Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12 Pharmacology

Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12

About Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Mechanism of Action of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Pharmacokinets of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Onset of Action for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Duration of Action for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Half Life of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Side Effects of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Contra-indications of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Special Precautions while taking Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Pregnancy Related Information
Use with caution
Old Age Related Information
N/A
Breast Feeding Related Information
Use with caution
Children Related Information
N/A
Indications for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
1.Disorders of calcium metabolism
2.Osteoporosis
3.Osteomalacia
4.Rickets
5.Tetany
Interactions for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
N/A
Typical Dosage for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
Oral: 1 tablet / day and if needed dose can be increased by 1 tablet every 2 week
Schedule of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Storage Requirements for Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Effects of Missed Dosage of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Effects of Overdose of Calcium + Vitamin D3 + Vit B6 + Magnesium + Vit B12
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Calcium

About Calcium
Calcium 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 Calcium
Calcium 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 Calcium
Absorption: 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 Calcium
N/A
Duration of Action for Calcium
N/A
Half Life of Calcium
N/A
Side Effects of Calcium
1.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 Calcium
1.Renal calculi
2.Hypophosphataemia
3.Hypercalcaemia
4.Ventricular fibrillation.
Special Precautions while taking Calcium
1.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 Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
May be used
Children Related Information
Use with caution
Indications for Calcium
1.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 Calcium
N/A
Typical Dosage for Calcium
Oral: 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 Calcium
N/A
Storage Requirements for Calcium
Store in a well closed container in a cool and dry place. Protect from light.


Effects of Missed Dosage of Calcium
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 Calcium
Remove calcium from stomach by induced emesis and gastric lavage. Provide symptomatic treatment and supportive measures.

Vitamin D3

About Vitamin D3
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Mechanism of Action of Vitamin D3
Vitamin D3 is a form of vitamin D. It is also called as Cholecalciferol.7-Dehydrocholesterol is the precursor of vitamin D3 and only forms the vitamin after being exposed to UV radiation.After exposure to the sun, cholecalciferol is sent to the liver to be hydroxylated where it becomes 25-Hydroxyvitamin D3.Next, it is sent to the kidney and once again hydroxylated becoming 1,25-Hydroxyvitamin D3. 1,25-Hydroxyvitmain D3 is the active form of vitamin D3, for this reason vitamin D is often referred to as a prohormone.Vitamin D exerts it`s action by influencing calcium homoeostasis. It increases the intestinal absorption of calcium and phosphate. It binds to the cytoplasmic Vitamin D receptor and translocates to the nucleus and thus increases the synthesis of specific m RNA and regulates protein synthesis. It increases the synthesis of a carrier protein for calcium called "calbindin" or calcium binding protein. Activation of Vitamin D receptor enhances endocytotic capture of calcium and it`s transport across duodenal mucosal cells in a vesicular form. Vitamin D promotes resorption of calcium and phosphate from bone by enhancing recruitment and differentiation of osteoclast precursors in the bone remodeling units. It helps in bone mineralization.
Pharmacokinets of Vitamin D3
Absorption: Well absorbed orally in the presence of bile salts, Malabsorption and steatorrhoea interfere with it`s absorption.
Distribution: Widely distributed in a protein bound form. It is stored in adipose tissue and liver.
Metabolism: It is hydroxylated in to both active and inactive metabolites and also metabolized in kidney.
Excretion: Metabolites are excreted mainly through bile.
Onset of Action for Vitamin D3
N/A
Duration of Action for Vitamin D3
N/A
Half Life of Vitamin D3
N/A
Side Effects of Vitamin D3
1. Hypercalcaemia
2. Fatigue
3. Weakness
4. Diarrhoea
5. Vomiting
6. Sluggishness
7. Albuminuria
8. Polyuria
9. Calcification of soft tissues (blood vessels, parenchymal organs including heart)
10. Arrhythmias
11. Renal stones
12. Growh retardation in children
13. Hypertension
14. Anorexia
15. Nausea
16. Constipation
17. Elevated liver enzymes
Contra-indications of Vitamin D3
1. Hypercalcaemia
2. Hypervitaminosis D
3. Renal osteodystrophy with hyperphosphatemia
4. Renal impairment
Special Precautions while taking Vitamin D3
1. Renal diseases
2. Renal stones
3. Cardiac diseases
4. Arteriosclerosis
5. Coronary diseases
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
Indications for Vitamin D3
1. Rickets and Osteomalacia
2. Hypoparathyroidism
3. Fanconi`s syndrome
4. Osteoporosis
Interactions for Vitamin D3
Antacids: Hypermagnesemia may develop in patients on renal dialysis who take magnesium containing antacids.
Digitalis glycosides: May precipitate cardiac arrhythmias due to hypercalcemia.
Verapamil: Atrial fibrillation may occur.
Cholestyramine: Intestinal absorption of Vitamin D may be reduced.
Mineral Oil: Prolonged use of mineral oil may result in reduced absoprtion of Vitamin D.
Phenytoin, Barbiturates: Half life of vitamin D may be reduced.
Thaizide diuretics: Hypoparathyroid patients on Vitamin D may develop hypercalcemia due to thiazide diuretics.
Typical Dosage for Vitamin D3
Oral:
Adults:
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 7.5mg orally or 250mcg I.M.
Vitamin dependent Rickets: 250mcg to 1.5mg daily
Hypoparathyroidism: 625mcg to 5mg daily with calcium supplements
Fanconi`s syndrome: 1.25 to 5mg daily
Osteoporosis: 25 to 250mcg daily or 1.25mg once weekly with calcium and fluoride supplements.
Hypophosphatemia: 250mcg to 1.5mg along with phosphate supplements
Children:
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 625mcg orally
Vitamin dependent Rickets: 75 to 125mcg daily.
Fanconi`s syndrome: 625mcg to 1.25mg daily
Hypophosphatemia: 1 to 2mg daily with phosphate supplements. Increase the dose in increments of 250 to 500mcg at intervals of 3 to 4months until desired therapeutic response is obtained.

