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Levocarnitine + acetylcysteine is a compounded combination therapy being investigated for the treatment of refractory subjective tinnitus associated with post-acute sequelae of SARS-CoV-2 (PASC/Long COVID) and post-COVID-19 vaccine injury. The formulation is typically prepared as a transdermal cream in a dimethyl sulfoxide (DMSO) base, which acts as a penetration enhancer to facilitate delivery to the mastoid and periauricular regions. Levocarnitine (L-carnitine) is an essential cofactor in mitochondrial fatty acid metabolism, helping to maintain cellular energy production, while acetylcysteine (N-acetylcysteine) serves as a precursor to glutathione, providing potent antioxidant and neuroprotective effects. Together, these components aim to mitigate oxidative stress and mitochondrial dysfunction in the auditory system, which are hypothesized to contribute to the persistence of tinnitus in these patient populations.
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