FREDOFS MENOPAUSE SUPPORT CAPSULES

Indications

• Vitamin B6 deficiency
• Isoniazid-induced neuropathy (prophylaxis and treatment)
• Idiopathic sideroblastic anaemia
• Prevention of penicillamine-induced neuropathy in Wilson's disease
• Metabolic diseases such as cystathioninuria and homocystinuria
• Premenstrual syndrome

Mechanism of action

Pyridoxine hydrochloride is converted in the body to pyridoxal phosphate, which is the active form of vitamin B6. It serves as a cofactor for more than 100 enzymatic reactions, particularly those involved in the metabolism of amino acids, the synthesis of neurotransmitters (such as serotonin, dopamine, and gamma-aminobutyric acid), and the production of hemoglobin. Its role in neurotransmitter synthesis makes it crucial for normal brain function and mood regulation.

Pharmacodynamics

Pyridoxine hydrochloride exerts its effects by facilitating the conversion of amino acids into neurotransmitters and is involved in the synthesis of heme. It impacts the metabolism of tryptophan to serotonin and is essential for the production of norepinephrine and gamma-aminobutyric acid, which are vital for proper neurological function. Deficiency of vitamin B6 can lead to neurological symptoms, including peripheral neuropathy and cognitive disturbances.

Pharmacokinetics

Pyridoxine hydrochloride is readily absorbed from the gastrointestinal tract. It is primarily metabolized in the liver, where it is converted to its active form, pyridoxal phosphate. The elimination half-life of pyridoxine is approximately 15-20 days, and it is excreted primarily through the urine. Renal impairment may affect the metabolism and excretion of pyridoxine, necessitating dose adjustments.

Contra-indications

• Hyperkalaemia
• Severe liver damage

Adverse effects

• Peripheral neuritis
• Hepatitis
• Hypoglycaemia
• Urine discolouration

Interactions

• Potassium aminobenzoate
• Isoniazid

Precautions

• Caution in renal impairment (increased risk of hyperkalaemia)
• Interrupt treatment during periods of low food intake (such as fasting, anorexia, and nausea) to reduce risk of hypoglycaemia
• Monitor liver function tests monthly during high-dose therapy

Pregnancy

Manufacturer advises avoiding use in pregnancy due to potential risk of birth defects; however, no adverse effects have been reported at normal dietary levels.

Breast-feeding

Theoretical risk of toxicity in infants if mothers take large doses.

Storage

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

Formulations

• Pyridoxine hydrochloride 10 mg tablets
• Pyridoxine hydrochloride 20 mg tablets
• Pyridoxine hydrochloride 50 mg tablets
• Pyridoxine hydrochloride oral solution 20 mg per 1 ml

Indications

• Vitamin B2 deficiency
• Isoniazid-induced neuropathy (prophylaxis and treatment)
• Metabolic diseases
• Cystathioninuria
• Homocystinuria
• Wilson's disease
• Prevention of penicillamine-induced neuropathy

Mechanism of action

Riboflavin acts as a precursor to flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are essential coenzymes in various enzymatic reactions. It binds to riboflavin hydrogenase, riboflavin kinase, and riboflavin synthase, facilitating the production of FMN and FAD. These coenzymes are critical for normal tissue respiration and energy metabolism, influencing hydrogen transport in oxidative enzyme systems such as cytochrome C reductase and succinic dehydrogenase. Moreover, riboflavin contributes to the antioxidant activity by aiding in the production of reduced glutathione, a key antioxidant in the body.

Pharmacodynamics

Riboflavin is an easily absorbed, water-soluble micronutrient that supports energy production by assisting in the metabolism of fats, carbohydrates, and proteins. It is vital for red blood cell formation, antibody production, and regulating growth and reproduction. The vitamin plays a significant role in maintaining healthy skin, nails, and hair, as well as supporting thyroid activity. Riboflavin also has therapeutic implications in preventing or treating various eye disorders, including cataracts.

Pharmacokinetics

Riboflavin is rapidly absorbed in the gastrointestinal tract, with its bioavailability influenced by dietary intake. It is primarily excreted through urine, with excess intake leading to bright yellow urine, which is a harmless side effect. The vitamin does not accumulate in the body, necessitating regular dietary intake to maintain adequate levels.

Adverse effects

• Urine discolouration
• Peripheral neuritis

Precautions

• With intravenous use, risk of cardiovascular collapse; resuscitation facilities must be available and monitor closely.

Pregnancy

Crosses the placenta but no adverse effects reported; information at high doses limited.

Breast-feeding

Present in breast milk but no adverse effects reported; information at high doses limited.

