PREMICAL SOFT GEL CAPSULES (Each capsule Calcium hydroxyapatite / Magnesium oxide / Cholecalciferol / Fructose oligosaccharide / Plum juice powder / Collagen peptides / Zinc oxide / Vitamin K2 385mg/125mg/ 100iu/ 50mg/50mg/ 50mg/5.6mg/ 10mcg)

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

• Skin aging and wrinkle reduction
• Joint pain and osteoarthritis
• Tendon and ligament injuries
• Bone health
• Wound healing

Dosage

Children: Refer to specific product guidelines or consult a healthcare professional for appropriate dosing based on the indication and formulation used.

Adults: Refer to specific product guidelines or consult a healthcare professional for appropriate dosing based on the indication and formulation used.

Mechanism of action

Collagen exerts its effects primarily by providing the necessary amino acids, such as glycine, proline, and hydroxyproline, that are crucial for the synthesis of new collagen in the body. It is thought to stimulate fibroblast proliferation, which leads to increased collagen production and improved tissue repair. Additionally, collagen may enhance the hydration of the skin and improve its elasticity.

Pharmacodynamics

Collagen supplementation may promote the synthesis of new collagen and improve the integrity of the extracellular matrix. This can lead to improved skin hydration, elasticity, and the reduction of wrinkles. In joint health, collagen may help reduce inflammation and pain, contributing to improved mobility and function. The effects can vary based on the source of collagen (bovine, porcine, marine) and the form of administration (powder, liquid, capsules).

Pharmacokinetics

After oral administration, collagen peptides are absorbed in the gastrointestinal tract and enter the bloodstream. They can be transported to various tissues where they may be incorporated into the extracellular matrix. The half-life of collagen peptides is relatively short, and they are metabolized in the liver and other tissues. The bioavailability of collagen can vary based on the formulation and the presence of other dietary components.

Adverse effects

• Allergic reactions
• Skin rash
• Itching
• Gastrointestinal disturbances
• Nausea

Precautions

• Use with caution in individuals with fish allergies if derived from fish sources
• Monitor for allergic reactions

Pregnancy

Collagen is generally considered safe during pregnancy, but consult a healthcare professional before use.

Breast-feeding

Collagen is likely safe during breastfeeding, but consult a healthcare professional before use.

Storage

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

Formulations

• Powder
• Capsules
• Liquid

Indications

• Used as a sweetener in food products
• Management of hypoglycemia (under specific conditions)
• Potential use in metabolic studies

Dosage

Children: Refer to BNF for Children for specific dosing guidance based on age and clinical conditions.

Adults: Refer to BNF for specific dosing guidance based on clinical conditions and formulations.

Mechanism of action

Fructose is absorbed in the small intestine and transported to the liver where it is phosphorylated to fructose-1-phosphate. This compound is then further metabolized through the glycolytic pathway, providing an energy source. Fructose metabolism bypasses the main regulatory step of glycolysis, making it a quick source of energy.

Pharmacodynamics

Fructose does not elicit a significant insulin response compared to glucose, thus affecting glucose metabolism and insulin sensitivity differently. The metabolism of fructose can lead to the generation of triglycerides, which can impact lipid profiles and cardiovascular health if consumed in excess.

Pharmacokinetics

Fructose is rapidly absorbed from the gastrointestinal tract. Its absorption does not require insulin, and it is primarily metabolized in the liver. The half-life of fructose in the bloodstream is short, as it is quickly taken up and utilized by the liver and other tissues.

Contra-indications

• Fructose intolerance
• Hereditary fructose intolerance

Adverse effects

• Diarrhea
• Nausea
• Abdominal discomfort
• Hypoglycemia (in sensitive individuals)

Precautions

• Use with caution in patients with diabetes or insulin resistance
• Monitor blood glucose levels in diabetic patients

Pregnancy

Fructose is generally considered safe during pregnancy when consumed in normal dietary amounts.

Breast-feeding

Fructose is safe during breastfeeding; it is a natural sugar found in fruits and is metabolized by the body.

Storage

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

Formulations

• Liquid form
• Powder form
• As an ingredient in various food products

Indications

• Bone defects
• Osteoporosis
• Dental implants
• Bone grafting
• Maxillofacial surgery

Dosage

Children: Refer to specific guidelines for paediatric applications, as dosage can vary significantly based on age and condition.

Adults: Dosage varies based on specific formulation and clinical application; refer to product-specific guidelines.

Mechanism of action

Hydroxyapatite facilitates bone repair and regeneration by providing a scaffold for new bone formation. It promotes osteoblast activity and serves as a reservoir for calcium and phosphate ions, essential for mineralization processes in bone tissue.

