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active ingredients of Tivorel: levocarnitine and arginine hydrochloride

1 ml contains 42 mg of arginine hydrochloride and 20 mg of levocarnitine;

excipient Tyvorel: water for injection.


Solution for infusions.


clear, colorless, or slightly yellowish liquid.


Additional solutions for intravenous administration. Amino acids. ATX code B05X B.


Pharmacological. Tivorel contains both the active ingredients of the amino acids levocarnitine and arginine hydrochloride.

Arginine (a-amino-d-guanidinovaleric acid) is an amino acid that belongs to the class of conditionally essential amino acids and is an active and versatile cellular regulator of numerous vital functions of the body, showing important protective effects in a critical state of the body.

Arginine has an antihypoxic, membrane-stabilizing, cytoprotective, antioxidant, anti-radical, detoxifying effect, manifests itself as an active regulator of intermediate metabolism and energy supply processes, plays a certain role in maintaining hormonal balance in the body. It is known that arginine increases the content of insulin, glucagon, somatotropic hormone and prolactin in the blood, participates in the synthesis of proline, polyamine, agmatine, is involved in the processes of fibrinogenolysis, spermatogenesis, and has a membrane-depolarizing effect.

Arginine is one of the main substrates in the urea synthesis cycle in the liver. The hypoammonemic effect of the drug Tivorel is realized by activating the conversion of ammonia to urea. It has a hepatoprotective effect due to its antioxidant, antihypoxic and membrane-stabilizing activity, and has a positive effect on the energy supply processes in hepatocytes.

Arginine is a substrate for NO-synthase, an enzyme that catalyzes the synthesis of nitric oxide in endotheliocytes. The drug Tivorel activates guanylate cyclase and increases the level of cyclic guanidine monophosphate (cGMP) in the vascular endothelium, reduces the activation and adhesion of leukocytes and platelets to the vascular endothelium, suppresses the synthesis of adhesion proteins VCAM-1 and MCP-1, thereby preventing the formation and development of atherosclerotic plaques, suppresses the synthesis of endothelin-1, which is a powerful vasoconstrictor and stimulant proliferation and migration of smooth myocytes of the vascular wall. Arginine also inhibits the synthesis of asymmetric dimethylarginine , a powerful endogenous oxidative stress stimulator. The drug Tyvorel stimulates the activity of the thymus gland, which produces T-cells, regulates blood glucose during physical activity.

Levocarnitine is a natural substance involved in energy metabolism, as well as the metabolism of ketone bodies. Only the L-isomer of carnitine is biologically active.

Levocarnitine is necessary for the transport of long-chain fatty acids to the mitochondria for their further beta-oxidation and energy production. Fatty acids are used as an energy substrate by all tissues, with the exception of the brain. In skeletal muscles and the myocardium, fatty acids are the main substrate for energy production.

Levocarnitine plays an important role in cardiac metabolism, since the oxidation of fatty acids depends on the availability of sufficient amounts of this substance. Experimental studies have shown that under certain conditions, such as stress, acute ischemia, and myocarditis, it is possible to reduce the level of levocarnitine in the myocardial tissue. A large number of studies have been conducted on animals that have confirmed the positive effect of levocarnitine in the case of various induced cardiac disorders: acute and chronic ischemia, decompensation of cardiac activity, heart failure as a result of myocarditis, drug-induced cardiotoxicity (taxanes, adriamycin, etc.).

By releasing coenzyme-A from complex thioesters, levocarnitine also increases the oxidation of carbohydrates in the Krebs tricarboxylic acid cycle, stimulates the activity of the key glycolysis enzyme - pyruvate dehydrogenase, and in skeletal muscles - the oxidation of branched-chain amino acids. Thus, levocarnitine is directly or indirectly involved in most energy processes, its presence is necessary for the oxidation of fatty acids, amino acids, carbohydrates and ketone bodies.

In humans, the physiological needs for carnitine are replenished by the consumption of foods containing carnitine (primarily meat), and by endogenous synthesis in the liver with trimethyllysine. The highest concentration of levocarnitine is determined in the muscle tissue, in the myocardium and liver.

Primary systemic carnitine deficiency is characterized by low concentrations of levocarnitine in blood plasma, red blood cells, and / or tissues. Secondary carnitine deficiency may be the result of congenital disorders of carnitine metabolism or iatrogenic interventions such as hemodialysis.

