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1-6 Secondary carnitine deficiency can be a consequence of inborn errors of metabolism or iatrogenic factors such as hemodialysis

timing can matter with drugs that rely on oxidative stress

A randomized controlled trial on the effect of metformin in CHD patients without diabetes showed that it (2000 mg/day, P.O for 12 months) not only decreased oxidative stress but also lowered left ventricular mass (LVM) and improved blood pressure [227]

Studies that used 1 mg/day in oral and intravenous trials did not show meaningfully better outcomes than lower doses, and higher doses were associated with more reports of headache, diarrhea, and gastrointestinal effects