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Minimal side effects have been reported, and may include nausea, abdominal cramps, and diarrhea[6] L-carnitine may increase the effects of blood thinners like Coumadin (warfarin) and Sintrom (acenocoumarol), causing excessive bruising or bleeding

doi: 10.1089/thy.2007.0069 30 PlioplysAPlioplysS
The cancer cachexia syndrome

As previously mentioned, TMAO affects cholesterol metabolism by influencing BA biosynthesis pathways (Koeth et al., 2013), and research by Chen et al

Effects of pivalic acid-containing prodrugs on carnitine homeostasis and on response to fasting in children