Pharmacodynamics

Hydroxyapatite exhibits osteoconductive properties, allowing for the formation of new bone tissue around it. It enhances the mineralization process, which is crucial for the strength and stability of the newly formed bone. Its chemical structure closely resembles that of natural bone, promoting better integration and healing.

Pharmacokinetics

Hydroxyapatite is not absorbed in the traditional sense as it is used primarily as a biomaterial. It remains at the site of implantation and gradually gets integrated into the host bone. Its degradation and resorption rates vary depending on the specific formulation and application but are generally slow, allowing for sustained support during the healing process.

Pregnancy

There are no adequate and well-controlled studies in pregnant women. Hydroxyapatite should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

It is not known whether hydroxyapatite is excreted in human milk. Caution should be exercised when hydroxyapatite is administered to a nursing woman.

Storage

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

Indications

• Nutritional supplementation
• Hydration
• Antioxidant support
• Immune system support
• Digestive health

Dosage

Children: Refer to specific juice labels for serving sizes and nutritional content, as these can vary widely.

Adults: Refer to specific juice labels for serving sizes and nutritional content, as these can vary widely.

Mechanism of action

Juice primarily provides vitamins, minerals, and phytochemicals that can have various biological effects in the body. For example, vitamin C, found in many fruit juices, acts as an antioxidant, helping to protect cells from damage caused by free radicals. Other components, like flavonoids and carotenoids, may also contribute to health benefits through anti-inflammatory and immune-modulating effects.

Pharmacodynamics

The pharmacodynamics of juice depend on its specific components. For example, fruit juices rich in vitamin C can enhance immune function and promote collagen synthesis, while juices high in potassium can aid in blood pressure regulation. The bioavailability of these nutrients can vary based on the type of juice, preparation method, and individual metabolism.

Pharmacokinetics

The absorption and metabolism of nutrients in juice occur primarily in the gastrointestinal tract. Water-soluble vitamins, such as vitamin C, are absorbed in the small intestine and distributed throughout the body via the bloodstream. The presence of dietary fiber in whole fruits can slow down the absorption of sugars and enhance satiety, though this is less relevant in juice as the fiber content is often reduced during extraction. The elimination of excess vitamins occurs through renal excretion.

Pregnancy

Juice consumption in moderation is generally considered safe during pregnancy. However, it is important to choose pasteurized juices to avoid the risk of foodborne illness.

Breast-feeding

Most juices are safe to consume while breastfeeding, but it is advisable to monitor for any potential allergic reactions in the infant, particularly with juices that are known allergens.

Storage

Juices should be stored in a cool, dry place and refrigerated after opening. Fresh juices should be consumed within a few days to prevent spoilage.

Formulations

• fresh juice
• bottled juice
• frozen juice concentrate

Indications

• Prebiotic supplementation
• Support for digestive health
• Enhancement of gut microbiota
• Improvement of bowel regularity
• Potential immune modulation

Dosage

Children: Refer to relevant clinical guidelines and individual products for dosing information, as specific dosing can vary based on the type of oligosaccharide and

Adults: Refer to relevant clinical guidelines and individual products for dosing information, as specific dosing can vary based on the type of oligosaccharide and the intended use.

Mechanism of action

Oligosaccharides act primarily by serving as substrates for beneficial gut bacteria, promoting their growth and activity. This fermentation process leads to the production of short-chain fatty acids (SCFAs), which have various health benefits, including anti-inflammatory effects and improved gut barrier function. Certain oligosaccharides may also modulate immune responses and influence the absorption of minerals.

Pharmacodynamics

The pharmacodynamics of oligosaccharides relate to their fermentation in the colon, where they are metabolized by gut microbiota. This fermentation process results in the production of SCFAs, such as acetate, propionate, and butyrate, which can influence gut motility, enhance nutrient absorption, and provide energy to colonic epithelial cells. Additionally, oligosaccharides can modulate immune functions by influencing the activity of immune cells and cytokine production.

Pharmacokinetics

Oligosaccharides are generally not absorbed in the upper gastrointestinal tract; instead, they reach the colon intact, where they are fermented by the gut microbiota. The absorption of any resultant metabolites, such as SCFAs, occurs in the colon. The time to fermentation can vary based on the type of oligosaccharide and individual gut microbiota composition. Due to their low digestibility, they typically have a low caloric value.

Adverse effects

• Gastrointestinal discomfort
• Bloating
• Flatulence
• Diarrhea

Precautions

• Individuals with known allergies to oligosaccharides should avoid use.
• Use with caution in patients with gastrointestinal disorders.

