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doi: 10.1111/acel.14054

Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue inmultiple sclerosis: results of a pilot, randomised, double-blind, crossover trial

In rare cases, especially with high doses or improper administration, more serious side effects can occur, such as issues affecting the liver or kidneys

That said, the clinical evidence for routine 5-MTHF in over-35s without an MTHFR polymorphism remains limited, and folic acid at the 400 g dose remains the guideline-backed default