Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids Pharmacology

Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

About Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Mechanism of Action of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Pharmacokinets of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Onset of Action for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Duration of Action for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Half Life of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Side Effects of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Contra-indications of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Special Precautions while taking Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Pregnancy Related Information

Use with caution

Old Age Related Information

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Breast Feeding Related Information

Use with caution

Children Related Information

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Indications for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

1.Calcium deficiency
2.Osteoporosis
3.Osteocalcaemia

Interactions for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Typical Dosage for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

Adult: 1 capsule / day and if needed dose can be increased by 1 capsule every 2 week

Schedule of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Storage Requirements for Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Effects of Missed Dosage of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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Effects of Overdose of Calcium + Vitamin D3 + Phosphorus + Vit B12 + Amino acids

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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

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Duration of Action for Calcium

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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

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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

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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

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Duration of Action for Vitamin D3

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Half Life of Vitamin D3

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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

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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.

Phosphorus

About Phosphorus

Essential nutritional element , Mineral.

Mechanism of Action of Phosphorus

The second most abundant mineral in the body, phosphorus is needed for bone growth, kidney function and cell growth. It also plays a role in maintaining the body`s acid-alkaline balance. Phosphorus is found in many foods, but in order to be properly utilized, it must be in proper balance with magnesium and calcium in the blood. Excessive levels of phosphorus in the blood, often due to the consumption of soft drinks containing phosphoric acid, can lead to calcium loss and to cravings for sugar and alcohol; too little phosphorus inhibits calcium absorption and can lead to osteoporosis. Best sources are animal products, whole grains, legumes and nuts.

Pharmacokinets of Phosphorus

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Onset of Action for Phosphorus

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Duration of Action for Phosphorus

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Half Life of Phosphorus

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Side Effects of Phosphorus

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Contra-indications of Phosphorus

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Special Precautions while taking Phosphorus

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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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Children Related Information

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Indications for Phosphorus

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Interactions for Phosphorus

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Typical Dosage for Phosphorus

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Schedule of Phosphorus

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Storage Requirements for Phosphorus

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Effects of Missed Dosage of Phosphorus

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Effects of Overdose of Phosphorus

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Vit B12

About Vit B12

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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

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Duration of Action for Vit B12

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Half Life of Vit B12

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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

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.

Amino acids

About Amino acids

An amino acid is any molecule that contains both amine and carboxyl functional groups. These amino acids are the basic components of proteins. There are twenty standard amino acids used by cells in protein biosynthesis that are specified by the general genetic code.
Amino acids are joined to each other by peptide bonds. A peptide bond is a chemical bond formed between two molecules (carboxyl group of one molecule reacts with the amino group of the other molecule), releasing a molecule of water (H2O). The resulting CO-NH bond is called a peptide bond, the chemical bond that links the amino acid monomers in a protein chain. Each protein has its own unique amino acid sequence that is known as its primary structure. Amino acids can be linked together in varying sequences to form a huge variety of proteins. The unique shape of each protein determines its function in the body.
Aminoacids are of 2 types, essential and nonessential. Essential amino acids are the ones that must be obtained in the diet and non-essential are synthesized within the body
Essential aminoacids: Methionine, Threonine, Tryptophan, Valine, Isoleucine, Leucine, Lysine, Phenylalanine, Histidine,
Nonessential aminoacids: Alanine, Asparagine, Aspartic acids, Proline, Glutamic acid, Glutamine, Serine
Amino acids Arginine, Cysteine, Glycine and Tyrosine are considered conditionally essential, meaning they are not normally required in the diet, but must be supplied exogenously to specific populations that do not synthesize it in adequate amounts
Histidine and Arginine are generally only considered essential in children, because the metabolic pathways that synthesize these amino acids are not fully developed in children.
Nutritional role of aminoacids: Aminoacids have been used orally or in relatively dilute solutions intravenously as supplementary nutrients for patients unable to metabolize intact protein adequately. For patients in whom oral or tube feeding is contraindicated or Inadequate good nutrition may be achieved or maintained by intravenous feeding known as total parenteral nutrition or intravenous or parenteral hyperalimentation. Such feeding provides essential nutrients in a sufficiently concentrated form that does not exceed normal daily fluid requirements.

Mechanism of Action of Amino acids

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Pharmacokinets of Amino acids

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Onset of Action for Amino acids

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Duration of Action for Amino acids

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Half Life of Amino acids

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Side Effects of Amino acids

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Contra-indications of Amino acids

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Special Precautions while taking Amino acids

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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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Children Related Information

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Indications for Amino acids

1.Hypoproteinaemia
2.Pre and post surgery

Interactions for Amino acids

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Typical Dosage for Amino acids

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Schedule of Amino acids

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Storage Requirements for Amino acids

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Effects of Missed Dosage of Amino acids

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Effects of Overdose of Amino acids

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