NEUROFORGE CAPSULES (Each capsules contains contains Alpha Lipoic Acid USP 300mg/ Benfothiamine 100mg/ Methylcobalamin USP 1500mcg/ Folic Acid USP 1.5mg/ Chromium Picolinate USP 200mcg/ Selenomethionine USP 55mcg/ Zinc Sulfate USP 25mg)

Indications

• Hypertension
• Benign prostatic hyperplasia
• Urinary retention related to prostate enlargement

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines in the paediatric population.

Adults: Refer to the BNF for specific dosing recommendations based on individual clinical scenarios.

Mechanism of action

Alpha acts by selectively blocking alpha-1 adrenergic receptors, which are responsible for mediating vasoconstriction in blood vessels. By inhibiting these receptors, alpha promotes vasodilation, leading to a decrease in peripheral vascular resistance and subsequently lowering blood pressure. Additionally, this action can help alleviate urinary symptoms associated with an enlarged prostate.

Pharmacodynamics

The pharmacodynamics of alpha involve its competitive antagonism at alpha-1 adrenergic receptors, resulting in decreased vasoconstriction and increased blood flow. This mechanism is beneficial in conditions characterized by high blood pressure and urinary retention due to prostatic enlargement. The onset of action typically occurs within hours, with peak effects observed within a few days of consistent dosing.

Pharmacokinetics

Alpha is absorbed well from the gastrointestinal tract, with peak plasma concentrations achieved within 1-3 hours post-administration. The drug undergoes hepatic metabolism, primarily via cytochrome P450 enzymes, resulting in active and inactive metabolites. The elimination half-life varies, but it generally is around 6-12 hours, allowing for once-daily dosing in many cases. Renal excretion is a significant route for its metabolites, necessitating caution in patients with renal impairment.

Interactions

• maois, irreversible + alpha blockers: Severe (increases effects)
• ribociclib + alpha blockers: Severe (increases exposure)
• cobicistat + alpha blockers: Moderate (increases exposure)
• idelalisib + alpha blockers: Moderate (increases exposure)
• dronedarone + alpha blockers: Unknown (increases exposure)
• antifungals, azoles + alpha blockers: Unknown (increases exposure)
• crizotinib + alpha blockers: Unknown (increases exposure)
• imatinib + alpha blockers: Unknown (increases exposure)
• letermovir + alpha blockers: Unknown (increases exposure)
• clarithromycin + alpha blockers: Unknown (increases exposure)

Indications

• Thiamine deficiency
• Diabetic neuropathy
• Alcohol-related Wernicke's encephalopathy
• Beriberi

Dosage

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

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Benfothiamine is converted into thiamine in the body, where it acts as a coenzyme in carbohydrate metabolism. It facilitates the decarboxylation of alpha-keto acids and is essential for the synthesis of neurotransmitters, thus helping to maintain nervous system function and glucose metabolism.

Pharmacodynamics

Benfothiamine enhances thiamine levels in tissues, leading to improved energy metabolism in neurons and peripheral tissues. Its neuroprotective effects may help prevent complications associated with diabetic neuropathy and other disorders related to thiamine deficiency.

Pharmacokinetics

Benfothiamine is well-absorbed in the gastrointestinal tract due to its lipid-soluble nature. It undergoes rapid conversion to thiamine, which is then distributed throughout body tissues. The half-life of thiamine is relatively short, necessitating regular dosing for sustained therapeutic effects.

Pregnancy

There is limited data on the use of benfothiamine in pregnancy. Caution is advised when prescribing.

Breast-feeding

The safety of benfothiamine during breastfeeding has not been established. Caution is recommended.

Storage

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

Formulations

• Tablets
• Capsules

Indications

• Type 2 diabetes mellitus
• Insulin resistance
• Impaired glucose tolerance
• Metabolic syndrome
• Hyperlipidemia

Dosage

Children: Refer to the BNF for Children for specific dosage recommendations suitable for pediatric patients.

Adults: Refer to the BNF for specific dosage recommendations based on the condition being treated.

Mechanism of action

Chromium enhances insulin signaling by upregulating insulin receptor-mediated pathways. It affects downstream effector molecules after insulin binds to its receptor, leading to the activation of phosphatidylinositol 2-kinase (PI3K) and protein kinase B (Akt). This process promotes the translocation of glucose transporter-4 (Glut4) to the cell membrane, facilitating increased glucose uptake. Additionally, chromium can promote GLUT-4 transporter translocation independently of insulin receptor activity under insulin-resistant conditions and aids in cholesterol efflux by increasing membrane fluidity.

