Re: RE : Re:Carnitor and lipodystrophy

[Guest guest]

NY Medicaid mandates generics where available, so the pharmacy has switched

to High-Tech Pharmacal Levocarnitine (really encouraging - generic sounding

name) from Carnitor. I asked for Acetyl initially, and would have to pay out

of pocket.

That's been my experience. My neuropathy has gotten worse the past year, but

I've had several causes to contribute - plantar fasciitis, compressed disk,

HIV disease and meds ... so I can't tell whether it's making any difference

or not. As long as it's covered, it's not hurting to my knowledge. I could

probably get prior approval for Carnitor specifically, if I convince my

doctor the generic is inferior. Unfortunately, they may start covering the

acetyl L-carnitine about the same year they cover sculptra treatments (not

holding my breath).

>

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Subject: Re: RE : Re:Carnitor and lipodystrophy

I don't think there's a lot of reason to think L-carnitine alone

would help REVERSE the fat loss, maybe a bit more rationale for it to

help reduce visceral fat increase (it shuttles fatty acids into cells

to metabolize them).

On the other hand, if it helps reduce inflammation (i.e., lower TNF)

it may help reduce the RATE of fat loss. The one VERY small and not

yet reproduced study by de Simone et al. showed a nice normalization

of TNF levels among HIV+ people but they used a high dose of 6 grams

a day. (The other happy thing was that it did not drop TNF levels

that were normal; this contrasted to other drugs like thalidomide or

pentoxifylline that tended to wipe the level out in everyone which

ain't good cause it is there for useful purposes as well.) Also, fat

loss may be due to different things, whether from nuke-related

mitochondrial toxicity or direct effects of HIV itself (e.g.,

increasing inflammatory cytokines like TNF-tumor necrosis factor).

For lipodystrophy, then, I think a range of different agents may help

to manage fat loss and maybe others for fat gain. But as far as I'm

aware, there are no studies evaluating this.

A special note regarding neuropathy. Remember, the data have been

done mostly on a different form, acetyl-L-carnitine, for neuropathy.

At 3 grams, it seems to have benefit in ameliorating the effects.

That's different from the L-carnitine -- adding the acetyl group

helps it to cross the " blood-brain barrier " which also has an impact

on the capacity to help peripheral nerves.

As to brands, I think Carnitor will be a safer bet generally as it is

a pharmaceutical grade. Carnitine can deteriorate rapidly and store

brands may not be so good. See www.consumerlab.com where they have I

think tested some brands. We have a subscription so drop me an email

and I can pull the full report from them.

Acetyl-carnitine is NOT covered by insurance however. And it can be a

bit expensive at 6 grams. The original idea of FIAR had been to see

if agents like this are beneficial to increase physician awareness

and also perhaps get states to expand ADAP and/or Medicaid

formularies to cover such generally less-costly-than drug agents.

But the pharmaceutical companies, most egregiously Abbott and

ritonavir, are raping the crap out all those programs and politicians

do their level best to suck up to those big profits, etc., ad

nauseam, ad infinitum.

Say--check out Confessions of an Economic Hit Man. Slightly off

topic, but the same general idea.

M.