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- Pharmacology For Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc
Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc Pharmacology
Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc
About Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AMechanism of Action of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/APharmacokinets of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AOnset of Action for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/ADuration of Action for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AHalf Life of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/ASide Effects of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AContra-indications of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/ASpecial Precautions while taking Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/APregnancy Related InformationUse with cautionOld Age Related InformationN/ABreast Feeding Related InformationUse with cautionChildren Related InformationN/AIndications for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc1.Osteoporosis
2.Osteomalacia
3.Hypoparathyroidism
4.Rickets
5.Vitamin supplement
Interactions for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/ATypical Dosage for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc2 capsule / daySchedule of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AStorage Requirements for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AEffects of Missed Dosage of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/AEffects of Overdose of Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + ZincN/ACalcium
About CalciumCalcium is necessary for cardiac function, muscle contraction, nervous activity, coagulation of blood and for maintaining structural integrity of cell membranes.
Plasma concentration of calcium is kept in normal range by three endocrine factors which control metabolism of calcium. These are (a) Parathyroid hormone, (b) Calcitonin, (c) Vitamin D. Calcium in plasma is bound to albumin, is complexed with anions (e.g. phosphate) and as diffusible ionic calcium. The physiological effects are exerted by ionic calcium. The predominant source of calcium is dairy products and the daily intake varies from 200 - 2500 mg. Adequate calcium intake is particularly important during periods of bone growth in childhood and adolescence and during pregnancy and lactation.
Patients with advanced renal insufficiency exhibit phosphate retention and some degree of hyperphosphataemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy and soft tissue calcification. Calcium acetate, when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the faeces.
Deficiency signs and symptoms: Osteoporosis, pathological fractures, brittle nails and hair.Mechanism of Action of CalciumCalcium is essential for maintaining the functional integrity of nervous, muscular, and skeletal system. It controls excitability of nerves and muscles and regulates permeability of cell membrane. It also regulates cell adhesion and maintains integrity of cell membrane. Calcium acts as intracellular messenger for hormones, autacoids, and transmitters. It is required for excitation-contraction coupling in all types of muscle and excitation-secretion coupling in exocrine and endocrine glands. It is essential for release of transmitters from nerve endings and other release reactions. It is also essential for impulse generation in heart and determines level of automaticity and
A-V conduction. Calcium is also required for blood-coagulation.
Pharmacokinets of CalciumAbsorption: Actively absorbed from gastrointestinal tract in an ionized form; and vitamin D in it`s active form is required for calcium absorption, Distribution: Distributed mainly in to skeletal tissue (99%) and 1% is distributed equally between the intracellular and extra cellular fluid. CSF levels are about half of the serum calcium levels, Metabolism: Not significantly metabolized in the body, Excretion: Excreted mainly through faeces and a small amount is excreted through urine.Onset of Action for CalciumN/ADuration of Action for CalciumN/AHalf Life of CalciumN/ASide Effects of Calcium1.Constipation
2.Bloating
3.Excess gas
4.Anorexia
5.Nausea
6.Vomiting
7.Abdominal pain
8.Thirst
9.Hypercalcaemia
10.Polyuria
11.Dry mouth
12.Delirium
13.Confusion
Contra-indications of Calcium1.Renal calculi
2.Hypophosphataemia
3.Hypercalcaemia
4.Ventricular fibrillation.
Special Precautions while taking Calcium1.Renal impairment
2.Cardiac diseases
3.Sarcoidosis
4.Cor pulmonale
5.Respiratory acidosis
6.Respiratory failure
7.End stage renal failure
8.Hypoparathyroid patients
9.Digitalized patients
10.Prolonged use of therapeutic amounts.
Pregnancy Related InformationUse with cautionOld Age Related InformationUse with cautionBreast Feeding Related InformationMay be usedChildren Related InformationUse with cautionIndications for Calcium1.Hypocalcaemia
2.Calcium and vitamin D deficiency
3.Calcium deficiency during pregnancy and lactation
4.Rickets
5.Prevention of osteoporosis in postmenopausal women
6.Chronic renal failure.
