ESTOVON

Indications

• Low blood volume
• Hypovolemic shock
• Burns
• Cardiopulmonary bypass

Dosage

Children: Initially 10-20 mL per kilogram. Adjust according to the patient's condition and response, using 3.5-4% solution. Use under specialist supervision to mitigate the risk of fluid overload.

Adults: Dose according to requirements, typically administered intravenously. Consult product literature for specific dosing guidance.

Mechanism of action

Gelatin acts as a plasma expander by increasing the oncotic pressure in the vascular compartment, which helps to retain fluid within the bloodstream and restore circulating blood volume. This mechanism aids in maintaining blood pressure and improving tissue perfusion.

Pharmacodynamics

Gelatin solutions increase blood volume and improve hemodynamic stability in patients experiencing hypovolemic conditions. By drawing water into the vascular space, they help to counteract the effects of low blood volume, such as hypotension and compromised organ perfusion.

Pharmacokinetics

Gelatin is administered intravenously, and its effects can be observed relatively quickly. The half-life and the metabolic clearance depend on the formulation and concentration of the solution. Gelatin is gradually metabolized by macrophages and eliminated by the renal system. Close monitoring of fluid balance is essential, particularly in patients with cardiac or renal impairment.

Contra-indications

• Severe liver disease
• History of circulatory disease
• Severe cardiac disease

Adverse effects

• Fever
• Flushing
• Nausea
• Urticaria
• Rare or very rare shock

Interactions

• Calcium salts

Precautions

• Monitor cardiovascular and respiratory function
• Correct dehydration when administering
• Administer slowly to avoid rapid rise in blood pressure and cardiac failure
• Increased capillary permeability

Pregnancy

Consult product literature for specific guidance regarding use in pregnancy.

Breast-feeding

Consult product literature for specific guidance regarding use in breastfeeding.

Storage

Store at controlled room temperature, protect from light. Refer to product-specific storage instructions.

Formulations

• 5% solution for infusion
• 20% solution for infusion
• Concentrated solution (15-25% protein)
• Isotonic solution (3.5-5% protein)

Indications

• To protect sensitive active ingredients
• To mask unpleasant tastes
• To provide controlled or delayed release of medication
• To enhance patient compliance

Dosage

Children: Refer to the specific product information for dosing recommendations in children, as it varies by formulation and indication. Consult the relevant pediatric dosing guidelines for accurate dosing.

Adults: Refer to the specific product information for dosing recommendations, as it varies by formulation and indication. Consult the relevant pharmacopoeia or prescribing guidelines for precise dosing.

Mechanism of action

The mechanism of action for coated drugs varies depending on the active ingredient within the coating. Generally, the coating may influence the drug's absorption, distribution, metabolism, and excretion (ADME) properties. Some coatings are designed to dissolve at specific pH levels, allowing for targeted release in particular areas of the gastrointestinal tract.

Pharmacodynamics

Coated drugs may exhibit modified pharmacodynamic profiles compared to their uncoated counterparts. The coating can alter the rate at which the drug is absorbed into systemic circulation, affecting the onset and duration of action. The pharmacological effects are primarily influenced by the active ingredient but may be enhanced or diminished by the presence of a coating that modifies absorption characteristics.

Pharmacokinetics

The pharmacokinetics of coated drugs are influenced by the properties of the coating material, as well as the characteristics of the active pharmaceutical ingredient. Factors such as solubility, permeability, and the presence of excipients can significantly impact the rate and extent of absorption. Coatings may delay the release of the drug, resulting in altered peak plasma concentrations and time to peak effect. The elimination half-life may also be affected depending on the drug's formulation.

Pregnancy

The safety of coated formulations during pregnancy has not been established. Consult a healthcare provider before use.

Breast-feeding

Consult a healthcare provider before using coated formulations while breastfeeding, as safety and excretion in breast milk are not well studied.

Storage

Store in a cool, dry place, away from direct sunlight and moisture. Keep out of reach of children.

