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Drug interactions Pivalic acid combines with L-carnitine and is excreted in the urine as pivaloylcarnitine, thereby increasing L-carnitine losses (see also Secondary carnitine deficiency)

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Bischoff SC, Barbara G, Buurman W, et al

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However, the company recommends waiting until the refill date so your medical provider has time to determine if the drug is working as it should be