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Important safety considerations when using these supplements together include: Drug interactions : Berberine may potentially interact with numerous medications, including antidiabetic drugs (increasing hypoglycaemia risk), anticoagulants, and medications metabolised by CYP450 enzymes (such as ciclosporin and certain statins)

However, the Some people receiving certain treatment, such as hemodialysis, may also be deficient in L-carnitine

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doi: 10.1016/j.gene.2014.10.040

Another meta-analysis of four randomized, placebo-controlled trials found evidence of a reduction in fasting plasma glucose concentration and no improvement of glycated hemoglobin concentration in subjects with type 2 diabetes mellitus supplemented with acetyl-L-carnitine (ALCAR) (44)