Indications

• Malabsorption syndromes
• Crohn's disease
• Cystic fibrosis
• Short bowel syndrome
• Severe food allergies
• Inability to meet nutritional needs through standard diets

Dosage

Children: Refer to specific formulations for dosing, as paediatric dosages depend on the product and the child's nutritional needs.

Adults: Refer to specific formulations for dosing, as adult dosages vary based on the product used and the patient's nutritional requirements.

Mechanism of action

Elemental formulations provide nutrients in their simplest forms, which are readily absorbed in the small intestine. This bypasses complex digestive processes, making them suitable for individuals with compromised digestion or absorption capabilities. The nutrients in these formulations include amino acids, simple carbohydrates, and fatty acids, which can be directly utilized by the body's metabolic pathways.

Pharmacodynamics

Elemental formulations help restore nutritional balance by supplying essential macronutrients and micronutrients needed for metabolic processes. They support growth, maintain energy levels, and promote healing in patients with malabsorption or increased nutritional needs. The bioavailability of nutrients in elemental forms is typically high, allowing for efficient uptake and utilization by the body.

Pharmacokinetics

Following administration, elemental nutrients are absorbed in the gastrointestinal tract, primarily in the jejunum and ileum. The rate of absorption can vary based on the specific formulation and the individual's gastrointestinal health. Once absorbed, these nutrients enter systemic circulation and are transported to various tissues for utilization in metabolic processes. The elimination of unabsorbed nutrients occurs primarily through feces.

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Stomach cramps
• Dark stools
• Metallic taste
• Allergic reactions

Precautions

• Use with caution in patients with a history of gastrointestinal disorders.
• Monitor for signs of iron overload in patients receiving multiple iron products.
• Assess for the need for supplementation in patients with conditions causing malabsorption.

Pregnancy

Iron is essential during pregnancy, but supplementation should be guided by clinical need and under healthcare supervision.

Breast-feeding

Iron is excreted in breast milk; supplementation may be necessary depending on maternal iron status.

Storage

Store in a cool, dry place, away from direct sunlight and moisture. Keep out of reach of children.

Formulations

• Oral tablets
• Liquid formulations
• Injectable solutions

Indications

• General wellness support
• Anti-inflammatory effects
• Antioxidant activity
• Digestive aid
• Support for immune function

Dosage

Children: Paediatric dosing should be determined based on the specific extract and its intended use. Consultation with a healthcare provider is recommended for accurate dosing.

Adults: Dosage varies widely depending on the specific extract and formulation. It is essential to follow the manufacturer's instructions or consult a healthcare professional for appropriate dosing.

Mechanism of action

The mechanism of action of herbal extracts can vary significantly based on their constituents. Commonly, they exert their effects through multiple pathways including modulation of neurotransmitter systems, interference with inflammatory processes, or direct antioxidant activity. Some extracts may activate certain receptors or inhibit enzymes related to disease processes.

Pharmacodynamics

The pharmacodynamics of extracts is complex due to the presence of multiple active compounds which can have synergistic or antagonistic effects. These compounds may influence cellular signaling pathways, alter gene expression, or modulate immune response. The overall pharmacological profile is determined by the specific composition of the extract, its concentration, and the biological target it interacts with.

Pharmacokinetics

The pharmacokinetics of extracts involves absorption, distribution, metabolism, and excretion of the active compounds. Generally, herbal extracts are absorbed in the gastrointestinal tract, with bioavailability influenced by factors such as formulation, the presence of food, and individual metabolic differences. Compounds may undergo hepatic metabolism, and elimination can occur through urine or feces, depending on their chemical nature.

Pregnancy

Consult a healthcare professional before use, as the safety of the extract during pregnancy has not been established.

Breast-feeding

Consult a healthcare professional before use, as the safety of the extract during breastfeeding has not been established.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Indications

• Menopausal symptoms
• Cardiovascular health
• Bone health
• Estrogen-dependent cancers

Dosage

Children: Use in children is not

Adults: Dosage varies based on the specific formulation and indication. Refer to the specific product guidelines or the BNF for detailed dosing recommendations.