Pregnancy

Oligosaccharides are generally considered safe during pregnancy, but it is advisable to consult a healthcare provider before use.

Breast-feeding

Oligosaccharides are typically safe while breastfeeding, as they are naturally occurring in breast milk and may promote gut health in infants.

Storage

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

Formulations

• Powder
• Capsules
• Tablets

Mechanism of action

Oxides do not have a single mechanism of action as they are a broad category of compounds. However, in general, metal oxides can exhibit catalytic properties, while non-metal oxides may participate in biochemical reactions by forming acids or bases upon dissolution in water.

Pharmacodynamics

The pharmacodynamics of oxides depend on the specific type of oxide and its interaction with biological systems. For instance, metal oxides may have antimicrobial properties, while certain non-metal oxides can influence metabolic pathways through their acid-base chemistry. The effects vary widely, necessitating specific studies for each oxide's role in therapeutic contexts.

Pharmacokinetics

The pharmacokinetics of oxides are also variable. Many metal oxides are poorly soluble and thus have limited absorption when ingested. Non-metal oxides, such as carbon dioxide, can be readily absorbed and utilized in metabolic processes. The distribution, metabolism, and excretion of oxides depend on their chemical form and the biological system in which they are involved.

Pregnancy

Not applicable as oxide is not a drug but a class of chemical compounds.

Breast-feeding

Not applicable as oxide is not a drug but a class of chemical compounds.

Storage

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

Indications

• Hormone replacement therapy
• Diabetes management
• Muscle growth enhancement
• Weight loss
• Treatment of certain cancers
• Antimicrobial activity

Dosage

Children: Refer to specific peptide formulations for dosing recommendations, as they vary widely based on the intended use and formulation.

Adults: Refer to specific peptide formulations for dosing recommendations, as they vary widely based on the intended use and formulation.

Mechanism of action

Peptides exert their effects by binding to specific receptors on target cells, initiating a cascade of intracellular signaling pathways. This can lead to various physiological responses such as modulation of enzyme activity, gene expression, and cellular metabolism. The specific mechanism varies according to the peptide's structure and the biological system it affects.

Pharmacodynamics

The pharmacodynamic profile of peptides is closely related to their structure and the receptors they target. Many peptides function as hormones, neurotransmitters, or growth factors, leading to dose-dependent effects. The potency and efficacy of a peptide are influenced by factors such as receptor affinity, downstream signaling pathways, and the presence of receptor antagonists.

Pharmacokinetics

Peptides are typically administered via injection as they can be degraded by gastrointestinal enzymes when taken orally. Their absorption, distribution, metabolism, and elimination vary based on the peptide's size, structure, and formulation. Generally, peptides have short half-lives due to rapid enzymatic degradation. Modifications to peptide structure can enhance stability and bioavailability.

Pregnancy

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

Breast-feeding

Safety during breastfeeding has not been established; use with caution.

Storage

Store in a cool, dry place, protected from light and moisture.

Indications

• Digestive health
• Antioxidant support
• Weight management
• Cardiovascular health

Dosage

Children: There is no established specific dosage for plums for children. They can be included as part of a healthy diet.

Adults: There is no established specific dosage for plums. They are generally consumed as part of a balanced diet.

Mechanism of action

Plums contain various bioactive compounds, including phenolic acids, flavonoids, and vitamins, which exert antioxidant effects, reduce oxidative stress, and modulate inflammation. The dietary fiber in plums aids in digestion and can improve gut health by promoting beneficial intestinal bacteria.

Pharmacodynamics

The antioxidant properties of plums help neutralize free radicals in the body, thereby protecting cells from oxidative damage. The fiber content is beneficial for digestive health, promoting regular bowel movements and potentially lowering cholesterol levels. Additionally, the vitamins and minerals in plums contribute to overall health, supporting immune function and metabolic processes.

Pharmacokinetics

Plums are primarily composed of water, carbohydrates, and dietary fiber, with minimal fat and protein content. The bioactive compounds are absorbed in the gastrointestinal tract, with their effects largely depending on the individual's metabolism and gut microbiota. The antioxidants are distributed throughout the body and can exert systemic effects after absorption.

Pregnancy

Plum is generally considered safe in moderation during pregnancy, but excessive consumption should be avoided.

Breast-feeding

Plum is safe to consume during breastfeeding in moderate amounts, as it is a nutritious fruit.

Storage

Store plums in a cool, dry place. Refrigeration can prolong freshness, typically up to one week.

Formulations

• Fresh plums
• Dried plums (prunes)
• Plum juice

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

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.