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Several forms of carnitine exist, and the distinctions matter for understanding supplement formulations: L-carnitine (levocarnitine) is the biologically active form and the one used in most compounded semaglutide formulations Acetyl-L-carnitine (ALCAR) is an acetylated form that crosses the blood-brain barrier more readily and is more commonly studied for cognitive applications L-carnitine L-tartrate is a form often used in sports supplements due to faster absorption rates Propionyl-L-carnitine shows particular benefit for circulation and is studied in peripheral vascular disease When compounding pharmacies add L-carnitine to semaglutide, they use levocarnitine, the standard bioactive form