Storage

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

Formulations

• 100 mg modified-release tablets
• 50 mg capsules
• 100 mg capsules
• 100 mg tablets
• Oral solution

Indications

• Mild muscle pain
• Joint pain
• Minor arthritis pain
• Muscle strains
• Bruises
• Skin irritation

Dosage

Children: Refer to the BNF for Children for specific dosing information based on age and weight, as doses may vary.

Adults: Apply a thin layer to the affected area up to three times daily. Do not apply to broken skin.

Mechanism of action

The active ingredients in balm, such as menthol and camphor, produce a cooling sensation when applied to the skin. This cooling effect is thought to activate certain receptors (TRPM8) that trigger a sensation of cold, which can distract from pain. Additionally, camphor and eucalyptus oil have mild anti-inflammatory properties, which may further contribute to pain relief.

Pharmacodynamics

Balm formulations primarily exert their effects locally on the site of application. The cooling sensation induces vasodilation, which can promote blood flow and potentially aid in the healing process. The anti-inflammatory effects of certain components may reduce swelling and discomfort associated with minor injuries or inflammatory skin conditions.

Pharmacokinetics

When applied topically, the absorption of balm ingredients can vary based on formulation and skin integrity. The onset of action is typically rapid, with effects usually felt within minutes. Systemic absorption is minimal, which limits systemic side effects but may still occur if large amounts are applied or if used on broken skin. The duration of action is usually several hours, necessitating reapplication as needed.

Adverse effects

• Skin irritation
• Allergic reactions
• Contact dermatitis

Precautions

• Avoid contact with eyes and mucous membranes
• Use with caution in patients with sensitive skin
• Not recommended for use on broken skin or open wounds

Pregnancy

Consult healthcare provider before use, as safety during pregnancy has not been established.

Breast-feeding

Consult healthcare provider before use, as safety during breastfeeding has not been established.

Storage

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

Formulations

• Topical ointment
• Cream
• Gel

Indications

• Nutritional supplementation
• Support for weight management
• Management of blood glucose levels
• Promotion of heart health
• Improvement of digestive health

Dosage

Children: Refer to dietary guidelines for children; beans can be introduced as a protein source in appropriate serving sizes based on age and dietary recommendations.

Adults: Refer to dietary guidelines for general consumption; beans can be included in daily meals as a primary protein source, with recommended servings varying based on dietary needs.

Mechanism of action

Beans exert their health benefits primarily through their high fiber content, which can improve digestion and glucose metabolism. They also contain phytochemicals, such as polyphenols and saponins, that may have antioxidant properties and can help reduce inflammation. Additionally, the protein in beans contributes to muscle repair and maintenance.

Pharmacodynamics

The consumption of beans has been associated with a variety of health benefits. Their high fiber content aids in the regulation of blood sugar levels, lowers cholesterol levels, and promotes satiety, which can be beneficial for weight management. The presence of antioxidants in beans helps to combat oxidative stress and inflammation in the body.

Pharmacokinetics

Beans are digested in the gastrointestinal tract, where dietary fibers are fermented by gut microbiota, producing short-chain fatty acids that are beneficial for colon health. The protein undergoes digestion in the stomach and small intestine, with amino acids being absorbed into the bloodstream. The absorption rate may vary depending on the type of bean and preparation method.

Adverse effects

• Gastrointestinal discomfort
• Bloating
• Flatulence
• Allergic reactions in sensitive individuals

Interactions

• May interact with anticoagulants due to high vitamin K content
• Possible interaction with medications affecting blood sugar levels

Precautions

• Use caution in individuals with a history of gastrointestinal disorders
• Monitor for allergic reactions in individuals sensitive to legumes

Pregnancy

Generally considered safe, but excessive consumption should be avoided due to potential effects on digestion.

Breast-feeding

Safe for consumption; however, it may cause gas in infants if consumed in large amounts.

Storage

Store in a cool, dry place away from direct sunlight. Keep in an airtight container to maintain freshness.

Formulations

• Dried beans
• Canned beans
• Bean flour
• Bean protein powder

Dosage

Children: Refer to specific guidelines or literature for dosing information.

Adults: Refer to specific guidelines or literature for dosing information.

Pregnancy

Consult healthcare professionals before use. Safety during pregnancy is not well established.

Breast-feeding

Consult healthcare professionals before use. Safety during breastfeeding is not well established.

Storage

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

Indications

• Premenstrual syndrome (PMS)
• Menstrual irregularities
• Menopause symptoms
• Hormonal imbalance
• Luteal phase defects

Dosage

Children: Safety and efficacy in children have not been established; consult a healthcare professional.

Adults: Refer to specific product guidelines or consult a healthcare professional for appropriate dosing.

Mechanism of action

Chasteberry is believed to exert its effects by influencing the hypothalamic-pituitary-gonadal axis. It appears to increase the secretion of luteinizing hormone (LH) while inhibiting the release of prolactin from the pituitary gland. This action may help restore hormonal balance and regulate menstrual cycles. Additionally, it may have dopaminergic effects, mimicking the action of dopamine which can contribute to reduced prolactin levels.

