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Specific Populations: People with certain health conditions (like kidney failure or liver disease) or those pregnant or breastfeeding should use L-Carnitine cautiously and under medical supervision, as long-term effects in these populations are less understood

Inform patients of the signs and symptoms of acute kidney injury and instruct them to promptly report any of these signs or symptoms or persistent (or extended) nausea, vomiting, and diarrhea to their healthcare provider [see Warnings and Precautions (5.5)]

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This produces tolerance subjects require progressively higher doses to maintain pigmentation, which increases off-target side effect risk

doi:10.1021/ja954077c