Name:	Acetyl-l-carnitine HCI
Other Names:	ALCAR
Development Status:	investigational in U.S.
FDA Phase:	Discontinued
Primary Medical Role:	Attenuate Alzheimer's symptoms
Role in Alzheimer's Disease:	Lessen cognitive deterioration
Pharmacological Role:	Not exactly known; some hypotheses: improve efficiency of CNS cells mitochondrial/energy production; stabilizes membranes; elevate NGF; and decrease accumulations of toxic fatty acids.
Contraindications:	None known.
Side Effects:	A relatively well-tolerated drug. In one study, the only adverse experience that reached statistical significance between placebo and ALCAR-treated groups was a worsening of body odor.
Evidence pro its efficacy:	There is some evidence of a modest effect of ALCAR on younger (<=65 y.o.) onset AD patients.
Evidence con its efficacy:	The evidence of ALCAR's efficacy is not very substantial or convincing. Moreover, some evidence suggests that it actually hastens the cognitive decline in some older-onset AD patients (which compose the bulk of the population that contracts the disease). A 1-year, multicenter, double- blind, placebo-controlled, randomized trial showed that ALCAR (1 g tid) failed to decrease the rate of decline in early onset AD patients.
Dosage:	3g/ day
Cost:	N/A
Companies:	Sigma-Tau Pharmaceuticals

References

Hudson S, Tabet N. Acetyl-l-carnitine for dementia (Cochrane Review). Cochrane Database Syst Rev. 2003 ; :CD003158. Abstract

Thal LJ, Calvani M, Amato A, Carta A. A 1-year controlled trial of acetyl-l-carnitine in early-onset AD. Neurology. 2000 Sep 26;55(6):805-10. Abstract

Brooks JO 3rd, Yesavage JA, Carta A, Bravi D. Acetyl L-carnitine slows decline in younger patients with Alzheimer's disease: a reanalysis of a double-blind, placebo-controlled study using the trilinear approach. Int Psychogeriatr 10(2): 193-203. (1998) Abstract

Scorziello A, Meucci O, Calvani M, Schettini G. Acetyl-L-carnitine arginine amide prevents beta 25-35-induced neurotoxicity in cerebellar granule cells. Neurochem Res 22 (3): 257-265 (1997). Abstract

Kuratsune H, Watanable Y, Yamaguti K, Jacobsson G, Takahashi M, Machii T, Onoe H, Onoe K, Matsumura K, Valind S, Kitani T, Langstrom B. High uptake of [2-11C]acetyl-L-carnitine into the brain: a PET study. Biochem Biophys Res Commun 231 (2): 488-493 (1997). Abstract

Thal LJ, Carta A, Clarke WR, Ferris SH, Friedland RP, Petersen RC, Pettegrew JW, Pfeiffer E, Raskind MA, Sano M, Tuszynski MH, Woolson RF. A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's disease. Neurology 47 (3): 705-711 (1996). Abstract

Virmani MA, Biselli R, Spadoni A, Rossi S, Corsico N, Calvani M, Fattorossi A, De Simone C, Arrigoni-Martelli E. Protective actions of L-carnitine and acetyl-L-carnitine on the neurotoxicity evoked by mitochondrial uncoupling or inhibitors. Pharmacol Res 32 (6): 383-389 (1995). Abstract

Bruno G, Scaccianoce S, Bonamini M, Patacchioli FR, Cesarino F, Grassini P, Sorrentino E, Angelucci L, Lenzi GL. Acetyl-L-carnitine in Alzheimer disease: a short-term study on CSF neurotransmitters and neuropeptides. Alzheimer Dis Assoc Disord 9 (3): 128-131 (1995). Abstract

Pettegrew JW, Klunk WE, Panchalingam K, Kanfer JN, McClure RJ. Clinical and neurochemical effects of acetyl-L- carnitine in Alzheimer's disease. Neurobiol Aging 16 (1): 1-4 (1995). Abstract