Acetyl-l-carnitine (ALC), a natural substance marketed over the counter as a dietary supplement, has been reported to be an effective therapy for reducing and preventing peripheral neuropathy from chemotherapy and for cancer-related fatigue. The following 3 studies help us to better define the potential role of ALC for these common symptoms.
ALC for the Prevention of Peripheral Neuropathy:
- In a trial among 409 women receiving adjuvant taxane chemotherapy for early breast cancer, investigators reported that those who took ALC (1,000 mg three times daily, for 24 weeks) had an INCREASE in the development & severity of peripheral neuropathy symptoms relative to those who were given a placebo. They also found no difference in improvement in cancer-related fatigue between the two groups.
One of the study investigators stated, “Based on these data, physicians should be telling patients not to take ALC during adjuvant chemotherapy.”
ALC for the Treatment of Peripheral Neuropathy (& Fatigue, Strength and Nerve Function):
- For the next study, investigators enrolled 239 patients who had cancer of various types and stages, had completed chemotherapy, and had moderate-to-severe peripheral neuropathy for up to 6 months.
- The patients were randomly assigned to receive either oral ALC (3,000 mg per day) or placebo, for 8 weeks.
- Results: Patients in the ALC group had an IMPROVEMENT in their neuropathy (at 8 & 12 weeks) compared with placebo. Additionally, ALC IMPROVED cancer-related fatigue, physical strength, and electrophysiology in peripheral nerves compared with placebo.
ALC (3,000 mg per day) appears to be an effective therapy for reducing peripheral neuropathy and fatigue after chemotherapy.
ALC for the Treatment of Cancer-Related Fatigue:
- In this study, investigators randomized 376 patients with invasive cancers to receive either 1,000 mg twice per day day of ALC or placebo for 4-weeks.
- Results: There was NO DIFFERENCE in improvement in cancer-related fatigue between the two groups.
- Based on the mixed results of ALC for Cancer-Related Fatigue, it is not clear whether ALC is effective. Considering the negative results from the last study (also the largest of its’ kind), I am not in favor of recommending ALC for the treatment of cancer-related fatigue.
ALC for the Prevention of the Cardiac Side Effects of Chemotherapy:
Treatment with ALC may protect the heart and kidney against the toxic side effects of chemotherapy medications (i.e. doxorubicin and cisplatin), without reducing the chemotherapy’s effectiveness.
Studies are ongoing.
Precaution for Drug Interactions:
Taking carnitine may reduce the effectiveness of these important medications:
- Thyroid hormone
- Valproic acid (Depakote)
Read more about ALC in cancer care here (MSKCC About Herbs website)