Pharmacodynamics

Trivalent chromium is essential for the glucose tolerance factor, which activates insulin-mediated pathways. It enhances insulin binding to cells, increases the density of insulin receptors, and activates insulin receptor kinase, all of which contribute to improved insulin sensitivity. Chromium deficiency can lead to impaired glucose metabolism, and supplementation can normalize glucose tolerance in individuals exhibiting diabetic-like characteristics due to deficiency.

Pharmacokinetics

Chromium absorption occurs primarily in the intestines, but its bioavailability is influenced by various dietary factors, such as the presence of other minerals and vitamins. The mineral is transported in the bloodstream bound to transferrin and is predominantly stored in the liver, spleen, and bone. The elimination of chromium occurs mainly through urine, with small amounts excreted in feces. The half-life and exact metabolic pathways for chromium can vary based on its form and the individual's nutritional status.

Pregnancy

Chromium is generally considered safe during pregnancy when taken in appropriate amounts, but it is advisable to consult a healthcare provider.

Breast-feeding

Chromium is excreted in breast milk, and while it is deemed safe in moderate amounts, consultation with a healthcare provider is recommended.

Storage

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

Indications

• Folate deficiency
• Megaloblastic anemia
• Prevention of neural tube defects in pregnancy
• Supplementation in patients on certain medications (e.g., methotrexate)

Dosage

Children: Refer to the BNF for Children for appropriate pa

Adults: Refer to specific guidelines or the BNF for appropriate adult dosing based on the indication.

Mechanism of action

Folate functions as a coenzyme in the conversion of homocysteine to methionine, a process that is vital for DNA synthesis and repair. It is involved in the one-carbon metabolism pathway, where it acts as a carrier of one-carbon units necessary for the synthesis of purines and thymidylate, thus supporting the production of nucleotides and DNA. This mechanism is particularly important in rapidly dividing cells.

Pharmacodynamics

Folate is critical for the formation of red blood cells and the proper functioning of the nervous system. It aids in the production of nucleic acids, which are essential for cell proliferation. Folate deficiency can lead to impaired DNA synthesis, resulting in megaloblastic anemia characterized by the presence of large, immature red blood cells in the bloodstream. Adequate folate levels are also associated with reduced risk of neural tube defects in developing fetuses.

Pharmacokinetics

Folate is absorbed in the proximal part of the small intestine, primarily in the jejunum, and is transported in the bloodstream bound to plasma proteins. It undergoes hepatic metabolism and is stored mainly in the liver. The elimination half-life varies, but dietary folate can be retained in the body for several weeks. Excess folate is excreted through the urine. The bioavailability of folate from food sources is lower compared to synthetic folic acid found in supplements.

Interactions

• folates+fluorouracil: Severe (increases risk of toxicity)
• folates+antiepileptics: Moderate (decreases concentration)
• folates+fosphenytoin: Moderate (decreases concentration)
• folates+phenobarbital: Moderate (decreases concentration)
• folates+phenytoin: Moderate (decreases concentration)
• folates+primidone: Moderate (decreases concentration)
• sulfasalazine+folates: Unknown (decreases absorption)

Pregnancy

Folate is essential for fetal development and is often recommended to prevent neural tube defects.

Breast-feeding

Folate is generally safe during breastfeeding, as it is important for both maternal and infant health.

Storage

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

Formulations

• Tablets
• Injection

Indications

• Diabetic neuropathy
• Oxidative stress-related disorders
• Metabolic syndrome
• Weight management
• Liver health

Dosage

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

Adults: Refer to specific product guidelines, as dosages may vary based on the formulation and indication.

Mechanism of action

Lipoic acid acts as a cofactor for mitochondrial enzyme complexes, particularly those involved in the Krebs cycle, enhancing energy production. It also possesses antioxidant properties, neutralizing free radicals and regenerating other antioxidants such as vitamins C and E. Additionally, lipoic acid can modulate various signaling pathways, including those related to insulin sensitivity and inflammation.

Pharmacodynamics

Lipoic acid has a dual role as a coenzyme and an antioxidant. By participating in the decarboxylation of alpha-keto acids, it aids in energy production. Its antioxidant properties contribute to the protection of cells from oxidative stress, which is implicated in various chronic diseases. Lipoic acid can improve insulin sensitivity, making it beneficial in managing glucose metabolism disorders.