Pharmacodynamics

Chasteberry has been shown to have a modulatory effect on progesterone and estrogen levels, promoting reproductive health. Its potential anti-inflammatory and antioxidant properties may contribute to its therapeutic effects, though the exact pharmacodynamic profile is not fully understood. The plant’s extracts are thought to interact with neurotransmitter receptors, particularly dopamine receptors, which plays a role in its ability to reduce symptoms associated with hormonal imbalances.

Pharmacokinetics

The pharmacokinetics of chasteberry are not extensively characterized. However, it is known that the active components, such as flavonoids and iridoid glycosides, are absorbed in the gastrointestinal tract. The onset of action can vary based on the formulation and individual metabolism, and studies suggest that sustained use may be necessary to achieve therapeutic effects. Excretion pathways are not well defined, but it is presumed that metabolites are eliminated primarily through urine.

Adverse effects

• Gastrointestinal disturbances
• Headache
• Rash
• Nausea
• Menstrual changes

Interactions

• May interact with hormonal medications
• Potential interaction with dopamine agonists

Precautions

• Use with caution in individuals with hormone-sensitive conditions
• Monitor for changes in menstrual cycle

Pregnancy

Chasteberry is not recommended during pregnancy due to its potential effects on hormonal balance.

Breast-feeding

Limited data is available; consult a healthcare provider before use while breastfeeding.

Storage

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

Formulations

• Dried berries
• Powder
• Tincture
• Capsules

Indications

• Vitamin D deficiency
• Rickets
• Osteomalacia
• Osteoporosis
• Hypoparathyroidism

Dosage

Adults: The usual adult dose for vitamin D deficiency is 800 to 2000 IU daily, depending on the severity of deficiency and clinical condition. Higher doses may be used under medical supervision.

Mechanism of action

Cholecalciferol is converted to its active forms, 25-hydroxyvitamin D in the liver and 1,25-dihydroxyvitamin D in the kidneys. These metabolites enhance the intestinal absorption of calcium and phosphorus, increase serum calcium levels, and mobilize these minerals from bone. This process is regulated by parathyroid hormone, which influences calcium and phosphate metabolism, particularly in the kidneys.

Pharmacodynamics

The pharmacodynamics of cholecalciferol involve its conversion to active metabolites that play a significant role in calcium and phosphorus homeostasis. The metabolites facilitate intestinal absorption of these minerals, promote bone mineralization, and influence renal reabsorption. The onset of action occurs within 10 to 24 hours following administration, as metabolic activation is required for its biological effects.

Pharmacokinetics

Cholecalciferol is absorbed in the gastrointestinal tract, and its absorption is enhanced by the presence of dietary fats. It is transported in the bloodstream bound to vitamin D-binding protein. Once in the liver, it undergoes hydroxylation to form 25-hydroxyvitamin D, which is further converted in the kidneys to the active form, 1,25-dihydroxyvitamin D. The elimination half-life of cholecalciferol varies, typically spanning several days, and it is primarily excreted in bile and urine.

Adverse effects

• Hypercalcemia
• Hypercalciuria
• Nausea
• Vomiting
• Constipation
• Weakness
• Fatigue

Interactions

• May enhance the effects of thiazide diuretics, leading to increased risk of hypercalcemia
• Anticonvulsants may increase metabolism of vitamin D, leading to reduced effectiveness
• Cholestyramine may reduce absorption of vitamin D

Precautions

• Monitor serum calcium levels in patients with renal impairment
• Caution in patients with a history of hypercalcemia or hyperparathyroidism
• Use with caution in patients taking other medications that affect calcium metabolism

Pregnancy

Cholecalciferol can be used during pregnancy if indicated, as vitamin D is essential for fetal bone development.

Breast-feeding

Cholecalciferol is excreted in breast milk, but is generally considered safe during breastfeeding.

Storage

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

Formulations

• Capsules
• Tablets
• Liquid formulations

Indications

• Menopausal symptoms
• Osteoporosis prevention
• Cardiovascular health
• Hormonal balance

Dosage

Children: Refer to established guidelines or consult a healthcare provider for specific dosing recommendations.

Adults: Refer to established guidelines or consult a healthcare provider for specific dosing recommendations.

Mechanism of action

The active compounds in clover, particularly in red clover, include isoflavones such as genistein and daidzein. These phytoestrogens can bind to estrogen receptors in the body, exerting estrogen-like effects. This mechanism may help alleviate menopausal symptoms by mimicking the effects of estrogen, thus potentially reducing hot flashes and improving bone health.

Pharmacodynamics

Clover's isoflavones have antioxidant properties and may influence various biological pathways, including modulation of lipid metabolism and inhibition of certain inflammatory processes. The estrogenic activity of these compounds can lead to alterations in hormone levels, which may contribute to its therapeutic effects in postmenopausal women.