Interactions for CalciumN/ATypical Dosage for CalciumOral: 500mg to 2g daily in two to four divided doses.
Hypocalcaemia:
Adults: 1g daily. Increases to 2g daily if required.
Prevention of osteoporosis: 1 to 1.5g daily.
Children: 45 to 65mg/kg daily.
Neonates: 50 to 150mg/kg and should not exceed 1g.
Schedule of CalciumN/AStorage Requirements for CalciumStore in a well closed container in a cool and dry place. Protect from light.
Effects of Missed Dosage of CalciumTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of CalciumRemove calcium from stomach by induced emesis and gastric lavage. Provide symptomatic treatment and supportive measures.Calcitriol
About CalcitriolN/AMechanism of Action of CalcitriolCalcitriol is a 1, 25-dihydroxycholecalciferol or a Vitamin D analogue. It increases the absorption of Calcium from intestine by forming a calcium binding protein. It reverses the signs of rickets and osteomalacia.Pharmacokinets of CalcitriolAbsorption: It is readily absorbed after oral administration. Distribution: It is widely distributed in protein bound form. Metabolism: It undergoes metabolism in the liver and kidney. Excretion: It is excreted mainly in the faeces.Onset of Action for Calcitriol2 - 6 hoursDuration of Action for Calcitriol3 - 5 daysHalf Life of Calcitriol3 - 8 hoursSide Effects of Calcitriol1. Nausea
2. Vomiting
3. Constipation
4. Headache
5. Somnolence
6. Weakness
7. Hypertension
8. Bone and muscle pain
9. Pruritus
10. Weight loss
11. Polyuria
12. Metallic taste
13. Anorexia
14. Dry mouth
Contra-indications of Calcitriol1. Hypercalcaemia
2. Metastatic calcification
3. Plasma phosphorus level greater than 6 mg/dl
Special Precautions while taking Calcitriol1.Liver impairment
2.Renal impairment
3.Monitor plasma calcium and creatinine in patients receiving high doses
Pregnancy Related InformationUse with cautionOld Age Related InformationUse with cautionBreast Feeding Related InformationUse with cautionChildren Related InformationUse with cautionIndications for Calcitriol1.Management of Hypocalcaemia
2.Management of hypoparathyroidism and pseudohypoparathyroidismInteractions for CalcitriolN/ATypical Dosage for CalcitriolAdult:
Oral:
Management of hypocalcaemia:0.25mcg/day.Dosage can be increased by 0.25mcg/day at 1 - 2 month interval.Maintenance dose:0.25 - 1 mcg/ day.
Management of hypoparathyroidism and psedohypothyroidism:0.25mcg/day in the morning and dosage can be incresed at 2 - 4 week intervals.Maintenance dose: 0.5 - 2 mcg/day
Children:above 6 years:same as adult dose
Children 1 - 5 years: 0.25 - 0.75mcg/day Schedule of CalcitriolN/AStorage Requirements for CalcitriolStore in a well closed container.Protect from heat,light and moisture.Keep out of the reach of children.Effects of Missed Dosage of CalcitriolTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Do not double the dose.Continue the regular schedule.Effects of Overdose of CalcitriolGive supportive mesures and symptomatic treatment. Vit B12
About Vit B12N/AMechanism of Action of Vit B12Vitamin B12 is an essential constituent for growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis. Vitamin B12 is converted in to coenzyme B12 in the tissues which is essential for conversion of methyl-malonate to succinate and synthesis of methionine from homocystine. It is also associated with fat and carbohydrate metabolism and protein synthesis. Cells characterized by rapid division such as epithelial cells, bone marrow, and myeloid cells appear to have greatest requirement of Cyanocobalamin.Pharmacokinets of Vit B12Absorption: Absorbed irregularly after oral administration and absorption depends on Ca and intrinsic factor. It is also administered subcutaneously and intramuscularly.
