Atorvastatin + Methylcobalamine + Folic acid + Vit B6 Pharmacology

Atorvastatin + Methylcobalamine + Folic acid + Vit B6

About Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Mechanism of Action of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Pharmacokinets of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Onset of Action for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Duration of Action for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Half Life of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Side Effects of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Contra-indications of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Special Precautions while taking Atorvastatin + Methylcobalamine + Folic acid + Vit B6
N/A
Pregnancy Related Information
Contraindicated; Since Atorvastatin is contraindicated in pregnancy.
Old Age Related Information
N/A
Breast Feeding Related Information
Contraindicated; Atorvastatin is contraindicated in lactation. So the combination generic is contraindicated in breast feeding mother
Children Related Information
N/A
Indications for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
1.Hypercholesterolemia
2.Combined hyperlipidaemia
Interactions for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
N/A
Typical Dosage for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
Adult: 1 tablet / day
Schedule of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Storage Requirements for Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Effects of Missed Dosage of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Effects of Overdose of Atorvastatin + Methylcobalamine + Folic acid + Vit B6
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Atorvastatin

About Atorvastatin
HMG-CoA Reductase Inhibitor, statins, Antilipemic agent.
Mechanism of Action of Atorvastatin
It is a more potent statin which competitively inhibits the conversion of 3-hydroxy-3-methyl glutaryl coenzyme A (HMG CoA) to mevalonate. The drug exerts it`s action by specific inhibition of enzyme; 3-hydroxy-3-methyl glutaryl coenzyme A reductase (HMG CoA reductase) and reduces cholesterol synthesis up to 50% at therapeutic doses. This results in compensatory increase in low density lipoprotein (LDL) receptor expression in liver which ultimately leads to increased receptor mediated uptake and catabolism of intermediate density lipoprotein(IDL) and low density lipoprotein (LDL). It causes dose dependent lowering of LDL cholesterol and reduces hepatic synthesis of very low density lipoprotein (VLDL) and lowers plasma triglyceride levels. It also increases high density lipoprotein (HDL) levels. It also exerts antioxidant property.
Pharmacokinets of Atorvastatin
Absorption: Readily absorbed orally, Distribution: Widely distributed in a highly protein bound form, Metabolism: Metabolized in liver in to active metabolite, Excretion: Excreted mainly through bile.
Onset of Action for Atorvastatin
N/A
Duration of Action for Atorvastatin
N/A
Half Life of Atorvastatin
18 to 24 hours
Side Effects of Atorvastatin
1.Headache
2.Dizziness
3.Insomnia
4.Alopecia
5.Anorexia
6.Abdominal discomfort
7.Heart burn
8.Abdominal pain
9.Nausea
10.Dyspepsia
11.Flatulence
12.Constipation
13.Abnormal liver function tests
14.Rash
15.Pruritus
16.Fatigue
17.Myositis
18.Chest pain
19.Impotence
20.Myopathy
21.Upper respiratory tract infections

Contra-indications of Atorvastatin
1.Hypersensitivity to the drug
2.Active liver diseases
3.Persistent elevation of serum transaminase levels
Special Precautions while taking Atorvastatin

1.Monitor hepatic function tests and lipid levels before and periodically during therapy and stop drug if there is marked elevation of creatinine phosphokinase level
2.History of liver diseases
3.Alcoholics
4.In severe adverse effects and fever


Pregnancy Related Information
Contraindicated
Old Age Related Information
May be used
Breast Feeding Related Information
Contraindicated
Children Related Information
Use with caution
Below 9years: Contraindicated
Indications for Atorvastatin
1.Hypercholesterolemia
2.Combined hyperlipidaemia
Interactions for Atorvastatin
N/A
Typical Dosage for Atorvastatin
Oral:
Starts with 10mg once daily; Increased if required based on patients response.
Maximum dose: 80mg
Schedule of Atorvastatin
H
Storage Requirements for Atorvastatin
Store at room temperature at a range of 15 to 25 degree C.
Effects of Missed Dosage of Atorvastatin
Take 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 Atorvastatin
Provide supportive care and symptomatic treatment.

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Pregnancy Related Information
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Old Age Related Information
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Breast Feeding Related Information
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Folic Acid

About Folic Acid
Dietary supplement, Folate derivative( B9 ), Water Soluble Vitamin.
Mechanism of Action of Folic Acid
Folic 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 Acid
Absorption: 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 Acid
Oral: 20 to 30minutes
I.V.: 5 minutes
I.M.:10 to 20minutes
Duration of Action for Folic Acid
Oral: 3 to 6 hours
I.V.:3 to 6minutes
I.M.:3 to 6hours
Half Life of Folic Acid
N/A
Side Effects of Folic Acid
N/A
Contra-indications of Folic Acid
N/A
Special Precautions while taking Folic Acid
1. 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 Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
May be used
Children Related Information
May be used
Indications for Folic Acid
1. 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 Acid
1. Hypersensitivity reactions with injection form
2. Bronchospasm
Typical Dosage for Folic Acid
Oral: 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 Acid
C1 (Oral)
C (Parenteral)
Storage Requirements for Folic Acid
Store 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 Acid
Take 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 Acid
Relatively non toxic. Provide symptomatic treatment and supportive measures.

Vit B6

About Vit B6
Physiological 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 B6
Vitamin 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 B6
Absorption: 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 B6
N/A
Duration of Action for Vit B6
N/A
Half Life of Vit B6
15-20 days
Side Effects of Vit B6
1. 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 B6
1. Hypersensitivity to Vitamin B6
Special Precautions while taking Vit B6
N/A
Pregnancy Related Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES: Contraindicated
Indications for Vit B6
1. 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 B6
Cycloserine, 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 B6
Adult: 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 B6
N/A
Storage Requirements for Vit B6
Store it at 15 - 30 degree C. Protect from moisture and heat.
Effects of Missed Dosage of Vit B6
Take 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 B6
Give supportive measures and symptomatic treatment. The signs of Pyridoxine overdose can be resolved by discontinuation (withdrawal) of Pyridoxine.

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