Pharmacokinetics

The bioavailability of isoflavones from clover can vary based on the formulation and individual metabolism. After ingestion, isoflavones are metabolized in the liver and can be excreted in urine as conjugated metabolites. Peak plasma concentrations typically occur within a few hours of consumption, and the half-life can vary depending on the specific isoflavone and individual factors.

Adverse effects

• Allergic reactions
• Gastrointestinal upset
• Headaches
• Fatigue

Interactions

• May interact with anticoagulants such as warfarin, increasing the risk of bleeding
• Can affect the efficacy of oral contraceptives
• May interact with other medications metabolized by the liver

Precautions

• Use with caution in individuals with clotting disorders
• Monitor for potential allergic reactions
• Consult healthcare professionals before use in conjunction with other medications

Pregnancy

There is insufficient reliable information regarding the safety of clover during pregnancy; consult a healthcare professional before use.

Breast-feeding

Consult a healthcare professional before using clover while breastfeeding, as safety has not been established.

Storage

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

Formulations

• Dried leaves
• Extracts
• Capsules
• Teas

Indications

• Menopausal symptoms
• Hot flashes
• Mood swings
• PMS (premenstrual syndrome)
• Menstrual irregularities
• Labor induction (blue cohosh)

Dosage

Children: Dosage for children is not well established; consult a healthcare provider or refer to specific

Adults: Refer to herbal medicine guidelines for dosing recommendations, typically ranging from 20 to 40 mg of standardized extract daily for black cohosh.

Mechanism of action

The exact mechanism of action of black cohosh is not fully understood, but it is believed to exert its effects through modulation of estrogen receptors and possibly through interaction with serotonin receptors. Some studies suggest that it may influence the hypothalamic-pituitary-gonadal axis, leading to alterations in hormone levels that can alleviate menopausal symptoms. Blue cohosh may have uterotonic properties, affecting smooth muscle contraction, possibly through the action of its alkaloids.

Pharmacodynamics

Cohosh species are generally regarded as having mild estrogenic activity, which can help alleviate menopausal symptoms. Black cohosh has been shown in some studies to reduce the frequency and intensity of hot flashes. The pharmacodynamic effects may vary between individuals due to variability in metabolism and receptor sensitivity, as well as the presence of other health conditions.

Pharmacokinetics

The pharmacokinetics of black cohosh are not well characterized. It is believed that the active compounds are absorbed in the gastrointestinal tract, with peak plasma concentrations occurring within a few hours post-ingestion. The elimination half-life is not well-defined, and the metabolites may vary. Blue cohosh also has variable pharmacokinetics, with its active components undergoing hepatic metabolism, leading to different bioavailability among individuals.

Adverse effects

• Gastrointestinal upset
• Headache
• Dizziness
• Rash
• Allergic reactions

Interactions

• May interact with anticoagulants
• Possible interaction with estrogen-containing medications
• May affect the metabolism of certain drugs processed by the liver

Precautions

• Use with caution in individuals with liver disease
• Possible effects on hormone-sensitive conditions
• Monitor for allergic reactions

Pregnancy

Cohosh is not recommended during pregnancy due to potential hormonal effects.

Breast-feeding

Safety during breastfeeding is not well established; caution is advised.

Storage

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

Formulations

• Dried root
• Tinctures
• Capsules
• Extracts

Indications

• Menstrual disorders
• Menopause symptoms
• Anemia
• Hormonal balance
• Circulatory issues

Dosage

Children: Refer to specific herbal product guidelines, as safety and efficacy in children have not been well established.

Adults: Refer to specific herbal product guidelines as doses can vary widely based on formulation and preparation.

Mechanism of action

The exact mechanism of action of dong quai is not fully understood. However, it is believed to exert its effects through modulation of estrogenic activity, enhancing blood circulation, and possessing anti-inflammatory properties. The presence of compounds like ferulic acid may influence the synthesis and metabolism of hormones, particularly estrogen, while other constituents may promote vasodilation and improve microcirculation.

Pharmacodynamics

Dong quai exhibits various pharmacodynamic effects, including potential estrogenic activity, which may help alleviate symptoms associated with hormonal imbalances such as hot flashes and menstrual discomfort. Additionally, its anti-inflammatory properties may contribute to overall wellness and pain relief. The herb may also have a role in promoting hematopoiesis, or the production of blood cells, which could be beneficial in conditions like anemia.

Pharmacokinetics

The pharmacokinetics of dong quai are not well characterized in terms of absorption, distribution, metabolism, and excretion. However, it is known that the active compounds are absorbed in the gastrointestinal tract. The bioavailability of these compounds may be affected by their solubility and interaction with other dietary components. Dong quai is metabolized in the liver, and its effects may vary based on the preparation method and the presence of other herbs in traditional formulations.

