Graziano, F., Bisonni, R., Catalano, V., Silva, R., Rovidati, S., Mencarini, E., . . . Lai, V. (2002). Potential role of levocarnitine supplementation for the treatment of chemotherapy-induced fatigue in non-anaemic cancer patients. British Journal of Cancer, 86, 1854–1857.

L-carnitine is essential for glucose and lipid turnover and has a role in maintaining energy metabolism.

A high daily fractionated dose ​L-carnitine 2-g solution was given twice daily (BID) for seven days. Ifosfamide and cisplatin cause increased renal excretion and alter the usual enzyme pathways, potentially causing asthenia with impaired energy metabolism.

The study included 50 nonanemic adults with stage IV solid tumors receiving combination chemotherapy, including ifosfamide or cisplatin, with palliative treatment intent.

Not described

The study used a prospective, nonrandomized, single-arm trial, open-label, pre-/posttest design.

Functional Assessment of Cancer Therapy-Fatigue (FACT-F), 13 items with ratings from zero to four

All 50 patients were evaluable; 20 patients had fatigue at the first cycle and 30 had fatigue at the second cycle. L-carnitine levels were greater than 30 μm in 100% of the patients, and it was well tolerated. Fatigue was ameliorated in 90% (n = 45) with L-carnitine (p < 0.001). Of the nonresponders, three patients were stable and two got worse.

• The study had a small sample size.
• The study used a nonrandomized design.
• No comparison group was included.
• L-carnitine depletion may not be the primary cause of fatigue experienced by these patients.
• L-carnitine could be resupplied through diet, which was not monitored.
• Urinary loss of L-carnitine may be asymptomatic.

Cost of supplements and monitoring levels of L-carnitine is unknown.