondria)
- Major Depression2 (more effective in chronic depression, TRD, or with elderly, medical illness, history of childhood trauma)
- Alcohol use disorder (mood, cravings, cognition)2
- Early stage Alzheimer’s3
Features
Dosing
Start 500-1000 mg daily, titrate every 3-7 days to 2,000 mg daily (can divide BID), max 3,000 mg daily.
Similar to l-carnitine (but the acetyl group allows it to cross the blood brain barrier).
$10-20/month.
Management
Treats depression with medical illnesses (liver disease, fibromylagia, low androgen levels, and multiple sclerosis). More effective in elderly.
Neuroprotective, helps acetylcholine production (which is involved in memory) and phospholipid synthesis in brain cell memories. Improves hyperammonemia (NH4) on valproate (a rare side effect). Patients with chronic depression, TRD, or history of childhood traumas have lower levels of ALC and respond better to it.
RISKS: Possible cardiovascular risks (it is derived from red meat, this risk identified with l-carnitine without acetyl).
EMR Text
Depression
Acetyl-l-carnitine (ACL) use based on randomized controlled trials in depression (Veronese N et al, Psychosom Med. 2018;80(2):154-159).
ACL’s side effects reviewed with patient.
Alcohol Use Disorder
Acetyl-l-carnitine (ACL) use based on randomized controlled trials in alcohol use disorder, where it improved cognition, mood, and cravings (Martinotti G et al, Alcohol Alcohol. 2010;45(5):449-55; Tempesta E et al, Int J Clin Pharmacol Res. 1990;10(1-2):101-7).
ACL’s side effects reviewed with patient.
Alzheimer’s
Acetyl-l-carnitine (ACL) use based on randomized controlled trials in Alzheimer’s dementia, where it was particularly effective in early stages (Montgomery SA et al, Int Clin Psychopharmacol. 2003;18(2):61-71.).
ACL’s side effects reviewed with patient.