Distribution: Distributed in to liver, bone marrow, and other tissues. It crosses the placenta and appears in breast milk.
Metabolism: It is metabolized in liver.
Excretion: In normal dosage it is reabsorbed from bile and a minute portion is excreted through urine but the extra drug is excreted through urine.
Onset of Action for Vit B12N/ADuration of Action for Vit B12N/AHalf Life of Vit B12N/ASide Effects of Vit B121. Anaphylaxis
2. Anaphylactoid reactions
3. Pain and burning sensation at injection site
4. Itching
5. Urticaria
6. Transient diarrhea
7. Peripheral vascular thrombosis
8. Pulmonary oedema
Contra-indications of Vit B121. Hypersensitivity to the drug
2. Leber`s disease
Special Precautions while taking Vit B121. Anemic patients with coexisting cardiac, pulmonary and hypertensive diseases.Pregnancy Related InformationMay be usedOld Age Related InformationMay be usedBreast Feeding Related InformationMay be usedChildren Related InformationUse with caution
NEONATES : Use with caution
Indications for Vit B121. Vitamin B12 deficiency
2. Pernicious Anaemia
3. Peripheral neuropathy (diabetic, alcoholic, and drug induced)
Interactions for Vit B12N/ATypical Dosage for Vit B12I.M., S.C.:
Pernicious Anaemia: 100mcg daily for 1 week followed by the same dose given on alternate days for 7 doses and then every 3 to 4days for another 3 weeks. This regimen should be followed by 100mcg monthly for life. Concurrently administer folic acid if required.
Vitamin B12 deficiency other than pernicious Anaemia: 30mcg daily for 5 to 10days depending up on the severity of the condition.
Maintenance dosage: 100 to 200mcg once monthly.
Children: 100mcg I.M. or S.C. over the course of 2 or more weeks.
Maintenance dosage: 60mcg monthly I.M. or S.C.
Schilling test flushing dose:
Adults and Children: 1000mcg I.M. in single dose
Recommended RDA (recommended dietary allowance) for Vitamin B12:
Infants up to 6months of age: 0.3mcg.
Children age 6 months to 1 year: 0.5mcg.
Children age 1 to 3: 0.7mcg.
Children age 4 to 6: 1mcg.
Children age 7 to 10: 1.4mcg.
Children age 11 to adult: 2mcg..
Pregnant women: 2.2mcg.
Breast feeding women: 2.6mcg.
Schedule of Vit B12CStorage Requirements for Vit B12Store at room temperature range of 15 to 30 degree C.in a light resistant well closed container in a dry place.Effects of Missed Dosage of Vit B12Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of Vit B12Not applicable. Even in large doses Vitamin B12 isn`t usually toxic.Folic Acid
About Folic AcidDietary supplement, Folate derivative( B9 ), Water Soluble Vitamin.Mechanism of Action of Folic AcidFolic acid reduced by enzymes folate reductase and dihydrofolate reductase and forms dihydrofolic acid tetrahydrofolic acid respectively. Tetrahydrofolic acid acts as a coenzyme which mediates a number of one carbon transfer reactions by carrying a methyl group as an adduct. It involves a number of reactions such as 1).conversion of homocysteine to methionine. 2).synthesis of thymidylate which is an essential constituent of DNA from methylene-tetrahydrofolic acid. 3). Conversion of serine to glycine by tetrahydrofolic acid and forms methylene-tetrahydrofolic acid. 4).to introduce carbon units at position 2 and 8 during de novo purine synthesis requires formyl-tetrahydrofolic acid and methenyl-tetrahydrofolic acid.5).generation and utilization of "formate pool". 6).For mediating formino group transfer in histidine metabolism. Folic acid is required to maintain normal erythropoiesis and nucleoprotein synthesis.Pharmacokinets of Folic AcidAbsorption: Well absorbed orally
Distribution: Widely distributed in the body and highest concentration is seen in liver. It appears in the CSF and breast milk
Metabolism: Metabolized in to N-methyl tetrahydrofolic acid in liver
Excretion: Extra drug is excreted unchanged in urine. A small portion of folate is lost by a combination of urinary and fecal excretion and oxidative cleavage of molecule.