Pregnancy

There is insufficient reliable information on the safety of dong during pregnancy. It is recommended to avoid its use unless prescribed by a healthcare professional.

Breast-feeding

Limited data is available regarding the excretion of dong components in breast milk. Caution is advised when using this product while breastfeeding.

Storage

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

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

• Nutritional support
• Prevention of chronic diseases
• Support for digestive health
• Antioxidant support
• Hydration

Dosage

Children: In children, the recommendation for fruit intake varies by age, with guidelines typically suggesting 1 to 2 servings per day, depending on age and dietary requirements.

Adults: Fruits are generally consumed as part of a balanced diet, with recommendations often suggesting 5 portions of fruits and vegetables per day, though specific amounts may vary based on individual dietary needs.

Mechanism of action

Fruits contain various bioactive compounds, including vitamins (such as vitamin C and folate), minerals (like potassium), dietary fiber, and phytochemicals (such as flavonoids and carotenoids). These components contribute to their health benefits through various mechanisms, including antioxidant activity, modulation of inflammation, and enhancement of immune function.

Pharmacodynamics

The pharmacodynamic effects of fruits are largely attributed to their phytochemical content, which can influence metabolic pathways, reduce oxidative stress, and improve cardiovascular health. The fiber content aids in digestion and can contribute to maintaining healthy cholesterol levels. The vitamins and minerals support various physiological functions, including immune response and cellular repair.

Pharmacokinetics

The bioavailability of nutrients from fruits can vary based on the composition of the fruit and the individual's digestive health. Vitamins and antioxidants are typically absorbed in the small intestine, while dietary fiber is fermented in the colon. The metabolism of fruit-derived nutrients occurs through various pathways, with some compounds undergoing conjugation and excretion via the kidneys.

Pregnancy

Fruits are generally safe to consume during pregnancy and provide essential nutrients. However, certain fruits may need to be limited due to sugar content or potential allergies.

Breast-feeding

Fruits are safe to consume while breastfeeding and can contribute to the nutritional needs of both the mother and the infant. Some fruits may help with lactation.

Storage

Fruits should be stored in a cool, dry place, and refrigeration can help prolong freshness. Some fruits may require specific storage conditions to maintain quality.

Formulations

• whole fruit
• dried fruit
• fruit juice
• fruit puree
• fruit smoothie

Indications

• Scurvy prevention
• Digestive aid
• Immune system support
• Skin health
• Antimicrobial applications

Dosage

Children: There is no specific paediatric dosage for lemon; it can be given to children in moderate amounts as part of a balanced diet.

Adults: There is no specific adult dosage for lemon; it can be consumed in various forms such as fresh fruit, juice, or as part of food and beverages.

Mechanism of action

Lemon contains compounds such as citric acid, flavonoids, and essential oils. Citric acid may enhance the absorption of minerals and has a role in the Krebs cycle, promoting energy metabolism. Flavonoids possess antioxidant properties, which help combat oxidative stress and inflammation, while essential oils can exhibit antimicrobial and anti-inflammatory effects.

Pharmacodynamics

The pharmacodynamic effects of lemon are primarily attributed to its antioxidant properties, which help neutralize free radicals, reduce oxidative stress, and support overall health. The citric acid in lemon may also aid in alkalizing the body, improving metabolic processes, and supporting digestion.

Pharmacokinetics

The bioavailability of lemon compounds can vary based on the form of consumption (whole fruit, juice, or extract). Vitamin C is rapidly absorbed in the gastrointestinal tract and distributed throughout the body. The metabolism of flavonoids occurs primarily in the liver, and they may have a variable half-life depending on individual metabolism.

Adverse effects

• Allergic reactions in sensitive individuals
• Gastrointestinal discomfort
• Tooth enamel erosion with excessive use

Precautions

• Caution in individuals with citrus allergies
• May cause skin irritation if applied topically in concentrated forms

Pregnancy

Lemon is generally considered safe during pregnancy, but excessive intake should be avoided.

Breast-feeding

Lemon is safe during breastfeeding when consumed in normal dietary amounts.

Storage

Store in a cool, dry place. Fresh lemons should be kept in the refrigerator to maintain freshness.

Formulations

• Fresh lemon
• Lemon juice
• Lemon essential oil
• Lemon zest

Indications

• Vitamin B6 deficiency
• Peripheral neuropathy associated with isoniazid therapy
• Supplementation in specific dietary deficiencies

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing guidance.

Adults: Refer to the BNF for specific dosing details, typically 10-50 mg daily for deficiency.

