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High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series Full Text
BMC Neurology, 08/17/2011
Clinical Article
Boles RG – This data suggests that a protocol consisting of mitochondrial–targeted cofactors (co–enzyme Q10 and L–carnitine) plus amitriptyline (or possibly cyproheptadine in preschoolers) coupled with blood level monitoring is highly effective in the prevention of vomiting episodes.
Methods- Retrospective chart review of 42 patients seen by one clinician that met established Cyclic vomiting syndrome(CVS) diagnostic criteria revealed 30 cases with available outcome data.
- Participants were treated on a loose protocol consisting of fasting avoidance, co-enzyme Q10 and L-carnitine, with the addition of amitriptyline (or cyproheptadine in those< 5 years) in refractory cases.
- Blood level monitoring of the therapeutic agents featured prominently in management.
- Vomiting episodes resolved in 23 cases, and improved by>75% and >50% in three and one additional case respectively.
- Among the three treatment failures, two could not tolerate amitriptyline (as was also the case in the child with only>50% efficacy) and one had multiple congenital gastrointestinal anomalies.
- Excluding the latter case, substantial efficacy (>75% response) was 26/29 at the start of treatment, and 26/26 in those able to tolerate the regiment, including high dosages of amitriptyline.
