Standard dosage	Oral: Children: 20–100 mg/kg/d divided into two or three doses; higher doses have been used. Adults: 330–990 mg/dose two or three times per day; 3 g/d is the usual maximum. IV: Children and adults: 50–100 mg/kg/d divided every 4–6 hours, increased as needed to a maximum of 300 mg/kg/d.
Contraindications	Hypersensitivity to carnitine.
Main drug interactions	None.
Main side effects	Body odor due to bacterial breakdown of carnitine in the gut, which is often dose-related and may be treated by dose reduction; a short course of metronidazole or neomycin also can help. Gastrointestinal upset (particularly flatulence and diarrhea) also may occur. Allergic reactions are rare. Tachyarrhythmia occurred in an animal model of very long chain acyl CoA dehydrogenase def ciency. Chronic administration of high doses of oral carnitine in patients with severely compromised renal function may result in accumulation of potentially toxic metabolites [32, Class IV].
Cost	$70: 90 generic tablets (330 mg). $35: 118 mL of 1 g/10 mL generic suspension.