Onset of Action for Folic AcidOral: 20 to 30minutes
I.V.: 5 minutes
I.M.:10 to 20minutes
Duration of Action for Folic AcidOral: 3 to 6 hours
I.V.:3 to 6minutes
I.M.:3 to 6hours
Half Life of Folic AcidN/ASide Effects of Folic AcidN/AContra-indications of Folic AcidN/ASpecial Precautions while taking Folic Acid1. In patients with undiagnosed anaemia; because it may mask pernicious anaemia
2. In pernicious anaemia and other megaloblastic where vitamin B12 is deficient
Pregnancy Related InformationMay be usedOld Age Related InformationMay be usedBreast Feeding Related InformationMay be usedChildren Related InformationMay be usedIndications for Folic Acid1. Megaloblastic anaemia
2. Folic acid deficiency
3. Anaemias of pregnancy
4. Nutritional anaemia
5. Alcoholism
6. Tropical sprue
7. Non tropical sprue
Interactions for Folic Acid1. Hypersensitivity reactions with injection form
2. Bronchospasm
Typical Dosage for Folic AcidOral: 5mg 1 to 4 times daily; depending up on the severity of deficiency.
Maintenance dosage: Half of the therapeutic dosage.
Children: 2.5 to 5mg 1 to 2 times daily.
Schedule of Folic AcidC1 (Oral)
C (Parenteral)
Storage Requirements for Folic AcidStore at controlled room temperature at a range of 15 to 25 degree C in a well closed container. Protect from excess heat, light and moisture.Effects of Missed Dosage of Folic AcidTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of Folic AcidRelatively non toxic. Provide symptomatic treatment and supportive measures.Vit B6
About Vit B6Physiological functions: It is involved as a coenzyme (Pyridoxal phosphate) in metabolism of tryptophan, in several metabolic transformations of amino acids including transamination, decarboxylation & racemization.
Deficiency symptoms: Peripheral neuritis, seizures, stomatitis, glossitis, anaemia, seborrhea like lesions.Mechanism of Action of Vit B6Vitamin B6 is a collective term for Pyridoxine, Pyridoxal, Pyridoxamine and their phosphorylated derivatives such as Pyridoxine phosphate, Pyridoxal phosphate and Pyridoxamine derivatives respectively. Vitamin B6 is essential for the metabolism of amino acid, glycogen and fatty acids, for nerve functions, for the formation of red blood cells and also helps the skin healthy. Vitamin B6 is also used for the synthesis of nucleic acid, Haemoglobin, Sphingomyelin, other Sphingolipids, Serotonin, Dopamine, Noradrenaline and GABA.Pharmacokinets of Vit B6Absorption: Vitamin B6 is readily absorbed after oral administration.
Distribution: It is mainly distributed in the body in protein bound form. It is stored primarily in the liver and to a lesser extent muscle and brain.
Metabolism: It is metabolised in the liver
Onset of Action for Vit B6N/ADuration of Action for Vit B6N/AHalf Life of Vit B615-20 daysSide Effects of Vit B61. Neuropathy
2. Unstable gait
3. Drowsiness
4. Perioral numbness
5. Paresthesia
6. Numbness of feet
7. Somnolence
8. Sensory neuropathy
9. Ataxia
Contra-indications of Vit B61. Hypersensitivity to Vitamin B6Special Precautions while taking Vit B6N/APregnancy Related InformationMay be usedOld Age Related InformationMay be usedBreast Feeding Related InformationUse with cautionChildren Related InformationUse with caution
NEONATES: Contraindicated
Indications for Vit B61. Vitamin B6 deficiency including inadequate diet and drug induced causes
2. Neuropathy
3. Premenstrual syndrome
4. Hyperoxaluria type 1
5. Metabolic disorder
6. Isoniazid poisoning
Interactions for Vit B6Cycloserine, Hydralazine, Isoniazide, Oral contraceptive, Penicillamine: Increase Pyridoxine requirement.