Mechanism of action

Pyridoxine, mainly in its active form pyridoxal 5'-phosphate, is involved in numerous biochemical reactions, including amino acid metabolism, glycogen breakdown, nucleic acid synthesis, and the production of key neurotransmitters. It aids in the synthesis of hemoglobin and sphingolipids, and its deficiency can impair several physiological processes, including immune response and vascular health.

Pharmacodynamics

Pyridoxine is utilized for the prevention and treatment of vitamin B6 deficiency, particularly in individuals undergoing treatment with isoniazid, which can deplete vitamin B6 levels. It may also have beneficial effects on blood pressure and lipid profiles, as studies have shown it can lower both systolic and diastolic blood pressure, inhibit platelet aggregation, and improve cholesterol levels. Additionally, it plays a role in enhancing immune function and protecting endothelial cells from injury.

Pharmacokinetics

Pyridoxine is rapidly absorbed from the gastrointestinal tract. It is transported to tissues where it is phosphorylated to its active form, pyridoxal 5'-phosphate. The vitamin is primarily excreted in urine as pyridoxine and its metabolites. Its half-life varies depending on the individual’s nutritional status and other factors. Adequate dietary intake is essential for maintaining optimal levels in the body.

Pregnancy

Pyridoxine is generally considered safe during pregnancy. However, high doses should be avoided unless specifically prescribed.

Breast-feeding

Pyridoxine is excreted in breast milk, but at normal dietary levels it is considered safe for breastfeeding mothers.

Storage

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

Formulations

• Tablets
• Oral solution
• Injectable form

Indications

• Malaria (uncomplicated)
• Leg cramps (off-label)
• Cardiac arrhythmias (off-label)

Dosage

Children: Refer to the BNF for Children for appropriate dosing recommendations.

Adults: Refer to the BNF for specific dosing guidelines based on the condition and patient characteristics.

Mechanism of action

Quinine exerts its antimalarial effects by interfering with the parasite's ability to metabolize and digest hemoglobin. It inhibits the polymerization of heme into hemozoin, leading to toxic accumulation of free heme, which is detrimental to the parasite. Quinine also has effects on the cardiac conduction system, affecting ion channels and potentially leading to changes in myocardial excitability.

Pharmacodynamics

Quinine has a dose-dependent effect on the malaria parasite, with higher concentrations leading to greater parasiticidal activity. It has a half-life of approximately 10 hours, but this can vary based on individual metabolism and the presence of other medications. Its effect on the cardiovascular system can lead to QT interval prolongation, necessitating monitoring in susceptible patients.

Pharmacokinetics

Quinine is well absorbed from the gastrointestinal tract, with peak plasma concentrations occurring within 1 to 3 hours post-administration. It is extensively metabolized in the liver, primarily through the cytochrome P450 system, and is eliminated via both renal and biliary pathways. Renal impairment can lead to increased plasma concentrations, requiring dose adjustments in patients with compromised renal function.

Pregnancy

Safety during pregnancy has not been established. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is unknown whether quai is excreted in human milk. Caution is advised when administering to nursing mothers.

Storage

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

Dosage

Children: Refer to specific formulations and preparations for recommended dosing in children, as it varies widely by plant and intended use.

Adults: Refer to specific formulations and preparations for recommended dosing, as it varies widely by plant and intended use.

Mechanism of action

The mechanism of action varies significantly depending on the specific root being referred to. Many plant roots contain bioactive compounds such as alkaloids, flavonoids, and glycosides, which can modulate various biochemical pathways in the body. For instance, certain roots may inhibit enzymes involved in inflammation or microbial growth, while others may enhance immune responses or modulate neurotransmitter activity.

Pharmacodynamics

Pharmacodynamics will differ based on the specific root and its active compounds. Generally, roots may exhibit anti-inflammatory, analgesic, antimicrobial, or antioxidant effects. The pharmacodynamic profile will also depend on factors such as dosage, preparation method (e.g., decoction, tincture), and the specific condition being treated. For example, some roots may interact with cellular receptors, while others may exert their effects through modulation of gene expression.

Pharmacokinetics

The pharmacokinetics of a root extract will vary with the specific plant. Typically, factors such as absorption, distribution, metabolism, and excretion are influenced by the chemical composition of the root, the method of preparation, and the route of administration. Many active compounds are absorbed in the gastrointestinal tract, metabolized in the liver, and excreted via urine or feces. The bioavailability of these compounds can be affected by their solubility and stability.

Pregnancy

The safety of root during pregnancy has not been established. Consult a healthcare professional before use.

Breast-feeding

It is unknown whether root is excreted in human milk. Caution is advised when administering to nursing mothers.