Mechanism of action

Isoflavones are selective estrogen receptor modulators that exert estrogenic-like effects under certain conditions. They bind preferentially to estrogen receptor beta (ERβ) with a binding affinity approximately 20 times higher than that to estrogen receptor alpha (ERα). Isoflavones can exhibit antiestrogenic actions by blocking the binding of endogenous estrogens and their receptor signaling. They may inhibit the proliferation of breast cancer cells by arresting cell cycle progression and inducing apoptosis. Additionally, isoflavones may act on androgen receptors to inhibit tyrosine kinase activity, blocking cancer cell growth.

Pharmacodynamics

Isoflavones, particularly from soy, have been shown to lower LDL cholesterol levels and improve blood pressure in women with hypertension. In postmenopausal women, dietary intake of isoflavones has been associated with reduced bone resorption and increased bone formation markers. Their effects on menopausal symptoms, breast cancer, and prostate cancer remain controversial, though some studies suggest they may decrease cancer development markers in prostate cells.

Pharmacokinetics

Isoflavones are metabolized in the gut and liver, leading to various bioactive metabolites. Their bioavailability can be affected by dietary factors and individual metabolism. Peak plasma concentrations occur about 2 to 4 hours after ingestion, with a half-life that varies depending on the specific isoflavone and individual factors. Isoflavones are primarily excreted via urine.

Adverse effects

• gastrointestinal disturbances
• allergic reactions
• headaches
• fatigue
• dizziness

Interactions

• may interact with anticoagulants, potentially increasing bleeding risk
• may affect the metabolism of certain medications via CYP450 enzymes
• estrogenic drugs may exhibit compounded effects when used with isoflavones

Precautions

• use cautiously in individuals with hormone-sensitive conditions
• monitor patients with a history of breast or prostate cancer
• consider potential interactions with other medications

Pregnancy

Isoflavones should be used with caution during pregnancy due to their estrogen-like effects; consult healthcare professionals for guidance.

Breast-feeding

Limited data is available; consult healthcare professionals before use during breastfeeding.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• capsules
• tablets
• powdered supplements
• soy-based food products

Indications

• Phosphorus deficiency
• Bone health maintenance
• Nutritional supplementation
• Metabolic bone diseases

Dosage

Children: Refer to the BNF for Children for specific dosing information.

Adults: Refer to the BNF for specific dosing information.

Mechanism of action

Phosphorus decreases the absorption of intercellular calcified cartilage matrix by osteoclasts in the metaphyseal region of growing bones. This results in the formation of 'phosphorus bands' of increased bone density and thickness. Additionally, exposure to white phosphorus impairs protein synthesis by damaging the rough and smooth endoplasmic reticulum, leading to an accumulation of triglycerides in the liver and resulting in hepatic steatosis and fibrosis.

Pharmacodynamics

Phosphorus is vital for the formation of hydroxyapatite in bone, which is necessary for maintaining bone density and strength. It also plays a significant role in energy transfer through ATP and in cellular signaling pathways. The balance of phosphorus in the body is tightly regulated, as both deficiency and excess can lead to serious health issues, including bone disorders and metabolic dysfunctions.

Pharmacokinetics

Phosphorus is absorbed primarily in the intestines, with bioavailability influenced by dietary factors. It is distributed throughout the body and is predominantly found in bones and teeth. Phosphorus is excreted mainly via the kidneys, with regulation occurring through various hormonal mechanisms, including parathyroid hormone and calcitriol. The half-life can vary depending on dietary intake and individual metabolism.

Pregnancy

Phosphorus is generally regarded as safe during pregnancy when consumed in appropriate dietary amounts. However, excessive phosphorus intake should be avoided as it may lead to complications.

Breast-feeding

Phosphorus is excreted in breast milk, but it is essential for the health of both the mother and the infant. Supplementation should be considered carefully.

Storage

Store in a tightly closed container, in a cool, dry place away from direct sunlight.

Indications

• Vitamin deficiency syndromes (e.g., scurvy for vitamin C deficiency, rickets for vitamin D deficiency)
• Support for immune function
• Antioxidant support
• Bone health maintenance
• Vision health
• Energy metabolism support

Dosage

Children: Refer to the BNF for Children for specific vitamin dosing guidelines, which depend on age and nutritional requirements.

