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This cold-chain requirement adds substantial cost, limits distribution to pharmacies with adequate cold storage capacity, and creates logistical challenges in resource-limited settings and during natural disasters or supply chain disruptions
Long-term effects of L-carnitine on hyperammonemia and hepatic encephalopathy in patients with liver cirrhosis: a multicenter retrospective study Joji Tani a Akio Moriya b Tetsu Tomonari c Chikara Ogawa d Akemi Tsutsui e Asahiro Morishita a Teppei Sakamoto f Hiroki Tai a Rie Yano a Mai Nakahara a Kyoko Oura a Tomoko Tadokoro a Koji Fujita a Shima Mimura a Takashi Himoto g Hironori Tanaka c Ryosuke Imado d Takushi Manabe d Kei Takuma a Takuya Nagano e Koichi Takaguchi e Tetsuji Takayama c Hideki Kobara a Objective Long-term efficacy data for L-carnitine in managing blood ammonia concentration (BAC) and preventing hepatic encephalopathy recurrence remain limited
Some patients experience mild stomach discomfort, especially in the first few weeks
Hence, the urgent need arises to ascertain novel aetiological factors, particularly those that are modifiable, as they could contribute to the formulation of an evidence-based strategy for the primary prevention of NAFLD
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