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Nauck MA, Meier JJ, Cavender MA, Abd El MA, Drucker DJ

It is important to note that concentration is not the only factor determining efficacy: the galenic formulation, pH and presence of cofactors significantly influence the peptide's bioavailability

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On the other hand, the (R)-4-chloro-3-hydroxy butyric acid alkyl ester is reacted with trimethylamine and then the reaction product is treated with hydrochloric acid to thereby prepare L-carnitine hydrochloride which is then reacted with acetic acid containing acetyl chloride to prepare acetyl L-carnitine hydrochloride