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10.3390/cells8091106 78 KimuraI.InoueD.MaedaT.HaraT.IchimuraA.MiyauchiS.et al (2011)

however, the majority have failed clinical trials due to adverse side effects, which typically include increased blood lipid levels and/or fatty liver, suggesting that prolonged and chronic activation of hepatic GCK adversely affects hepatic lipid metabolism (69, 84)

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Infants, particularly premature infants, are born with low stores of L-carnitine, which could put them at risk of deficiency given their rapid rate of growth

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It undergoes significant first-pass metabolism in the liver and intestines, where the enzyme arginase breaks it down, reducing bioavailability