{"entity":{"id":"carnitine-acetyl-l-carnitine","kind":"technology","name":"Carnitine and acetyl-L-carnitine","aka":["L-carnitine","Acetyl-L-carnitine","ALCAR"],"tldr":"Acetyl-L-carnitine was tested to prevent nerve damage from chemotherapy and made it worse, with the extra damage still present two years later; guidelines advise against it. Plain L-carnitine for cancer fatigue has mixed results and guidelines do not recommend it either.","summary":"Memorial Sloan Kettering's About Herbs entry reports that in cancer settings acetyl-L-carnitine increased chemotherapy-induced peripheral neuropathy, an effect that persisted at two-year follow-up, and that current guidelines do not recommend it for preventing neuropathy. For L-carnitine, small oncology studies suggest improved nutritional status and quality of life in pancreatic cancer, fewer muscle spasms with vismodegib, and less chemotherapy-related fatigue alone or with coenzyme Q10, but a trial found no improvement in fatigue in people with invasive cancers and current guidelines do not recommend L-carnitine for cancer-related fatigue. Carnitine deficiency does occur with malnutrition, malabsorption and dialysis, and whether chemotherapy-induced carnitine insufficiency contributes to fatigue is unresolved. Side effects are usually mild (indigestion, a fishy body odour at high doses); MSK notes that L-carnitine may add to the anticoagulant effect of warfarin. Exercise and the approaches graded strong for fatigue are better supported.","status":"negative","asOf":"2026-11-04","links":[{"label":"MSK About Herbs: Carnitine (page last updated 15 October 2026)","url":"https://www.mskcc.org/cancer-care/integrative-medicine/herbs/carnitine"}],"tags":["complementary","supportive-care","evidence:harm"],"related":["alpha-lipoic-acid","creatine-supplements"],"cancers":[],"sections":["supportive-care","chemotherapy","nutrition-lifestyle"],"technologies":["integrative-oncology","dietary-supplements-treatment-interactions","cipn-recovery-and-treatment","cancer-related-fatigue-management"],"targets":[],"drugs":["vismodegib"],"companies":[],"institutions":[],"pathways":[],"terms":["peripheral-neuropathy"],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"principle":"Carnitine carries long-chain fatty acids into mitochondria for energy; the acetyl form crosses into the nervous system, where the expected protection did not appear in trials.","strengths":["Correcting true deficiency (for example on dialysis) is reasonable","Small signals in pancreatic cancer nutrition"],"limitations":["Acetyl-L-carnitine worsened chemotherapy neuropathy in a trial, lasting two years","Not recommended by guidelines for fatigue or neuropathy","Possible additive effect with warfarin"]},"route":"/technologies/carnitine-acetyl-l-carnitine/","neighbours":{"technology":[{"id":"alpha-lipoic-acid","kind":"technology","name":"Alpha-lipoic acid","route":"/technologies/alpha-lipoic-acid/"},{"id":"creatine-supplements","kind":"technology","name":"Creatine supplements","route":"/technologies/creatine-supplements/"},{"id":"dietary-supplements-treatment-interactions","kind":"technology","name":"Dietary supplements during cancer treatment: interactions and harms","route":"/technologies/dietary-supplements-treatment-interactions/"},{"id":"integrative-oncology","kind":"technology","name":"Evidence-based integrative oncology","route":"/technologies/integrative-oncology/"},{"id":"cancer-related-fatigue-management","kind":"technology","name":"Fatigue after cancer treatment: what actually works","route":"/technologies/cancer-related-fatigue-management/"},{"id":"hmb-supplements","kind":"technology","name":"HMB (beta-hydroxy-beta-methylbutyrate)","route":"/technologies/hmb-supplements/"},{"id":"cipn-recovery-and-treatment","kind":"technology","name":"Nerve damage from chemotherapy: what recovers, and what helps","route":"/technologies/cipn-recovery-and-treatment/"}],"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"drug":[{"id":"vismodegib","kind":"drug","name":"Vismodegib","route":"/drugs/vismodegib/"}],"term":[{"id":"peripheral-neuropathy","kind":"term","name":"Peripheral neuropathy (chemotherapy-induced)","route":"/terms/peripheral-neuropathy/"}],"bottleneck":[{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}]}}