Levocarnitine

Levocarnitine (L-carnitine) is a naturally occurring amino acid derivative synthesized in vivo from methionine and lysine, essential for normal fat utilization and energy metabolism. In veterinary medicine, it is primarily utilized as a nutraceutical adjunct for: * **Dilated Cardiomyopathy (DCM)** in dogs (especially American Cocker Spaniels and Boxers, where up to 90% may have a carnitine deficiency). * **Feline Hepatic Lipidosis**, where it facilitates hepatic lipid metabolism and clearance. * Protection against **doxorubicin-induced cardiomyopathy**. * Adjunctive treatment for **valproic acid toxicity**. **Clinical Pearl:** Only the L-isomer (levocarnitine) is biologically active and beneficial. Racemic mixtures containing D-carnitine must be avoided as they competitively inhibit L-carnitine uptake and can induce a deficiency.

กลไกการออกฤทธิ์: 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).

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