Folic Acid + L-Carnitine L-Tartrate + Methylcobalamin

Usage

This combination is primarily prescribed for the treatment and prevention of nutritional deficiencies, particularly those involving folic acid (vitamin B9) and vitamin B12 (methylcobalamin). It is also used to address specific conditions related to these deficiencies, such as megaloblastic anemia (a type of anemia caused by impaired DNA synthesis), peripheral neuropathy (nerve damage), and hyperhomocysteinemia (high levels of homocysteine in the blood). L-Carnitine L-Tartrate supports energy production by aiding in fatty acid transport and may be beneficial for fatigue and certain metabolic conditions.

• Pharmacological Classification: Nutritional Supplement.

• Mechanism of Action: Folic acid is essential for DNA synthesis, red blood cell formation, and cell division. Methylcobalamin is crucial for nerve function, myelin sheath formation, and red blood cell production. L-Carnitine L-Tartrate facilitates the transport of long-chain fatty acids into the mitochondria, where they are oxidized to produce energy.

Alternate Names

While there is no standard international nonproprietary name (INN) for this combination product, variations may refer to the individual components (e.g., “folic acid/methylcobalamin/levocarnitine”).

• Brand Names: Various brand names exist, often including combinations like “LCARNITIME PLUS”, “Nanocob-LC”, “Folmicob-LC”, “Cobanerve-LC”, “AudiTAB LC”, “SARFAST-LC”, “Trinerve-LC”, “Nurokind LC”, and “MYSCOM LC.”

How It Works

• Pharmacodynamics: Folic acid is converted to its active form, tetrahydrofolic acid, which is involved in DNA synthesis, cell division, and homocysteine metabolism. Methylcobalamin acts as a cofactor for methionine synthase, crucial for DNA and red blood cell production and homocysteine metabolism. L-carnitine transports fatty acids into mitochondria for beta-oxidation, contributing to energy production.

• Pharmacokinetics:

  • Absorption: Folic acid is well-absorbed from the gastrointestinal tract. L-Carnitine is absorbed via active transport. Methylcobalamin is absorbed in the ileum and requires intrinsic factor.
  • Metabolism: Folic acid is metabolized in the liver. L-Carnitine and Methylcobalamin undergo limited metabolism.
  • Elimination: Folic acid metabolites are primarily excreted renally. L-Carnitine and its metabolites are mainly excreted in urine. Methylcobalamin is primarily eliminated via biliary excretion, with some renal excretion.

• Mode of Action: See Pharmacodynamics.

• Receptor Binding/Enzyme Inhibition: Folic acid and Methylcobalamin function as cofactors for various enzymes.

• Elimination Pathways: See Pharmacokinetics.

Dosage

Dosage is determined by the specific condition and the individual patient’s needs. A healthcare professional should be consulted for the appropriate dosage.

Standard Dosage

Adults:

One tablet per day is a common recommendation, although this may vary. The formulation and strength (e.g., 500 mg L-Carnitine L-Tartrate, 1500 mcg Methylcobalamin, 1.5 mg Folic Acid) influence the prescribed dose.

Children:

Pediatric dosage should be determined by a pediatrician, considering factors like age and weight.

Special Cases:

• Elderly Patients: Dosage adjustments may be necessary due to age-related changes in renal function.
• Patients with Renal Impairment: Caution is advised, as L-carnitine metabolites can accumulate. Dosage adjustments are often required.
• Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be required.
• Patients with Comorbid Conditions: Dosage should be individualized considering potential drug interactions and the patient’s specific condition.

Clinical Use Cases

Dosage for specific clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations are not standardized for this combination and must be determined by the attending physician on a case-by-case basis.

Dosage Adjustments

Adjustments may be necessary based on patient-specific factors such as renal or hepatic dysfunction, metabolic disorders, or genetic polymorphisms.

Side Effects

Common Side Effects:

• Nausea
• Vomiting
• Diarrhea
• Stomach upset
• Heartburn
• Body odor (fishy smell)
• Headache

Rare but Serious Side Effects:

• Seizures
• Allergic reactions (rash, itching, swelling, difficulty breathing)

Long-Term Effects:

Limited information is available. Regular monitoring of relevant parameters is advised.

Adverse Drug Reactions (ADR):

Clinically significant ADRs requiring immediate intervention include severe allergic reactions and seizures.

Contraindications

• Hypersensitivity to any component.
• Leber’s hereditary optic neuropathy (Methylcobalamin).
• Active cancer (Folic acid may promote cancer cell growth).

Drug Interactions

• Alcohol (reduces folic acid absorption)
• Anticonvulsants (e.g., phenytoin, valproic acid)
• Proton pump inhibitors (e.g., omeprazole)
• Antibiotics (e.g., chloramphenicol, neomycin)
• Anticoagulants (e.g., warfarin)
• Methotrexate
• Fluorouracil
• Colchicine
• Cimetidine
• Metformin
• Sulfasalazine
• Cholestyramine

Pregnancy and Breastfeeding

Folic acid is recommended during pregnancy. However, the safety of this combination product during pregnancy and breastfeeding should be assessed by a physician. Both methylcobalamin and L-carnitine can be excreted in breast milk.

Drug Profile Summary

• Mechanism of Action: See “How It Works” section.
• Side Effects: See “Side Effects” section.
• Contraindications: See “Contraindications” section.
• Drug Interactions: See “Drug Interactions” section.
• Pregnancy & Breastfeeding: Consult a physician.
• Dosage: See “Dosage” section.
• Monitoring Parameters: Complete blood count, liver function tests, renal function tests, vitamin B12 levels, folate levels.

Popular Combinations

This combination itself is a popular formulation.

Precautions

• Pre-existing medical conditions (renal/hepatic impairment, cardiovascular conditions, diabetes).
• Alcohol consumption should be limited.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Folic Acid + L-Carnitine L-Tartrate + Methylcobalamin?

A: Dosage varies. Consult a doctor for personalized advice. One tablet daily is a common recommendation, but this depends on individual factors and the specific formulation.

Q2: Can this combination be used during pregnancy?

A: Folic acid is generally recommended during pregnancy, but consult a doctor about the combined product’s safety.

Q3: What are the common side effects?

A: Common side effects include nausea, vomiting, diarrhea, stomach upset, heartburn, body odor, and headache.

Q4: Are there any serious side effects?

A: Rare but serious side effects can include seizures and allergic reactions.

Q5: Does this combination interact with other medications?

A: Yes, it can interact with several medications, including alcohol, anticonvulsants, proton pump inhibitors, and antibiotics. Consult a doctor about potential drug interactions.

Q6: How does L-Carnitine L-Tartrate contribute to this combination?

A: L-Carnitine L-Tartrate aids in fatty acid transport for energy production, potentially benefiting cardiovascular and muscular function and addressing fatigue.

Q7: What should patients with kidney disease be aware of?

A: Patients with kidney disease should exercise caution, as L-carnitine metabolites can accumulate. Dosage adjustments are often necessary.

Q8: Can this combination help improve nerve pain?

A: Methylcobalamin, a form of vitamin B12, is beneficial for nerve function and can potentially help with nerve pain associated with conditions like peripheral neuropathy.

Q9: Does this combination boost the immune system?

A: While not directly boosting the immune system, the components contribute to overall health, which can indirectly support immune function.