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2010 Sep-Oct;45(5):449-55

2022 (atherosclerosis RCT): A clinical trial in 157 individuals aged 5875 with metabolic syndrome who received 1 g L-carnitine or placebo twice daily for 6 months found that total cholesterol and LDL cholesterol levels were higher in participants taking L-carnitine

First injection: severe redness, significant itching, 72+ hours Second injection: same or worse Third injection: same or worse Long-term outcome: requires intervention (technique optimization, antihistamines, or provider evaluation) The three-injection rule helps set expectations

Other, less common side effects include flushing and headache.

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