BIVA PLUS TONIC

Indications

• Allergic conditions
• Hay fever
• Urticaria
• Pruritus
• Appetite stimulation

Dosage

Children: For children aged 6 months to 5 years, the dose is 5-15 mg daily in divided doses, adjusted according to weight, with a maximum of 2 mg/kg per day. For children aged 6-17 years weighing up to 40 kg, the initial dose is 15-25 mg daily in divided doses, adjusted as necessary to a maximum of 2 mg/kg per day. For those weighing 40 kg and above, the initial dose is 15-25 mg daily in divided doses, increased if necessary to 50-100 mg daily.

Adults: Initially, 25 mg daily, taken at night; may be increased if necessary to 25 mg 3-4 times a day. Maximum dose is 32 mg per day.

Mechanism of action

Cyproheptadine acts as a competitive antagonist at histamine H1 receptors, thereby inhibiting the action of histamine, which is responsible for allergic symptoms. Additionally, it may also block serotonin receptors, contributing to its appetite-stimulating effects.

Pharmacodynamics

The drug exhibits sedative effects by crossing the blood-brain barrier, leading to central nervous system depression. It can also produce anticholinergic effects, such as dry mouth and urinary retention, due to its action on muscarinic receptors. The sedative properties can impair the performance of skilled tasks and may be potentiated by alcohol consumption.

Pharmacokinetics

Cyproheptadine is well-absorbed from the gastrointestinal tract and undergoes hepatic metabolism. Its elimination half-life is approximately 8-12 hours, and it is excreted primarily in urine. The onset of action is typically within 1-2 hours, with effects lasting for several hours.

Contra-indications

• Acute porphyrias
• Prolonged QT-interval
• Risk factors for QT prolongation

Adverse effects

• Drowsiness
• Dizziness
• Dry mouth
• Nausea
• Constipation
• Headache
• Palpitations
• Tachycardia
• Fatigue
• Irritability
• Paradoxical excitability
• Tremor

Interactions

• Antihistamines
• Sedating agents
• Alcohol

Precautions

• Use with caution in the elderly
• Patients with epilepsy
• Prostatic hypertrophy
• Pyloroduodenal obstruction
• Susceptibility to angle-closure glaucoma
• Urinary retention

Pregnancy

Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity. Use in the latter part of the third trimester may cause adverse effects in neonates.

Breast-feeding

Most antihistamines are present in breast milk in varying amounts; although not known to be harmful, most manufacturers advise avoiding their use in mothers who are breastfeeding.

Storage

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

Formulations

• Oral suspension
• Tablets (4 mg)

Indications

• Allergic rhinitis
• Allergic conjunctivitis
• Urticaria
• Angioedema
• Anaphylaxis (as adjunct therapy)
• Appetite stimulation in certain conditions

Dosage

Children: Refer to BNF for Children for appropriate pediatric dosing, as it varies by age and condition. Generally, doses may start at 0.25 mg/kg for younger children, but specific guidelines should be

Adults: The usual adult dose for allergic conditions is 4 mg three times daily, which may be increased to a maximum of 12 mg per day as needed. For appetite stimulation, the starting dose is often 4 mg taken once or twice daily.

Mechanism of action

Cyproheptadine exerts its effects by competing with free histamine and serotonin for binding at their respective receptors. Its action as an H1 blocker is complemented by its antagonism of serotonin at 5-HT2A receptors, particularly influencing the appetite center in the hypothalamus. This dual action accounts for its appetite-stimulating properties and mitigates several pharmacodynamic effects of serotonin.

Pharmacodynamics

Cyproheptadine antagonizes several effects of serotonin and histamine, including bronchoconstriction and vasodepression. Its efficacy in combatting histamine-mediated effects has been established, although the details regarding its role in preventing anaphylactic shock remain unclear, likely linked to its anti-serotonergic activity. The drug's sedative properties arise from its central nervous system effects.

Pharmacokinetics

Cyproheptadine is well-absorbed after oral administration. It is metabolized in the liver, with a variable half-life and is primarily excreted in urine. The onset of action typically occurs within one to two hours, and the duration of action can last up to 12 hours. The pharmacokinetic profile may be influenced by individual metabolic variations.

