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Meldonium is thought to influence energy metabolism through its reduction of levocarnitine (L-carnitine). L-carnitine transports activated long-chain fatty acids from the cytosol into the mitochondria where a-oxidation and adenosine triphosphate (ATP) production occur. Meldonium inhibits the enzyme g-butyrobetaine hydroxylase and the transportation of fatty acids by L-carnitine. In combination, this reduces the levels of L-carnitine in tissues and plasma. The reduction of L-carnitine causes a shift of energy metabolism from highly oxygen-consuming fatty acid oxidation to increased glucose metabolism. Aerobic glucose oxidation is more efficient, consumes far less oxygen, and increases the effectiveness of ATP generation.
Fig. 1 Meldonium reduces L-carnitine production through competitive inhibition of g-butyrobetaine dehydrogenase. (Cordiner R. 2016)
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