Comparison of the Effect of Adding L-Carnitine to Propranolol in the Prevention of Cyclic Vomiting Syndrome Attacks in Children

Fatemeh Famouri; Somayeh Janani; Victoria Chegini; Hossein Saneian; Majid Khademian; Mehri Khoshhali; Peiman Nasri

doi:10.18502/jimc.v5i3.10948

Fatemeh Famouri Metabolic Liver Disease Research Center, Imam Hosein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Somayeh Janani Metabolic Liver Disease Research Center, Imam Hosein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Victoria Chegini Department of Pediatrics, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hossein Saneian Metabolic Liver Disease Research Center, Imam Hosein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Majid Khademian Metabolic Liver Disease Research Center, Imam Hosein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Mehri Khoshhali Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
Peiman Nasri Metabolic Liver Disease Research Center, Imam Hosein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/jimc.v5i3.10948

Keywords: Children, Cyclic vomiting syndrome, L-carnitine, Propranolol

Abstract

Background: Cyclic Vomiting Syndrome (CVS) is an idiopathic, complex, multifactorial disorder that is often characterized by recurrent episodes of vomiting and is usually separated by asymptomatic episodes. Prophylaxis should be considered in children with frequent or severe periods. Prevention and treatment of CVS in children is very difficult and no specific and effective treatment has been proven in clinical trials. Propranolol is approved for the prophylaxis of CVS in children of all ages, but its effectiveness has been variable. In this study, we investigated the efficacy and safety of adding L-Carnitine to propranolol therapy in the prevention of pediatric CVS.

Methods: 76 children who were diagnosed with CVS were included in this study. They were divided into two equal groups. The first group received high dose of Propranolol and the case group received L-Carnitine with low dose of propranolol for 6 months.

Results: CVS attacks’ frequency in both groups of treatment with propranolol alone and in combination with L-Carnitine and propranolol, before and after the treatment was significantly reduced. But there is no significant difference between the two groups 70.6%) vs. 90.9%) (p-value=0.062). There was no significant reduction in the duration days between vomiting attack index in both groups (31.6 % vs.43.2%) (p-value= 0.345).

Conclusion: Our research revealed that combination of low dose propranolol with L-Carnitine has comparable efficacy with high dose Propranolol in prophylaxis of CVS.