Adults: Refer to specific vitamin guidelines as dosage varies significantly depending on the type of vitamin and individual needs.

Mechanism of action

Vitamins function primarily as coenzymes or precursors for coenzymes in enzymatic reactions. For instance, B vitamins are involved in energy metabolism, while vitamins A, C, D, E, and K support various physiological functions including vision, antioxidant activity, calcium regulation, and blood clotting. Each vitamin has a unique mechanism of action based on its structure and role in the body.

Pharmacodynamics

Vitamins exert their effects at the cellular level, influencing metabolic pathways, gene expression, and immune responses. For example, vitamin D regulates calcium and phosphate homeostasis, while vitamin A is crucial for vision and immune function. Deficiencies in vitamins can lead to a range of disorders, highlighting their importance in maintaining health.

Pharmacokinetics

The pharmacokinetics of vitamins vary widely. Fat-soluble vitamins (A, D, E, and K) are stored in liver and adipose tissues and can be released into circulation as needed. Water-soluble vitamins (B-complex and C) are not stored and must be consumed regularly, with excess amounts excreted in urine. Absorption rates, half-lives, and distribution can also differ based on the specific vitamin and individual metabolic factors.

Interactions

• tretinoin+vitamin: Severe (increases risk of vitamin toxicity)
• retinoids+vitamin: Severe (increases risk of vitamin toxicity)
• retinoids+vitamin: Moderate (increases risk of toxicity)
• carbamazepine+vitamin: Unknown (decreases effects)
• cobicistat+vitamin: Unknown (increases exposure)
• vitamin D substances+digoxin: Unknown (increases risk of toxicity)
• idelalisib+vitamin: Unknown (increases exposure)
• clarithromycin+vitamin: Unknown (increases exposure)

Pregnancy

Consult healthcare professional before use. Vitamin supplementation during pregnancy should be carefully managed to avoid hypervitaminosis.

Breast-feeding

Consult healthcare professional before use. Some vitamins can pass into breast milk and may affect the infant.

Storage

Store in a cool, dry place, away from direct sunlight. Ensure it is kept out of reach of children.

Formulations

• {'name': 'Vitamin A', 'form': 'Capsule', 'strength': '10000 IU'}
• {'name': 'Vitamin D', 'form': 'Tablet', 'strength': '1000 IU'}
• {'name': 'Vitamin E', 'form': 'Softgel', 'strength': '400 IU'}

Mechanism of action

Isoflavones are selective estrogen receptor modulators that exert estrogenic-like effects under certain experimental conditions, as they are structurally similar to mammalian 17β-estradiol. They may bind to both α and β isoforms of estrogen receptor (ER), but with binding affinities to ERβ approximately 20 times higher than that to ERα. The role of isoflavones on estrogen-dependent cancer has been studied, since they may mediate antiestrogenic actions by blocking the binding of endogenous estrogens and their receptor signalling. In cell culture, [DB01645] inhibited the proliferation of MDA-MB-231 human breast cancer cells, probably by arresting the cell cycle progression at the G2–M transition. In addition, genistein was shown to induce apoptosis, modify eicosanoid metabolism, and inhibit angiogenesis. There is an evidence that soy isoflavones may act on androgen receptors to inhibit tyrosine kinase activity, thereby blocking the growth and proliferation of cancer cells. Isoflavones may not significantly contribute to the hypolipidemic effects of soy protein, but may exert coronary benefits by improving endothelial function; in clinical trials of postmenopausal women, isoflavones improved flow-mediated dilation in women with impaired endothelial function. Some observational data suggests that isoflavones improve endothelial function by increasing the number of circulating endothelial progenitor cells, which replace damaged endothelial cells. Isoflavone may modulate the key transcription factors involved in the regulation of lipid metabolism by acting on the peroxisome proliferator-activated receptors (PPAR) alpha and gamma, which are receptors that regulate the transcription of genes involved in lipid and glucose homeostasis and lipid metabolism. Multiple biological actions of isoflavones, such as favorable effect on the blood lipid profile and inhibition of LDL cholesterol oxidation, may lead to cardio protective effects. [DB01645] has been shown to have antioxidant properties on hydrogen peroxide production _in vitro_ and blocks the formation of oxygen free radicals. Studies also suggest that at micromolar concentrations, genistein increases glucose-stimulated insulin secretion in cell lines and mouse pancreatic islets via a cAMP-dependent protein kinase mechanism. Based on the findings of experimental studies, genistein may exert a positive effect on bone formation by decreasing osteoclastic resorption factor, such as collagen C-telopeptide, and increasing osteoblastic formation markers, such as bone-alkaline phosphatase. _In vitro_, it antagonized the catabolic effects of parathyroid hormone (PTH) in osteoblasts by reversing the PTH-induced increase in soluble receptor activator of nuclear factor-xB ligand and decrease in osteoprotegerin expression.