Pharmacokinetics

After oral administration, lipoic acid is absorbed in the gastrointestinal tract, with peak plasma concentrations occurring within 30 to 60 minutes. It undergoes hepatic metabolism, primarily via reduction and conjugation, resulting in various metabolites. The elimination half-life is approximately 30 minutes to 2 hours, and it is excreted primarily in urine. The bioavailability of lipoic acid can be affected by food intake.

Adverse effects

• Nausea
• Vomiting
• Abdominal pain
• Skin rash
• Hypoglycemia

Interactions

• May enhance the effects of insulin and other antidiabetic medications
• May interact with heavy metal chelators

Precautions

• Use with caution in patients with diabetes due to the risk of hypoglycemia
• Monitor blood sugar levels in diabetic patients

Pregnancy

Safety during pregnancy has not been established; use only if clearly needed.

Breast-feeding

It is not known whether lipoic acid is excreted in human breast milk; caution is advised.

Storage

Store in a cool, dry place away from light.

Formulations

• Capsules
• Tablets
• Injectable solutions

Indications

• Vitamin B12 deficiency
• Megaloblastic anemia
• Peripheral neuropathy
• Neuropathic pain
• Multiple sclerosis

Dosage

Children: For paediatric patients, refer to the BNF for Children for appropriate dosing guidelines.

Adults: The typical adult dosage for methylcobalamin is 500 micrograms to 1,000 micrograms administered intramuscularly or subcutaneously, usually once daily for the initial treatment, followed by maintenance doses as needed.

Mechanism of action

Methylcobalamin serves as a cofactor for the enzyme methionine synthase, which catalyzes the conversion of homocysteine to methionine. This reaction is crucial in the synthesis of S-adenosylmethionine (SAMe), an important methyl donor in numerous methylation reactions within the body. Methylcobalamin also plays a role in myelin formation and the maintenance of nerve cells.

Pharmacodynamics

Methylcobalamin exhibits neuroprotective effects, promoting nerve regeneration and repair in peripheral neuropathy. It is believed to enhance nerve conduction and improve neurological function. The physiological effects are primarily attributed to its role in methylation processes and the synthesis of neurotransmitters.

Pharmacokinetics

Methylcobalamin is water-soluble and is absorbed in the intestine. The bioavailability can be affected by gastrointestinal health, and intrinsic factor is not required for its absorption. It is distributed throughout the body, with high concentrations in the liver, kidneys, and brain. The elimination half-life of methylcobalamin is approximately 6 hours, and it is excreted primarily in the urine.

Adverse effects

• Nausea
• Diarrhea
• Headache
• Dizziness
• Anxiety
• Rash
• Pruritus

Precautions

• Monitor patients with Leber's disease due to potential optic nerve damage.
• Caution in patients with allergies to cobalt or vitamin B12.
• Use with caution in patients with renal impairment.

Pregnancy

Methylcobalamin is classified as a category A drug. It is generally considered safe during pregnancy, but consultation with a healthcare provider is recommended.

Breast-feeding

Methylcobalamin is excreted in breast milk. It is generally considered safe during breastfeeding, but consultation with a healthcare provider is recommended.

Storage

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

Formulations

• Tablets
• Injections
• Sublingual tablets
• Oral solutions

Dosage

Children: Refer to specific guidelines or consult a healthcare professional for appropriate dosing information, as current literature does not provide standardized dosing recommendations.

Adults: Refer to specific guidelines or consult a healthcare professional for appropriate dosing information, as current literature does not provide standardized dosing recommendations.

Mechanism of action

Picolinate acts as a metabolic intermediate, particularly in the catabolism of tryptophan. It participates in several biochemical pathways such as amino acid and derivative metabolism, and its presence is crucial for the degradation of tryptophan into various metabolites. This process includes its involvement in the production of important coenzymes and other bioactive compounds, thus influencing metabolic pathways and cellular functions.

Pharmacodynamics

Picolinate is involved in the metabolism of tryptophan, leading to the generation of kynurenine and other metabolites. The compound plays a role in the biosynthesis of NAD, which is essential for cellular respiration and energy production. Its effects may include modulation of metabolic pathways and potential influence on cognitive and metabolic health, although specific pharmacodynamic effects can vary based on the context of use.

