L-Carnitine and Acetyl-L-Carnitine in Drug Poisonings: A Systematic Review of Clinical and Experimental Evidence
Abstract
L-carnitine (LC) and acetyl-L-carnitine (ALC) aid in the transfer of fatty acids inside the mitochondria and may alleviate toxic syndromes marked by oxidative stress, poor β-oxidation, hyperammonemia, and mitochondrial dysfunction. The adjunctive role of LC/ALC in acute drug and chemical poisonings was assessed in this systematic study. Clinical studies, mechanistic models, and animal experiments involving LC/ALC in valproic acid, aluminum phosphide, organophosphates, paracetamol (acetaminophen), methanol and other toxic alcohols, and anthracycline cardiotoxicity were found by searching PubMed, Scopus, and Web of Science between February and July 2025. PRISMA guidelines and predetermined criteria were used in the selection of the study. Two reviewers did a basic domain-based bias appraisal, screened records, and extracted data using a standardized form. The results were narratively synthesized and organized by toxin and research type due to significant variation in design, demographics, dose, and outcomes. Nineteen research studies satisfied the requirements for inclusion. Adjunctive LC decreased lipid peroxidation, enhanced cholinesterase activity, and decreased atropine/oxime needs in organophosphate poisoning, according to two clinical studies, although there was no discernible mortality effect. A mortality signal was observed when LC was combined with N-acetylcysteine, whereas paraffin oil performed marginally better in some outcomes. Three small randomized trials in…
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