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- Pharmacology For Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acid
Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acid Pharmacology
Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidAbout Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AMechanism of Action of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/APharmacokinets of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AOnset of Action for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/ADuration of Action for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AHalf Life of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/ASide Effects of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AContra-indications of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/ASpecial Precautions while taking Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/APregnancy Related InformationUse with cautionOld Age Related InformationN/ABreast Feeding Related InformationUse with cautionChildren Related InformationN/AIndications for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidPeripheral neuropathy, Vitamin deficiencyInteractions for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/ATypical Dosage for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acid1 capsule/tablet per daySchedule of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AStorage Requirements for Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AEffects of Missed Dosage of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/AEffects of Overdose of Vit B12 + Folic acid + Vit B6 + Alpha-lipoic acidN/A
Vit B12About 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
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 AcidAbout 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
6. Tropical sprue
7. Non tropical sprue
Interactions for Folic Acid1. Hypersensitivity reactions with injection form
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)
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 B6About 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
4. Perioral numbness
6. Numbness of feet
8. Sensory neuropathy
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
Indications for Vit B61. Vitamin B6 deficiency including inadequate diet and drug induced causes
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.
Alpha-Lipoic acidAbout Alpha-Lipoic acidNaturally occurring dithiol compound , antioxidant, Agent for neuropathies.Mechanism of Action of Alpha-Lipoic acidAlpha-lipoic acid and its reduced metabolite, Dihydrolipoic acid (DHLA), form a redox couple and may scavenge a wide range of reactive oxygen species. Alpha-lipoic acid has been found to decrease urinary isoprostanes, O-LDL and plasma protein carbonyls, markers of oxidative stress. Further, alpha-lipoic acid and its redox couple DHLA have been found to have antioxidant activity in aqueous, as well as in lipophilic regions, and in extra cellular and intracellular environments. Alpha-lipoic acid participates in the recycling of other important biologic antioxidants, such as vitamins E and C, Ubiquinone and glutathione.
Both alpha-lipoic acid and DHLA can scavenge hydroxyl radicals, the nitric oxide radical, peroxynitrite, hydrogen peroxide and hypochlorite. Alpha-lipoic acid may scavenge singlet oxygen, and DHLA may scavenge super oxide and peroxyl reactive oxygen species.
Pharmacokinets of Alpha-Lipoic acidAbsorption: Alpha-lipoic acid is absorbed from the small intestine. The natural R-entantiomer is more readily absorbed than the L-entantiomer and is the more active form.
Distribution:It is distributed to the liver via the portal circulation and to various tissues in the body via the systemic circulation. . Alpha-lipoic acid readily crosses the blood-brain barrier. It is found, after its distribution to the various body tissues, intracellularly, intramitochondrialy and extracellularly.Metabolism: Alpha-lipoic acid is metabolized to its reduced form, dihydrolipoic acid (DHLA), by mitochondrial lipoamide dehydrogenase enzyme. DHLA, together with lipoic acid, form a redox couple. It is also metabolized to lipoamide, which functions as the lipoic acid cofactor in the multienzyme complexes that catalyze the oxidative decarboxylations of pyruvate and alpha-ketoglutarate. Alpha-lipoic acid may be metabolized to dithiol octanoic acid, which can undergo catabolism.
Onset of Action for Alpha-Lipoic acidN/ADuration of Action for Alpha-Lipoic acidN/AHalf Life of Alpha-Lipoic acidN/ASide Effects of Alpha-Lipoic acid1.Nausea
2.VomitingContra-indications of Alpha-Lipoic acid1.Contraindicated during radiotherapySpecial Precautions while taking Alpha-Lipoic acidPatient with diabetes and problems with glucose intolerancePregnancy Related InformationUse with cautionOld Age Related InformationN/ABreast Feeding Related InformationUse with cautionChildren Related InformationN/AIndications for Alpha-Lipoic acid1.Diabetic neuropathy
2.It may help prevent the oxidation of LDL cholesterol and may be protective, generally, against oxidative stress and, specifically, against atherosclerosis, ischemia-reperfusion injury and various radiologic and chemical toxins.
3.It may also be useful in some inborn metabolic disordersInteractions for Alpha-Lipoic acidN/ATypical Dosage for Alpha-Lipoic acidAdult: up to 600 milligrams daily
Diabetic neuropathy: 300 milligrams daily taken in divided doses.Schedule of Alpha-Lipoic acidN/AStorage Requirements for Alpha-Lipoic acidStore at room temperature away from moisture and heat.Keep out of the reach of children. Keep the medicine from freezing. Do not refrigerate.Effects of Missed Dosage of Alpha-Lipoic 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 Alpha-Lipoic acidGive supportive measures and symptomatic treatment.
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