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In summary, complex interactions between diet, genetics and the microbiota may impact on processing of oral l-carnitine into pro-atherogenic metabolites such as TMAO that regulate lipid metabolism

The US National Kidney Foundation did not recommend routine administration of L-carnitine to subjects undergoing dialysis yet encouraged the development of trials in patients with select symptoms that do not respond to standard therapy, i.e., persistent muscle cramps or hypotension during dialysis, severe fatigue, skeletal muscle weakness or myopathy, cardiomyopathy, and anemia requiring large doses of erythropoietin (74, 75)

Iwasaki Kuri Kogatana

L-carnitine may increase the risk of seizures in those with epilepsy

Carnitine: Fact Sheet for Health Professionals