Schedule of Vitamin D3
N/A
Storage Requirements for Vitamin D3
Store in a well closed container in a cool place. Protect from light and excess heat. Keep out of reach of children.
Effects of Missed Dosage of Vitamin D3
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 Vitamin D3
Provide supportive and symptomatic treatment. Stops the treatment and starting a low calcium diet. Increases the fluid intake and administer Loop diuretics like furosemide may be given with saline I.V. infusion to increase calcium excretion. Calcitonin may decrease hypercalcaemia.

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.

Magnesium

About Magnesium
Magnesium is essential for enzyme activity, calcium and potassium uptake, nerve transmission, bone formation and metabolism of carbohydrates and minerals. It is magnesium, not calcium, which helps form hard tooth enamel, resistant to decay. Like calcium and chloride, magnesium also plays a role in regulating the acid-alkaline balance in the body. High magnesium levels in drinking water have been linked to resistance to heart disease. Although it is found in many foods, including dairy products, nuts, vegetables, fish, meat and seafood, deficiencies are common in America due to soil depletion, poor absorption and lack of minerals in drinking water. A diet high in carbohydrates, oxalic acid in foods like raw spinach and phytic acid found in whole grains can cause deficiencies. An excellent source of usable magnesium is beef, chicken or fish broth. High amounts of zinc and vitamin D increase magnesium requirements. Magnesium deficiency can result in coronary heart disease, chronic weight loss, obesity, fatigue, epilepsy and impaired brain function. Chocolate cravings are a sign of magnesium deficiency.
Mechanism of Action of Magnesium
N/A
Pharmacokinets of Magnesium
N/A
Onset of Action for Magnesium
N/A
Duration of Action for Magnesium
N/A
Half Life of Magnesium
N/A
Side Effects of Magnesium
N/A
Contra-indications of Magnesium
N/A
Special Precautions while taking Magnesium
N/A
Pregnancy Related Information
N/A
Old Age Related Information
N/A
Breast Feeding Related Information
N/A
Children Related Information
N/A
Indications for Magnesium
N/A
Interactions for Magnesium
N/A
Typical Dosage for Magnesium
N/A
Schedule of Magnesium
N/A
Storage Requirements for Magnesium
N/A
Effects of Missed Dosage of Magnesium
N/A
Effects of Overdose of Magnesium
N/A

Vit B12

About Vit B12
N/A
Mechanism of Action of Vit B12
Vitamin 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 B12
Absorption: 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 B12
N/A
Duration of Action for Vit B12
N/A
Half Life of Vit B12
N/A
Side Effects of Vit B12
1. 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 B12
1. Hypersensitivity to the drug
2. Leber`s disease
Special Precautions while taking Vit B12
1. Anemic patients with coexisting cardiac, pulmonary and hypertensive diseases.
Pregnancy Related Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
May be used
Children Related Information
Use with caution
NEONATES : Use with caution
Indications for Vit B12
1. Vitamin B12 deficiency
2. Pernicious Anaemia
3. Peripheral neuropathy (diabetic, alcoholic, and drug induced)
Interactions for Vit B12
N/A
Typical Dosage for Vit B12
I.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 B12
C
Storage Requirements for Vit B12
Store 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 B12
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 B12
Not applicable. Even in large doses Vitamin B12 isn`t usually toxic.

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