Levodopa: Pyridoxine reverses the therapeutic effect of Levodopa.
Phenobarbital, Phenytoin: Pyridoxine decreases serum level of these anticonvulsants.
Typical Dosage for Vit B6Adult: 10 - 20 mg / day
Dietary deficiency: 2.5 -10 mg / day for effective therapeutic response is obtained.
Maintenance dose: 2 - 5 mg / day for several weeks.
Drug induced deficiency: 100 - 200 mg / day for 3 weeks.
Maintenance dose: 25 - 100 mg / day
Neuropathy: 50 - 200 mg /day
Premenstrual syndrome: 40 - 500 mg / day
Hyperoxaluria type 1: 25 - 300 mg / day
Metabolic disorder: 100-500 mg /day.
Isoniazid poisoning: Initial dose: 1 - 4 g as IV administration, then 1 g IM every 30 minute until Pyridoxine dose is equal to the Isoniazid dose has been given.
Schedule of Vit B6N/AStorage Requirements for Vit B6Store it at 15 - 30 degree C. Protect from moisture and heat.Effects of Missed Dosage of Vit B6Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of Vit B6Give supportive measures and symptomatic treatment. The signs of Pyridoxine overdose can be resolved by discontinuation (withdrawal) of Pyridoxine.Zinc
About ZincTrance metal, Dietary mineral, Nutritional supplement,Treatment of zinc deficiency,in wound healing.Mechanism of Action of ZincZinc acts as a cofactor for more than 70 different enzymes. Zinc dependent enzymes are involved in the metabolism of carbohydrates, lipids, and proteins. Zinc facilitates wound healing, normal growth rates, normal skin hydration and maintains senses of taste and smell. It provides normal growth and tissue repair. It also helps in development of cell mediated immunity.Pharmacokinets of ZincAbsorption: Poorly absorbed orally, Distribution: Zinc is distributed mainly in to skeletal muscle, skin, bone, pancreas, kidney, liver, retina, prostate, RBC, and WBC. Excretion: Excreted mainly through intestine; only 2% loss in the urine.Onset of Action for ZincN/ADuration of Action for ZincN/AHalf Life of ZincN/ASide Effects of Zinc1. Nausea
2. Vomiting
3. Abdominal distress
4. Gastric ulceration
5. Rashes
Contra-indications of ZincN/ASpecial Precautions while taking Zinc1.Don`t exceed prescribed dose
2.Renal failure
3.Biliary obstruction
Pregnancy Related InformationUse with cautionOld Age Related InformationN/ABreast Feeding Related InformationN/AChildren Related InformationN/AIndications for Zinc1. Zinc deficiency
2. Acne vulgaris
3. Chronic skin ulcers
4. Adjunct to antimicrobials
5. Delayed wound healing
6. Alopecia
Interactions for ZincFluoroquinolones, Tetracyclines: Decreased GI absorption and serum levels of some fluoroquinolone.
Pencillamine: Reduced absorption of zinc.
Iron: Reduced absorption of iron and vice versa.
Typical Dosage for ZincAdults: 25 to 50mg zinc daily or 1 to 2 tablets daily.
Children: 5mg/kg 1 to 3 times daily.
Schedule of ZincN/AStorage Requirements for ZincStore at a temperature below 30 degree CEffects of Missed Dosage of ZincTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of ZincProvide symptomatic treatment and supportive measuresHome Delivery for Calcium + Calcitriol + Vit B12 + Folic acid + Vit B6 + Zinc in Your City
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