Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3 Pharmacology

Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3

About Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Mechanism of Action of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Pharmacokinets of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Onset of Action for Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Duration of Action for Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Half Life of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Side Effects of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Contra-indications of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Special Precautions while taking Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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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 + Beta carotene + Vit B12 + Vit B3
1.Calcium deficiency
2.Vitamin A deficiency
3.Post-menopausal osteoporosis.
4.Rickets
5.Osteocalcaemia
6.Osteoporosis in males
Interactions for Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
N/A
Typical Dosage for Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
Adult: 1 capsule / day and if needed dose can be increased by 1 capsule every 2 week
Schedule of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Storage Requirements for Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Effects of Missed Dosage of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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Effects of Overdose of Calcium + Vitamin D3 + Beta carotene + Vit B12 + Vit B3
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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.

Beta Carotene

About Beta Carotene
A natural precursor to Vitamin A.
Mechanism of Action of Beta Carotene
Beta-carotene acts as the precursor of Vitamin A and in the body it is converted in to Vitamin A. Vitamin A is required for a variety of physiological functions in the body such as: - 1).Proper functioning of retina and formation of pigment Rhodopsin during dark adaptation. 2).promotes differentiation and maintains structural integrity of epithelia over the body and also retard the malignancies of epithelial structures.3).Promotes mucous secretion. 4).Inhibits keratinization, 5). Maintains proper bone growth, 6).Maintenance of spermatogenesis, 7).Supports foetal development, 8).Improves resistance to infection. It is required for proper antibody response, normal lymphocyte proliferation and killer cell function.
Pharmacokinets of Beta Carotene
Absorption: Completely absorbed normally. Steatorrhoea, bile deficiency, and protein poor diet adversely affects the absorption and absorption requires bile salts, pancreatic lipase, and dietary fat.
Distribution: Stored primarily as palmitate in kupffer`s cells in liver. Circulates in the form of specific alpha-1 protein; retinol binding protein and transported to cellular retinol binding protein of target cells.
Metabolism: Metabolized in the liver.
Excretion: Excreted mainly through bile and a small amount is excreted through urine.
Onset of Action for Beta Carotene
N/A
Duration of Action for Beta Carotene
N/A
Half Life of Beta Carotene
N/A
Side Effects of Beta Carotene
Adverse effects occurs only with higher doses and toxicity
1. Nausea
2. Vomiting
3. Itching
4. Dermatitis
5. Exfoliation
6. Alopecia
7. Bone and joint pain
8. Anorexia
9. Irritability
10. Increased intracranial pressure
11. Hepatic impairment
12. Anaphylactic shock
Contra-indications of Beta Carotene
1. Hypervitaminosis A
2. Hypersensitivity to Beta Carotene
Special Precautions while taking Beta Carotene
1. Oral form should not use in patients with malabsorption syndrome.
2. In inadequate bile secretion oral route may be used with concurrent administration of bile salts.
3. I. V. route is contraindicated except for special water miscible forms intended for infusion with large parenteral volumes and should not use I. V. push of vitamin A of any type.
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 Beta Carotene
1. Vitamin A deficiency
2. Xerophthalmia
3. Acne
4. Ichthyosis
5. Bitot`s spots
6. Night blindness
Interactions for Beta Carotene
Cholestyramine: Absorption of Vitamin A is reduced due to reduced availability of fat stabilizing bile salts.
Mineral oil: Interferes with intestinal absorption of Vitamin A.
Oral Contraceptives: Plasma Vitamin A levels are significantly increased.
Typical Dosage for Beta Carotene
Severe vitamin A deficiency with xerophthalmia: 500000 IU daily for 3 days followed by 50000 IU daily for 14 days. Then maintenance dosage of 10000 to 20000 IU for 2months followed by adequate dietary nutrition and RDA vitamin A supplements.
Severe vitamin A deficiency: 100000 IU daily for 3 days followed by 50000 IU daily for 14 days. Then maintenance dosage of 10000 to 20000 IU for 2months followed by adequate dietary nutrition and RDA vitamin A supplements.
Children: 5000 to 10000 IU daily for 14 days.
Schedule of Beta Carotene
C1 (Oral)
C (Parenteral)
Storage Requirements for Beta Carotene
Store in a well closed, airtight container in a cool dry place.
Effects of Missed Dosage of Beta Carotene
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 Beta Carotene
Discontinue the vitamin A if hypercalcaemia persists and administer I.V. saline, prednisolone, and calcitonin if required. Monitor hepatic function tests to detect liver damage.

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.

Vit B3

About Vit B3
N/A
Mechanism of Action of Vit B3
Niacin refers to Nicotinic acid as well as Nicotinamide which exerts it`s action by influencing metabolic reactions. It is converted in to coenzymes Ncotinamide adenine dinucleotide (NAD) and it`s phosphate Ncotinamide adenine dinucleotide phosphate (NADP) involved in oxidation reduction reactions. These pyridine nucleotides act as hydrogen acceptors in the electron transport chain in tissue respiration, glycolysis, and fat synthesis. Nicotinic acid in high doses has vasodilator effects and also improves lipid profile; reduces serum cholesterol, raises HDL level, lowers VLDL, and LDL levels.
Pharmacokinets of Vit B3
Absorption: Well absorbed orally, Distribution: Widely distributed in the body, and also secreted in to breast milk, Modest amounts are stored in liver, Metabolism: Metabolized in to active metabolites in liver, Excretion: Extra drug is excreted through urine.
Onset of Action for Vit B3
N/A
Duration of Action for Vit B3
N/A
Half Life of Vit B3
N/A
Side Effects of Vit B3
1. Flushing
2. Activation of peptic ulcer
3. Nausea
4. Vomiting
5. Diarrhoea
6. Headache
7. Rashes
8. Pruritus
9. Hypotension
10. Arrhythmias
11. Hepatic impairment
Contra-indications of Vit B3
1. Hypersensitivity to the drug
2. Hepatic impairment
3. Peptic ulcer
4. Severe hypotension
5. Arterial haemorrhage
Special Precautions while taking Vit B3
1.History of liver disease
2.Gall bladder diseases
3.Gout
4.Coronary artery diseases
5.Diabetes mellitus
6.When use along with Statins reduces the dosage of Statins
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 Vit B3
1. Pellagra
2. Niacin deficiency
3. Hartnup disease
4. Hyperlipidaemia (only nicotinic acid
5. Peripheral vascular diseases (only nicotinic acid)
Interactions for Vit B3
Aspirin: May decrease the metabolic clearance of nicotinic acid
Sympathetic blocking agent: May cause added vasodilation and hypotension
Isoniazid: may deplete levels of niacin and cause deficiency.
Typical Dosage for Vit B3
Oral:
Pellagra: 200 to 500mg daily in divided doses
Prophylactically: 20 to 50mg daily.
Dietary supplement: 10 to 20mg daily
Peripheral vascular diseases (only nicotinic acid): 100 to 150mg three to five times daily. Alternatively 1000 to 2000g once daily at bed time.
Hyperlipidaemia (only nicotinic acid): 1.5 to 6g daily in two to four divided doses with or after meals.
Hartnup disease: 50 to 200mg daily in divided doses.
Schedule of Vit B3
C1
Storage Requirements for Vit B3
Store at controlled room temperature at a range of 15 to 30 degree C
Effects of Missed Dosage of Vit B3
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 B3
Provide supportive measures and symptomatic treatment

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