Storage

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

Mechanism of action

Binds to riboflavin hydrogenase, riboflavin kinase, and riboflavin synthase. Riboflavin is the precursor of flavin mononucleotide (FMN, riboflavin monophosphate) and flavin adenine dinucleotide (FAD). The antioxidant activity of riboflavin is principally derived from its role as a precursor of FAD and the role of this cofactor in the production of the antioxidant reduced glutathione. Reduced glutathione is the cofactor of the selenium-containing glutathione peroxidases among other things. The glutathione peroxidases are major antioxidant enzymes. Reduced glutathione is generated by the FAD-containing enzyme glutathione reductase. Riboflavin is converted to 2 coenzymes, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), which are necessary for normal tissue respiration. Riboflavin is also required for activation of pyridoxine, conversion of tryptophan to niacin, and may be involved in maintaining erythrocyte integrity. Riboflavin functions as the coenzyme for flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN), which primarily influence hydrogen transport in oxidative enzyme systems (eg, cytochrome C reductase, succinic dehydrogenase, xanthine oxidase). Two active forms of riboflavin exist ... coenzyme flavin mononucleotide (FMN) and coenzyme flavin adenine dinucleotide (FAD). They are formed by reaction of riboflavin with 1 and 2 molecules of ATP as follow: riboflavin + ATP = riboflavin-P (FMN) + ADP; FMN + ATP = riboflavin-ADP (FAD) + PP. Riboflavin is a water-soluble, yellow, fluorescent compound. The primary form of the vitamin is as an integral component of the coenzymes flavin mononucleotide (FMN) and flavin-adenine dinucleotide (FAD). It is in these bound coenzyme forms that riboflavin functions as a catalyst for redox reactions in numerous metabolic pathways and in energy production. ... The redox reactions in which flavocoenzymes participate include flavoprotein-catalyzed dehydrogenations that are both pyridine nucleotide (niacin) dependent and independent, reactions with sulfur-containing compounds, hydroxylations, oxidative decarboxylations (involving thiamin as its pyrophosphate), dioxygenations, and reduction of oxygen to hydrogen peroxide. There are obligatory roles of flavocoenzymes in the formation of some vitamins and their coenzymes. For example, the biosynthesis of two niacin-containing coenzymes from tryptophan occurs via FAD-dependent kynurenine hydroxylase, an FMN-dependent oxidase catalyzes the conversion of the 5'-phosphates of vitamin B6 to coenzymic pyridoxal 5'-phosphate, and an FAD-dependent dehydrogenase reduces 5,10-methylene-tetrahydrofolate to the 5'-methyl product that interfaces with the B12-dependent formation of methionine from homocysteine and thus with sulfur amino acid metabolism. For more Mechanism of Action (Complete) data for Riboflavin (7 total), please visit the HSDB record page.

Pharmacodynamics

Riboflavin or vitamin B2 is an easily absorbed, water-soluble micronutrient with a key role in maintaining human health. Like the other B vitamins, it supports energy production by aiding in the metabolising of fats, carbohydrates, and proteins. Vitamin B2 is also required for red blood cell formation and respiration, antibody production, and for regulating human growth and reproduction. It is essential for healthy skin, nails, hair growth and general good health, including regulating thyroid activity. Riboflavin also helps in the prevention or treatment of many types of eye disorders, including some cases of cataracts.

