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As children with SMA may have a limited carnitine synthetic capacity due to significantly diminished skeletal muscle mass, and VPA is known to inhibit carnitine transport and deplete carnitine levels by binding to VPA metabolites, we elected to combine VPA therapy with sufficient supplemental carnitine to avoid concerns about a confounding effect of carnitine depletion
It can also increase the risk of pancreatitis, bowel obstruction, and gastroparesis (stomach paralysis)
Rotate the injection site each time to avoid irritation
Current state: VA formulary generally includes semaglutide for type 2 diabetes (Ozempic)
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