<p>Gastrointestinal reactions may result from a too rapid consumption of Levocarnitine. The safety and efficacy of oral levocarnitine has not been evaluated in patients with renal insufficiency. Chronic administration of high doses of oral levocarnitine in patients with severely compromised renal function or in ESRD patients on dialysis may result in accumulation of the potentially toxic metabolites, trimethylamine (TMA) and trimethylamine-N oxide (TMAO), since these metabolites are normally excreted in the urine.</p>