Mechanism of action

Most individuals naturally generate adequate amounts of vitamin D through ordinary dietary intake of vitamin D (in some foods like eggs, fish, and cheese) and natural photochemical conversion of the vitamin D3 precursor 7-dehydrocholesterol in the skin via exposure to sunlight. Conversely, vitamin D deficiency can often occur from a combination of insufficient exposure to sunlight, inadequate dietary intake of vitamin D, genetic defects with endogenous vitamin D receptor, or even severe liver or kidney disease. Such deficiency is known for resulting in conditions like rickets or osteomalacia, all of which reflect inadequate mineralization of bone, enhanced compensatory skeletal demineralization, resultant decreased calcium ion blood concentrations, and increases in the production and secretion of parathyroid hormone. Increases in parathyroid hormone stimulate the mobilization of skeletal calcium and the renal excretion of phosphorus. This enhanced mobilization of skeletal calcium leads towards porotic bone conditions. Ordinarily, while vitamin D3 is made naturally via photochemical processes in the skin, both itself and vitamin D2 can be found in various food and pharmaceutical sources as dietary supplements. The principal biological function of vitamin D is the maintenance of normal levels of serum calcium and phosphorus in the bloodstream by enhancing the efficacy of the small intestine to absorb these minerals from the diet. At the liver, vitamin D3 or D2 is hydroxylated to 25-hydroxyvitamin D and then finally to the primary active metabolite 1,25-dihydroxyvitamin D in the kidney via further hydroxylation. This final metabolite binds to endogenous vitamin d receptors, which results in a variety of regulatory roles - including maintaining calcium balance, the regulation of parathyroid hormone, the promotion of the renal reabsorption of calcium, increased intestinal absorption of calcium and phosphorus, and increased calcium and phosphorus mobilization of calcium and phosphorus from bone to plasma to maintain balanced levels of each in bone and the plasma. In particular, calcitriol interacts with vitamin D receptors in the small intestine to enhance the efficiency of intestinal calcium and phosphorous absorption from about 10-15% to 30-40% and 60% increased to 80%, respectively. Furthermore, calcitriol binds with vitamin D receptors in osteoblasts to stimulate a receptor activator of nuclear factor kB ligand (or RANKL) which subsequently interacts with receptor activator of nuclear factor kB (NFkB) on immature preosteoclasts, causing them to become mature bone-resorbing osteoclasts. Such mature osteoclasts ultimately function in removing calcium and phosphorus from bone to maintain blood calcium and phosphorus levels. Moreover, calcitriol also stimulates calcium reabsorption from the glomerular filtrate in the kidneys. Additionally, it is believed that when calcitriol binds with nuclear vitamin D receptors, that this bound complex itself binds to retinoic acid X receptor (RXR) to generate a heterodimeric complex that consequently binds to specific nucleotide sequences in the DNA called vitamin D response elements. When bound, various transcription factors attach to this complex, resulting in either up or down-regulation of the associated gene's activity. It is thought that there may be as much as 200 to 2000 genes that possess vitamin D response elements or that are influenced indirectly to control a multitude of genes across the genome. It is in this way that cholecalciferol is believed to function in regulating gene transcription associated with cancer risk, autoimmune disorders, and cardiovascular disease linked to vitamin D deficiency. In fact, there has been some research to suggest calcitriol may also be able to prevent malignancies by inducing cellular maturation and inducing apoptosis and inhibiting angiogenesis, exhibit anti-inflammatory effects by inhibiting foam cell formation and promoting angiogenesis in en

Pharmacodynamics

The in vivo synthesis of the predominant two biologically active metabolites of vitamin D occurs in two steps. The first hydroxylation of vitamin D3 cholecalciferol (or D2) occurs in the liver to yield 25-hydroxyvitamin D while the second hydroxylation happens in the kidneys to give 1, 25-dihydroxyvitamin D. These vitamin D metabolites subsequently facilitate the active absorption of calcium and phosphorus in the small intestine, serving to increase serum calcium and phosphate levels sufficiently to allow bone mineralization. Conversely, these vitamin D metabolites also assist in mobilizing calcium and phosphate from bone and likely increase the reabsorption of calcium and perhaps also of phosphate via the renal tubules. There exists a period of 10 to 24 hours between the administration of cholecalciferol and the initiation of its action in the body due to the necessity of synthesis of the active vitamin D metabolites in the liver and kidneys. It is parathyroid hormone that is responsible for the regulation of such metabolism at the level of the kidneys.

Mechanism of action

Vitamin B6 is the collective term for a group of three related compounds, pyridoxine (PN), pyridoxal (PL) and pyridoxamine (PM), and their phosphorylated derivatives, pyridoxine 5'-phosphate (PNP), pyridoxal 5'-phosphate (PLP) and pyridoxamine 5'-phosphate (PMP). Although all six of these compounds should technically be referred to as vitamin B6, the term vitamin B6 is commonly used interchangeably with just one of them, pyridoxine. Vitamin B6, principally in its biologically active coenzyme form pyridoxal 5'-phosphate, is involved in a wide range of biochemical reactions, including the metabolism of amino acids and glycogen, the synthesis of nucleic acids, hemogloblin, sphingomyelin and other sphingolipids, and the synthesis of the neurotransmitters serotonin, dopamine, norepinephrine and gamma-aminobutyric acid (GABA).

Pharmacodynamics

Vitamin B6 (pyridoxine) is a water-soluble vitamin used in the prophylaxis and treatment of vitamin B6 deficiency and peripheral neuropathy in those receiving isoniazid (isonicotinic acid hydrazide, INH). Vitamin B6 has been found to lower systolic and diastolic blood pressure in a small group of subjects with essential hypertension. Hypertension is another risk factor for atherosclerosis and coronary heart disease. Another study showed pyridoxine hydrochloride to inhibit ADP- or epinephrine-induced platelet aggregation and to lower total cholesterol levels and increase HDL-cholesterol levels, again in a small group of subjects. Vitamin B6, in the form of pyridoxal 5'-phosphate, was found to protect vascular endothelial cells in culture from injury by activated platelets. Endothelial injury and dysfunction are critical initiating events in the pathogenesis of atherosclerosis. Human studies have demonstrated that vitamin B6 deficiency affects cellular and humoral responses of the immune system. Vitamin B6 deficiency results in altered lymphocyte differentiation and maturation, reduced delayed-type hypersensitivity (DTH) responses, impaired antibody production, decreased lymphocyte proliferation and decreased interleukin (IL)-2 production, among other immunologic activities.