Lorenzo's Oil

Common Name(s): Erucic acid, Glyceryl trierucate, Glyceryl trioleate, Lorenzo's oil, Oleic acid

Medically reviewed by Drugs.com. Last updated on Sep 20, 2021.

Clinical Overview

Use

Open-label studies in asymptomatic boys (average age at diagnosis, 7 years) with negative magnetic resonance imaging (MRI) and in adults with "pure" adrenomyeloneuropathy (AMN) (ie, noncerebral) suggest that the administration of daily Lorenzo's oil can prevent or slow the progression of the disease. However, there have been no controlled clinical trials.

Dosing

Information is limited and dosage adjustment may be necessary to avoid adverse thrombocytopenia. Lorenzo's oil 2 to 3 mL/day in children 8 years of age (average) has been used in a clinical study. Case studies in Zellweger syndrome report using Lorenzo's oil 2 g/kg daily.

Contraindications

None well documented.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

None well documented.

Adverse Reactions

Thrombocytopenia has been reported following treatment with Lorenzo's oil.

Toxicology

Information is lacking.

History

A widely publicized 1992 film (Lorenzo's Oil) about a triglyceride mixture used in the treatment of adrenoleukodystrophy (ALD) made the general public aware of the product.Hudson 2000

Chemistry

Lorenzo's oil is a combination of glyceryl trierucate (an ester of erucic acid, a 22-carbon monounsaturated fatty acid) and glyceryl trioleate (an ester of oleic acid, an 18-carbon monounsaturated fatty acid), which are generally combined in an approximate ratio of 1:4 (glycerol trierucate:glycerol trioleate) when used for clinical evaluation.Moser 2004

Uses and Pharmacology

Diabetes

As a component of medical nutrition therapy for patients with type 2 diabetes, the American Diabetes Association Standards of Care (2014) recommend higher quality dietary fat intake, as an alternative to decreased fat intake, by replacing saturated and/or trans fats with mono- and poly-unsaturated fatty acids in the diet. This Mediterranean-style approach to eating may improve glycemic control and cardiovascular disease risk factors (moderate-quality evidence).ADA 2014

Peroxisomal disorders

Peroxisomal disorders are a group of inherited metabolic disorders that result in demyelination, progressive brain damage, and premature death.

In ALD, a deficiency in a transporter protein results in a lack of the enzyme required to oxidize very long chain fatty acids (VLCFA) with a consequent accumulation of these fatty acids in body fluids and tissues. This X-linked recessive disorder is characterized by demyelination of cerebral nerves resulting in a variety of neurological symptoms, including peripheral neuropathy, blindness, and spastic tetraplegia. The disease is also associated with adrenocortical insufficiency and hypogonadism.Moser 2004, Moser 2005, Moser 2006 Treatment includes adrenal steroid replacement, bone marrow transplantation, and Lorenzo's oil. Alternative therapies based largely on animal studies include lovastatin, phenylbutyrate, arginine butyrate, and gene therapy.Moser 2004, Pai 2000

Distinct forms of ALD exist. The most common form of ALD is adrenomyeloneuropathy (AMN), a slowly progressing, non-inflammatory form occurs mostly in adults. Childhood cerebral ALD, another of the most common forms, progresses rapidly, while adolescent cereb...