http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=NPS47094

Pharmacopsychiatry. Editor: B. Saletu (Vienna). Original Paper

L-Carnitine Decreases Severity and Type of Fatigue Induced by
Interferon- in the Treatment of Patients with Hepatitis C
Sergio Nerib, Giovanni Pistonea, Barbara Saracenoa, Giovanni Pennisic,
Salvatore Lucaa, Mariano Malaguarneraa

aDepartment of Senescence, Urological and Neurological Sciences,
University of Catania,
bDepartment of Internal Medicine of Santa Marta Hospital,
cDepartment of Neurological Sciences, University of Catania, Catania,
Italy

Neuropsychobiology 2003;47:94-97 (DOI: 10.1159/000070016)

Abstract

Background: Hepatitis C virus (HCV) is one of the major agents of
chronic hepatitis and liver disease worldwide. Infection with HCV
leads to chronic hepatitis in about 80% of the cases. The most used
treatment is based on interferon (IFN)-, which is effective in less
than 50% of patients; however, a high proportion of responders may
relapse after interferon withdrawal. Fatigue is a common complaint in
patients with liver disease. The aim of our study was to evaluate the
efficacy of carnitine on IFN-induced fatigue in subjects with chronic
hepatitis C. Patients and Methods: We studied 50 patients (30 males
and 20 females) with chronic hepatitis C. Chronic hepatitis was
diagnosed by determination of serum alanine aminotransferase (ALT) and
aspartate aminotransferase (AST) levels (at least 2-fold upper normal
values for 1 year). Our study series was divided into two groups and
matched as to number, age, sex, as well as grade and duration of
disease. Group 1, composed of 25 patients, was treated with leucocytic
IFN- at a dosage of 3 million IU thrice a week; group 2 (25 patients)
was treated with the same protocol as group 1, but was also
administered carnitine 2 g per os daily. Patients' response was
evaluated on the basis of serum levels of AST and ALT as well as liver
functions; fatigue was evaluated by Wessely and Powell scores. All
patients studied were tested before treatment and then 1, 3 and 6
months after the beginning of IFN administration. Results: The
difference of physical fatigue between the two groups after 1 month of
therapy was significant (p < 0.01) for patients treated with
carnitine. This significance continued at the end of month 3 (p <
0.01). With reference to mental fatigue, the comparison between the
two groups showed a significant difference for group 2 after 1 month
(p < 0.01). Finally, with respect to the fatigue severity, the
comparison between the two groups showed that after 1 and 3 months of
therapy, fatigue was significantly less severe in group 2 than group 1
(p < 0.0005). Conclusions: If we take into account baseline values of
mental and physical fatigue as well as the severity of this symptom in
our study series, one observes that therapy with IFN alone induces
fatigue in the majority of cases after 1 and 3 months, while at month
6, the values decrease. In contrast, patients treated with IFN +
carnitine show a marked and early significant reduction of fatigue
levels. These data suggest that the greater energetic substrate
utilised by group 2 patients may in some way provide a better response
of the patients to this side-effect. Abnormalities of
neurotransmission concerning serotonine seem involved in the genesis
of depression and fatigue. In addition, depression and fatigue
commonly occur together, and the former is the most commonly observed
symptom in patients with chronic fatigue syndrome.
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