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(II) stillbirth, neonatal death, fetal congenital abnormalities, and genetic metabolic diseases

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Chronic oral administration of high doses of L-Carnitine in patients with severe renal insufficiency can induce an accumulation of potentially toxic metabolites: trimethylamine (TMA) and trimethylamine-N oxide (TMAO). Very rare cases of increased INR (International Normalized Ratio) have been reported in patients undergoing concomitant therapy with L-Carnitine and coumarin drugs. The INR or other appropriate coagulation tests - must be checked weekly until the values ​​stabilize and subsequently monthly in patients taking anticoagulants together with L-Carnitine. Cases of seizures have been reported in patients, with or without a history of seizure activity, who have received L-Carnitine orally or intravenously. In patients with underlying predisposing conditions, treatment with L-Carnitine can trigger seizures. CoCarnitin B12 contains 4.075 g of sorbitol per vial. Sorbitol can cause gastrointestinal disorders e have a mild laxative effect. The additive effect of co-administration of medicinal products containing sorbitol (or fructose) and daily dietary intake of sorbitol (or fructose) should be considered. The sorbitol content in oral medicinal products may modify the bioavailability of other co-administered oral medicinal products. Patients with hereditary fructose intolerance should not be given this medicine. CoCarnitin B12 contains 1.5 g of sucrose per vial. Sucrose can be harmful to your teeth. Patients suffering from rare problems of fructose intolerance, glucose-galactose malabsorption, or sucrase isomaltase insufficiency should not take this medicine. CoCarnitin B12 contains 0.048 g sodium benzoate per vial. The increase in bilirubin following its detachment from albumin can increase neonatal jaundice which can progress to kernicterus (deposits of unconjugated bilirubin in the brain tissue). This medicinal product contains less than 1 mmol (23 mg) sodium per dose, i.e. essentially 'sodium-free'. Given the particular lability and photosensitivity of Cobamamide, any solution of the product in liquids or its mixing in other foods must take place immediately before the moment of administration. The drug is not habit-forming or addictive. Products containing Cobamamide should not be administered to anemic subjects unless on the basis of investigations aimed at establishing the exact nature of the anemia

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