Pharmacokinetics. With continuous infusion, the maximum concentration of arginine hydrochloride in the blood plasma is reached after 20 to 30 minutes from the start of administration. Arginine penetrates the placental barrier, is filtered in the renal glomeruli, but is almost completely reabsorbed in the renal tubules.

Levocarnitine is absorbed by the cells of the mucous membrane of the small intestine and enters the bloodstream relatively slowly; probably, the absorption is associated with an active transluminal mechanism. Absorption after ingestion is limited (<10%) and variable.

Absorbed levocarnitine is transported to various organs through the blood; it is believed that the transport system of red blood cells is involved in the transport process.

Levocarnitine is excreted in the urine. The rate of withdrawal is directly proportional to the concentration of carnitine in the blood.

Levocarnitine is practically not metabolized in the body.


Ischemic heart disease, acute myocardial infarction and conditions after acute myocardial infarction, angina.


Hypersensitivity to the drug Tivorel. Severe renal impairment, hyperchloremic acidosis, allergic reactions in the anamnesis, the use of potassium-sparing diuretics, as well as spironolactone.


When using the drug Tivorel, it is necessary to take into account that the drug Tivorel can cause severe and persistent hyperkalemia against the background of renal failure in patients taking or taking spironolactone. The preliminary use of potassium-sparing diuretics may also contribute to an increase in the level of potassium concentration in the blood. When used simultaneously with aminophilin, it is possible to increase the level of insulin in the blood.

Simultaneous use of glucocorticoids leads to the accumulation of levocarnitine in the body tissues (except the liver). Other anabolic agents enhance the effect of the drug Tivorel.


In patients with renal insufficiency, before starting the infusion, it is necessary to check the diuresis and the level of potassium in the blood plasma, since the drug Tivorel can contribute to the development of hyperkalemia.

The drug Tivorel is used with caution when the function of the endocrine glands is impaired. The drug Tivorel can stimulate the secretion of insulin and growth hormone.

If you have a dry mouth, you need to check your blood sugar level.

Caution should be used for disorders of electrolyte metabolism, kidney diseases. If the symptoms of asthenia increase while taking the drug Tivorel, treatment should be discontinued.

Levocarnitine improves glucose uptake, so the use of Tivorel in patients with diabetes mellitus treated with hypoglycemic drugs can lead to hypoglycemia. The level of glucose in the blood plasma in such cases should be regularly monitored for timely correction of therapy.


There are no data on the use of Tivorel in pregnant women. Data on the excretion of the drug Tyvorel in breast milk and its effect on the fetus are unknown. Therefore, during pregnancy and lactation, the drug Tyvorel is prescribed only when the expected benefit to the fetus exceeds the potential risk to the fetus.


In some cases, some adverse reactions from the central nervous system can affect the ability to drive vehicles or work with mechanisms.

Dosage and administration

The drug Tivorel is administered intravenously by drip at a rate of 10 drops per minute for the first 10-15 minutes, then the rate of administration can be increased to 30 drops per minute.

The daily dose of Tivorel is 100 ml of the solution.


There is no data on the use of the drug Tivorel in children.


Symptoms: kidney failure, hypoglycemia, metabolic acidosis, high doses of Tivorel can cause diarrhea.

Treatment. In case of overdose, the infusion of the drug Tivorel should be stopped. It is necessary to control the physiological reactions and maintain the vital functions of the body. If necessary, enter pidluzhuyuchi means and means for establishing diuresis (saluretics), electrolyte solutions (0.9% sodium chloride solution, 5% glucose solution).  

Adverse reactions

General disorders: hyperthermia, feeling of heat, body aches.

From the musculoskeletal system: joint pain.

From the digestive tract: dry mouth, nausea, vomiting, abdominal pain, diarrhea.

From the skin and subcutaneous tissue: changes in the injection site, including hyperemia, itching, pallor of the skin, up to acrocyanosis.

From the immune system: hypersensitivity reactions, including rash, urticaria, angioedema.

From the cardiovascular system: fluctuations in blood pressure, changes in heart rate, pain in the heart area.

From the nervous system: headache, dizziness, feeling of fear, weakness, convulsions, tremor, more often when exceeding the speed of administration.

Laboratory parameters: hyperkalemia.

Tags: Tivorel