Adverse effects

• Drowsiness
• Dizziness
• Dry mouth
• Constipation
• Blurred vision
• Increased appetite

Interactions

• cyproheptadine+metyrapone: Severe (decreases effects)
• cyproheptadine+fenfluramine: Unknown (decreases efficacy)

Precautions

• Caution in patients with glaucoma
• Caution in patients with prostate hypertrophy
• Use with caution in elderly patients due to increased sensitivity

Pregnancy

Cyproheptadine should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Limited data are available on its safety.

Breast-feeding

Cyproheptadine is excreted in breast milk. Caution is advised when administered to breastfeeding mothers.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Syrup

Indications

• Vitamin deficiency prevention
• Nutritional supplementation during pregnancy
• Support in chronic illness
• General health maintenance
• Support for individuals with restricted diets

Dosage

Children: Refer to specific product guidelines as pediatric doses vary depending on formulation.

Adults: Refer to specific product guidelines as doses vary widely depending on formulation.

Mechanism of action

Multivitamins provide essential vitamins and minerals that play critical roles in various biochemical pathways. Vitamins such as A, C, D, E, and the B-complex play roles in energy metabolism, immune function, and the maintenance of healthy skin and mucous membranes. Minerals like calcium, magnesium, and zinc are involved in bone health, enzymatic reactions, and cellular function. The specific mechanism of action varies by nutrient, as each vitamin and mineral has distinct physiological roles.

Pharmacodynamics

The pharmacodynamics of multivitamins are largely dependent on the individual vitamins and minerals included in the formulation. They contribute to various metabolic processes, antioxidant defenses, and immune responses. For example, vitamin C is known for its role in collagen synthesis and as an antioxidant, while vitamin D is crucial for calcium absorption and bone health. The synergistic effect of multiple vitamins and minerals can enhance overall health and physiological function.

Pharmacokinetics

The pharmacokinetics of multivitamins varies by individual nutrient. Water-soluble vitamins such as B vitamins and vitamin C are generally absorbed in the gastrointestinal tract and excreted in urine when in excess. Fat-soluble vitamins (A, D, E, K) are absorbed alongside dietary fats and can be stored in body tissues. The bioavailability of vitamins and minerals can be influenced by factors such as age, diet, and health status.

Adverse effects

• Gastrointestinal disturbances
• Nausea
• Diarrhea
• Constipation
• Allergic reactions

Interactions

• Certain antibiotics may interact with specific vitamins
• High doses of vitamin A can lead to toxicity if taken with retinoids
• Vitamin K can affect anticoagulant medications

Precautions

• Use with caution in patients with renal impairment
• Patients should be monitored for potential vitamin toxicity with high doses

Pregnancy

Generally considered safe when taken as directed, but high doses of certain vitamins can be harmful.

Breast-feeding

Generally safe; however, excessive doses should be avoided.

Storage

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

Formulations

• Tablets
• Capsules
• Powders
• Liquids

Indications

• Acne
• Psoriasis
• Dandruff
• Calluses
• Corns
• Keratosis pilaris
• Warts
• Plantar warts

Dosage

Adults: Refer to the specific product formulation and BNF guidelines for adult dosing of salicylic acid preparations. Generally, topical applications should follow instructions provided on the product label.

Mechanism of action

Salicylic acid directly and reversibly inhibits COX-1 and COX-2 enzymes, decreasing the conversion of arachidonic acid to precursors of prostaglandins and thromboxanes. This inhibition contributes to its analgesic and anti-inflammatory activities. Additionally, salicylic acid promotes the shedding of epidermal cells and has keratolytic effects at higher concentrations, making it useful for treating various skin conditions.

Pharmacodynamics

Salicylic acid enhances the desquamation of skin cells, preventing acne formation by keeping pores clear. It possesses keratoplastic activity in low concentrations, correcting abnormal keratinization, while at higher concentrations, it exhibits keratolytic activity, promoting skin peeling. The compound also demonstrates mild antiseptic properties when applied topically. Furthermore, in combination with bismuth, subsalicylate (from salicylic acid) aids in gastrointestinal relief by managing symptoms such as diarrhea and nausea.