Pharmacokinetics

The pharmacokinetics of picolinate, including absorption, distribution, metabolism, and excretion, are not extensively documented. It is generally understood that compounds involved in amino acid metabolism are absorbed and utilized by the body in a manner that supports metabolic functions. However, specific parameters such as bioavailability, half-life, and excretion pathways are not well-characterized.

Pregnancy

There is insufficient data on the safety of picolinate in pregnancy. Consult healthcare providers for advice.

Breast-feeding

Limited data is available on the excretion of picolinate in human milk. Caution is advised.

Storage

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

Indications

• Cancer chemoprevention
• Selenium deficiency

Dosage

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

Adults: Refer to the BNF for appropriate dosing information.

Mechanism of action

Selenomethionine exerts its anticancer effects primarily through metabolism into reactive metabolites that interact with cellular pathways. Specifically, when combined with methioninase, its anticancer activity is enhanced, leading to increased levels of superoxide and apoptosis in cancer cells expressing wild-type p53. This process involves translocation of p53 to mitochondria, activation of caspase pathways, and modulation of apoptosis-related proteins.

Pharmacodynamics

Selenomethionine has shown a capacity to induce apoptosis in certain cancer cell lines, particularly those with functional p53. The compound appears to increase superoxide production, mitochondrial dysfunction, and activation of apoptotic markers. While it has been investigated for its chemopreventive properties, its weaker efficacy compared to other selenium compounds limits its role as a primary agent in cancer therapy.

Pharmacokinetics

Upon administration, selenomethionine is absorbed and distributed throughout the body, where it participates in selenium metabolism and is incorporated into proteins in place of methionine. The metabolism involves conversion to various selenoamino acids and metabolites, which are then excreted primarily via renal pathways. The pharmacokinetics can be influenced by dietary selenium intake and individual metabolic variations.

Pregnancy

Selenomethionine should only be used in pregnancy if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Caution should be exercised when administering selenomethionine to nursing mothers.

Storage

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

Formulations

• Selenomethionine capsules
• Selenomethionine tablets

Mechanism of action

Chromium is an essential nutrient involved in the metabolism of glucose, insulin and blood lipids. Its role in potentiating insulin signalling cascades has been implicated in several studies. Chromium upregulates insulin-stimulated insulin signal transduction via affecting effector molecules downstream of the insulin receptor (IR). IR-mediated signalling pathway involves phoshorylation of multiple intracellular domains and protein kinases, and downstream effector molecules. Upon activation by ligands, intracellular β-subunit of IR autophosphorylates and activates tyrosine kinase domain of the IR, followed by activation and phosphorylation of regulatory proteins and downstream signalling effectors including phosphatidylinositol 2-kinase (PI3K). PI3K activates further downstream reaction cascades to activate protein kinase B (Akt) to ultimately promote translocation of glucose transporter-4 (Glut4)-vesicles from the cytoplasm to the cell surface and regulate glucose uptake. Chromium enhances the kinase activity of insulin receptor β and increases the activity of downstream effectors, pI3-kinase and Akt. Under insulin-resistant conditions, chromium also promotes GLUT-4 transporter translocation that is independent of activity of IR, IRS-1, PI3-kinase, or Akt; chromium mediates cholesterol efflux from the membranes via increasing fluidity of the membrane by decreasing the membrane cholesterol and upregulation of sterol regulatory element-binding protein. As a result, intracellular GLUT-4 transporters are stimulated to translocate from intracellular to the plasma membrane, leading to enhanced glucose uptake in muscle cells. Chromium attenuates the activity of PTP-1B _in vitro,_ which is a negative regulator of insulin signaling. It also alleviates ER stress that is observed to be elevated the suppression of insulin signaling. ER stress is thought to activate c-Jun N-terminal kinase (JNK), which subsequently induces serine phosphorylation of IRS and aberration of insulin signalling. Transient upregulation of AMPK by chromium also leads to increased glucose uptake. While the toxicity of metals and metalloids, like arsenic, cadmium, mercury, lead and chromium, is undisputed, the underlying molecular mechanisms are not entirely clear. General consensus holds that proteins are the prime targets; heavy metals interfere with the physiological activity of specific, particularly susceptible proteins, either by forming a complex with functional side chain groups or by displacing essential metal ions in metalloproteins. Recent studies have revealed an additional mode of metal action targeted at proteins in a non-native state; certain heavy metals and metalloids have been found to inhibit the in vitro refolding of chemically denatured proteins, to interfere with protein folding in vivo and to cause aggregation of nascent proteins in living cells. Apparently, unfolded proteins with motile backbone and side chains are considerably more prone to engage in stable, pluridentate metal complexes than native proteins with their well-defined 3D structure. By interfering with the folding process, heavy metal ions and metalloids profoundly affect protein homeostasis and cell viability. This review describes how heavy metals impede protein folding and promote protein aggregation, how cells regulate quality control systems to protect themselves from metal toxicity and how metals might contribute to protein misfolding disorders.

