High degree of efficacy in the treatment of cyclic vomiting syndrome with combined co-enzyme Q10, L-carnitine and amitriptyline, a case series

BMC Neurol. 2011 Aug 16;11:102. doi: 10.1186/1471-2377-11-102.

Abstract

Background: Cyclic vomiting syndrome (CVS), defined by recurrent stereotypical episodes of nausea and vomiting, is a relatively-common disabling and historically difficult-to-treat condition associated with migraine headache and mitochondrial dysfunction. Limited data suggests that the anti-migraine therapies amitriptyline and cyproheptadine, and the mitochondrial-targeted cofactors co-enzyme Q10 and L-carnitine, have efficacy in episode prophylaxis.

Methods: A retrospective chart review of 42 patients seen by one clinician that met established 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.

Results: 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.

Conclusion: Our data suggest 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenergic Uptake Inhibitors / therapeutic use*
  • Adult
  • Amitriptyline / therapeutic use*
  • Carnitine / therapeutic use*
  • Child
  • Child, Preschool
  • Diet Therapy
  • Female
  • Humans
  • Male
  • Retrospective Studies
  • Ubiquinone / analogs & derivatives*
  • Ubiquinone / therapeutic use
  • Vitamins / therapeutic use*
  • Vomiting / diet therapy
  • Vomiting / drug therapy*
  • Young Adult

Substances

  • Adrenergic Uptake Inhibitors
  • Vitamins
  • Ubiquinone
  • Amitriptyline
  • coenzyme Q10
  • Carnitine

Supplementary concepts

  • Familial cyclic vomiting syndrome