Pharmacokinetics

Salicylic acid is absorbed topically through the skin, with systemic absorption being minimal when used in low concentrations. It is metabolized primarily in the liver, undergoing conjugation to form salicyluric acid and other metabolites. The elimination half-life can vary significantly based on the dose and route of administration, with renal excretion being a primary route for metabolites. Local applications may lead to localized effects without significant systemic involvement.

Adverse effects

• Skin irritation
• Dryness
• Peeling
• Erythema
• Hypopigmentation
• Hyperpigmentation

Precautions

• Use with caution in patients with asthma due to potential for bronchospasm
• Not recommended for use on large areas of the body or on broken skin
• Caution in patients with renal impairment

Pregnancy

Salicylic acid is categorized as a pregnancy category C drug. Its use should be avoided during pregnancy unless clearly needed, as it may pose risks to the fetus.

Breast-feeding

Salicylic acid is excreted in breast milk. Caution is advised when using during breastfeeding, particularly in large amounts or over large areas.

Storage

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

Formulations

• Topical solutions
• Creams
• Gels
• Shampoos
• Ointments

Mechanism of action

Cyproheptadine appears to exert its antihistamine and antiserotonin effects by competing with free histamine and serotonin for binding at their respective receptors. Antagonism of serotonin on the appetite center of the hypothalamus may account for cyproheptadine's ability to stimulate the appetite. CYPROHEPTADINE...IS A SEROTONIN & HISTAMINE ANTAGONIST... ... It is an effective H1 blocker. Cyproheptadine also has prominent 5-H blocking activity on smooth muscle by virtue of its binding to 5-HT2A receptors. ... It has weak anticholinergic activity and possess mild central depressant properties.

Pharmacodynamics

Cyproheptadine has been observed to antagonize several pharmacodynamic effects of serotonin in laboratory animals, including bronchoconstriction and vasodepression, and has demonstrated similar efficacy in antagonizing histamine-mediated effects. The reason for its efficacy in preventing anaphylactic shock has not been elucidated, but appears to be related to its anti-serotonergic effects.

Mechanism of action

Salicylic acid directly and reversibly inhibits COX-1 and COX-2 to decrease conversion of arachidonic acid to precursors of prostaglandins and thromboxanes. Salicylate's use in rheumatic diseases is due to it's analgesic and anti-inflammatory activity. Salicylic acid is a key ingredient in many skin-care products for the treatment of acne, psoriasis, calluses, corns, keratosis pilaris, and warts. Salicylic acid allows cells of the epidermis to more readily slough off. Because of its effect on skin cells, salicylic acid is used in several shampoos used to treat dandruff. Salicylic acid is also used as an active ingredient in gels which remove verrucas (plantar warts). Salicylic acid competitively inhibits oxidation of uridine-5-diphosphoglucose (UDPG) with nicotinamide adenosine dinucleotide (NAD) and noncompetitively with UDPG. It also competitively inhibits the transferring of the glucuronyl group of uridine-5-phosphoglucuronic acid (UDPGA) to a phenolic acceptor. Inhibition of mucopoly saccharide synthesis is likely responsible for the slowing of wound healing with salicylates. Salicylic acid has a potent keratolytic action and a slight antiseptic action when applied topically to the skin. In low concentrations, the drug has keratoplastic activity (correction of abnormal keratinization) and in higher concentrations (i.e., 1% or higher, depending on the vehicle), the drug has keratolytic activity (causes peeling of skin). Salicylic acid softens and destroys the stratum corneum by increasing endogenous hydration (water concentration), probably because of decreased pH, which causes the cornified epithelium (horny layer) of the skin to swell, soften, and then desquamate.

Pharmacodynamics

Salicylic acid treats acne by causing skin cells to slough off more readily, preventing pores from clogging up. This effect on skin cells also makes salicylic acid an active ingredient in several shampoos meant to treat dandruff. Use of straight salicylic solution may cause hyperpigmentation on unpretreated skin for those with darker skin types (Fitzpatrick phototypes IV, V, VI), as well as with the lack of use of a broad spectrum sunblock. Subsalicylate in combination with bismuth form the popular stomach relief aid known commonly as Pepto-Bismol. When combined the two key ingredients help control diarrhea, nausea, heartburn, and even gas. It is also very mildly anti-biotic.