Pharmacodynamics

Trivalent chromium is part of glucose tolerance factor, an essential activator of insulin-mediated reactions. Chromium helps to maintain normal glucose metabolism and peripheral nerve function. Chromium increases insulin binding to cells, increases insulin receptor density and activates insulin receptor kinase leading to enhanced insulin sensitivity. In chromium deficiency, intravenous administration of chromium resulted in normalization of the glucose tolerance curve from the diabetic-like curve typical of chromium deficiency.

Mechanism of action

Selenomethionine (SeMet) is the chemical form or major component of selenium used for cancer chemoprevention in several clinical trials. However, evidence from experimental studies indicates that SeMet has weaker anticancer effects than most other forms of selenium. ... The anticancer activity of SeMet can be enhanced by methioninase (METase), indicating that SeMet metabolites are responsible for its anticancer activity. ... Wild-type p53-expressing LNCaP human prostate cancer cells were more sensitive to cotreatment with SeMet and METase than p53-null PC3 human prostate cancer cells. SeMet and METase cotreatment significantly increased levels of superoxide and apoptosis in LNCaP cells. Cotreatment with SeMet and METase resulted in increased levels of phosphorylated p53 (Ser15), total p53, Bax, and p21(Waf1) proteins. LNCaP cells treated with SeMet and METase also showed p53 translocation to mitochondria, decreased mitochondrial membrane potential, cytochrome c release into the cytosol, and activation of caspase-9. The effects of SeMet and METase were suppressed by pretreatment with a synthetic superoxide dismutase mimic or by knockdown of p53 via RNA interference. Reexpression of wild-type p53 in PC3 cells resulted in increases in superoxide production, apoptosis, and caspase-9 activity and a decrease in mitochondrial membrane potential following cotreatment with SeMet and METase. /The/ study shows that apoptosis induced by SeMet plus METase is superoxide mediated and p53 dependent via mitochondrial pathway(s). These results suggest that superoxide and p53 may play a role in cancer chemoprevention by selenium. ... The toxicity of Se is thought to arise from its ability to substitute for sulfur during the assembly of proteins. .../More/ recent studies also indicate that some forms of selenium are capable of generating oxidative stress in an in vitro test system that includes glutathione. L-Selenomethionine, the predominant form of selenium in the eggs of oviparous vertebrates, does not generate oxidative radicals in this system, but lesions consistent with oxidative stress have been identified in fish and birds with high concentrations of Se. /This study reports/ on the ability of rainbow trout embryos to transform L-selenomethionine to a form capable of producing a superoxide radical. Oxidative stress appears to be generated by methioninase enzyme activity in the embryos that liberates methylselenol from l-selenomethionine. Methylselenol redox cycles in the presence of glutathione producing superoxide and likely accounts for oxidative lesions present in fish and birds environmentally exposed to excessive loads of selenomethionine. /L-Selenomethionine/ Primary cultures of porcine aortic endothelial cells were used to test the potential protective effect ... against several types of oxidative stress. The stressors included exposure to hyperoxia, treatment with paraquat, and incubation in the presence of the hypoxanthine/xanthine oxidase system. This protective effect ... of selenomethionine ... is known to increase glutathione peroxidase activity. ... High-selenium containing yeast is being evaluated in clinical trials against colon polyp recurrence. However, the molecular targets for the anticancer effects of selenium remain unclear. Previous studies by our group demonstrated that selenomethionine-induced growth arrest appears to be mediated by activation of ERK and subsequent phosphorylation of RSK and histone H3. These results suggest that selenomethionine can alter gene expression. In the present study, we have used cDNA microarrays to determine whether gene expression differences exist in HCT116 colon cancer cells treated with selenomethionine. These experiments reveal statistically significant expression changes for 50 genes. Genes we found to increase with selenomethionine treatment include KLK6, ATOX1, SGK, GJB2, DAP-1, PLAU, VIM, DPYSL2, STC2 and PXN. Conversely, genes downregulated by selenomethionine include PRKACB,