레보카르니틴 / L-카르니틴

영양 보충제 / 아미노산 유도체

레보카르니틴(L-카르니틴)은 메티오닌과 라이신으로부터 체내에서 합성되는 천연 아미노산 유도체로, 정상적인 지방 이용과 에너지 대사에 필수적입니다. 수의학에서는 주로 다음 질환의 영양 보조제로 사용됩니다: * **반려견의 확장성 심근병증(DCM)** (특히 코카 스파니엘 및 복서, 최대 90%가 카르니틴 결핍을 보일 수 있음). * **고양이 지방간증**, 간의 지질 대사 및 제거를 촉진. * **독소루비신 유발 심장 독성**에 대한 보호. * **발프로산 독성**의 보조 치료. **임상 요점:** L-이성질체(레보카르니틴)만이 생물학적 활성을 가지며 유익합니다. D-카르니틴이 포함된 라세미 혼합물은 L-카르니틴의 흡수를 경쟁적으로 억제하여 결핍을 유발할 수 있으므로 반드시 피해야 합니다.

작용 기전: Levocarnitine acts as an essential cofactor for the **carnitine palmitoyltransferase (CPT)** system. It binds to long-chain free fatty acids in the cytosol, forming acylcarnitine, which is then transported across the inner mitochondrial membrane. Inside the mitochondria → the fatty acids undergo **beta-oxidation** → generating **ATP** (cellular energy). This mechanism is particularly crucial for the myocardium, which relies heavily on fatty acid oxidation for energy, and for the liver during states of lipid mobilization (e.g., feline hepatic lipidosis).

동물 종별 용량

Cats

Adjunctive dietary therapy in cats with severe hepatic lipidosis · 250 mg PO once daily · PO · q24h · Use Carnitor; also supplement with taurine (250 mg once to twice daily), Vitamin E (10 Units/kg/day), water soluble vitamins and determine B12 status (treat while awaiting data at 1 mg/cat SC).
Supplementation in cats with liver disease · 250-500 mg/day · PO · q24h

Dogs

Trial for treating canine dilated cardiomyopathy (large or giant breed dog) · 2 grams PO q8-12h · PO · q8-12h · Approximately 1 teaspoonful of pure powder
Adjunctive therapy of dilated cardiomyopathy in American Cocker spaniels · 1 gram PO q8-12h · PO · q8-12h · Give with taurine. Approximately 1/2 teaspoonful.
Severe myocardial failure in Boxers · 2-3 grams PO q12h · PO · q12h · 2-4 months · To determine if they respond
Adjunctive treatment of American cocker spaniels with dilated cardiomyopathy · 1 g PO q12h · PO · q12h · Give with taurine 500 mg q12h PO
Dilated cardiomyopathy in American Cocker spaniels · 1 g PO q8h · PO · q8h
Dilated cardiomyopathy in Boxer dogs · 2 g PO q8h · PO · q8h
Documented systemic carnitine deficiency · 50-100 mg/kg PO q8h · PO · q8h
Myocardial carnitine deficiency only · 200 mg/kg PO q8h · PO · q8h

투여 경로

POIVIMSC

금기

Use of D-carnitine or racemic (D,L) mixtures (competitively inhibits L-carnitine uptake)

이상반응

Gastrointestinal upset (loose stools, diarrhea, nausea, vomiting) - usually mild and dose-dependent
Increased body odor (reported in human patients)

약물 상호작용

Valproic acid · Patients receiving valproic acid may require higher dosages of levocarnitine due to drug-induced carnitine depletion.

모니터링

Clinical efficacy (improvement in cardiac or hepatic signs)
Periodic blood chemistries (recommended in humans, value in veterinary medicine is undetermined)

과용량

Levocarnitine is a relatively safe drug. * **Minor overdoses**: Need only to be monitored. * **Massive overdoses**: Consider gut emptying (emesis or gastric lavage). Refer to a veterinary poison control center for more information.

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