Pharmacodynamics

Isolated soy protein with isoflavones was shown to decrease LDL cholesterol levels in randomized trials assessed by the American Heart Association. In a study of postmenopausal women, daily dietary intake of 101 mg of aglycone isoflavones (indicating [DB01645] and [DB13182]) was associated with lowered LDL cholesterol and apolipoprotein B levels by 8% and reduced systolic and diastolic blood pressure by 6.8% in hypertensive women. In a meta-analysis of randomized controlled trials of menopausal women, soy isoflavones attenuated bone loss of the spine and decreased the levels of deoxypyridinoline, a bone resorption marker, while increasing serum bone-specific alkaline phosphatase, a bone formation marker. The findings from studies investigating the effects of soy consumption on menopausal symptoms, breast cancer, and prostate cancer remain somewhat controversial and inconclusive. Consumption of soy isoflavones may decrease the markers of cancer development and progression in prostate cells, including prostate-specific antigen (PSA), testosterone, and androgen receptor in patients with prostate cancer but not in normal subjects. Although epidemiologic data in Asian women demonstrate that high soy food intake is associated with protection against breast cancer, soy foods have little effect on intermediary markers of breast cancer risk and postmenopausal soy intake may not reduce the risk of developing breast cancer. However, preliminary studies show that soy food intake reduces tumor recurrence in breast cancer patients. Soy isoflavones reported to interfere with thyroid peroxidase, which are involved in the production of thyroid hormones.

Mechanism of action

Phosphorus apparently decreases the absorption of intercellular calcified cartilage matrix by osteoclasts, in the metaphyseal region of growing bones. Administration of phosphorus to growing animals or children produces "phosphorus bands" of increased bone density and thickness that are visible grossly or from radiograms. The "phosphorus bands" are observed in the metaphyseal region of growing bones, and represent areas of decreased absorption of the calcified cartilage matrix. Exposure to white phosphorus has been shown to damage the rough endoplasmic reticulum and cause a disaggregation of polyribosomes. This damage results in impairment of protein synthesis, in particular, a decrease in the synthesis of the apolipoprotein portion of very low density lipoproteins (VLDL), which are required for the transport of triglycerides. A significant decrease in protein synthesis has been detected as early as 3 hours after oral exposure. The smooth endoplasmic reticulum is also involved in the formation of the VLDLs, and damage to the smooth endoplasmic reticulum also impairs the formation of VLDLs. The net result of these ultrastructural changes is an accumulation of triglycerides in the liver. This results in steatosis and fibrosis, which is one of the mechanisms involved in the hepatotoxicity of white phosphorus. The mechanism behind the damage to the endoplasmic reticulum is not known; also, it is not known whether white phosphorus itself or a metabolite of white phosphorus is the damaging agent. In addition to these damages, white phosphorus or a metabolite causes damage to the mitochondria and nuclei in the livers of animals orally exposed to white phosphorus. The damage to the mitochondria may impair the cell's ability to produce ATP, thus resulting in necrosis of the cell. Fatty infiltration and/or cellular damage has also been observed in the kidney, brain, and heart. It is possible that white phosphorus (or a metabolite) also impairs the ability of cells in these organs to produce ATP. The mitochondrial damage may also inhibit fatty acid oxidation (also contributing to the decreased availability of ATP) which could result in an accumulation of fat in the organs.