IROVIT SYRUP

Indications

• Iron deficiency anemia
• Prophylaxis of iron deficiency in at-risk populations
• Epithelial tissue changes such as atrophic glossitis and koilonychia

Dosage

Children: For children aged 1 month to 11 years: 0.25 mL per kilogram twice daily, with the total daily dose possibly given in 3 divided doses, not exceeding 20 mL per day. For children aged 12-17 years: 10 mL once daily.

Adults: The dose is calculated according to body weight and the iron deficit, specifying both the iron salt and formulation. For specific dosing, consult product literature.

Mechanism of action

Iron is necessary for the production of hemoglobin. Iron deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia. Ferrous fumarate releases iron in the gastrointestinal tract, facilitating its absorption and subsequent incorporation into hemoglobin, thus alleviating anemia.

Pharmacodynamics

The major activity of supplemental iron, including ferrous fumarate, is in the prevention and treatment of iron deficiency anemia. Iron also has putative immune-enhancing, anticarcinogenic, and cognition-enhancing activities, supporting overall health and functionality.

Pharmacokinetics

Ferrous fumarate is absorbed in the gastrointestinal tract, with absorption being optimal in an acidic environment. The bioavailability can be influenced by dietary factors, such as the presence of certain foods or medications that may inhibit iron absorption. Once absorbed, iron is transported in the blood bound to transferrin and is stored in tissues as ferritin and hemosiderin. The elimination half-life of iron is variable and depends on the individual's iron status and the amount of iron stored.

Contra-indications

• Iron overload syndromes
• Repeated blood transfusions
• Porphyria cutanea tarda

Adverse effects

• Asthenia
• Drowsiness
• Urine discoloration
• Cold sweat
• Confusion
• Decreased level of consciousness
• Thrombophlebitis
• Headache
• Joint stiffness
• Pain in extremities
• Skin reactions
• Small intestinal bacterial overgrowth
• Thirst
• Nausea
• Constipation
• Diarrhea
• Decreased appetite

Interactions

• Iron absorption may be affected by antacids and certain medications that alter gastric pH.

Precautions

• Monitor iron status to avoid iron overload.
• Caution in patients with intestinal strictures or diverticular disease.
• Care in elderly patients and those on high doses.

Pregnancy

Iron is generally considered safe during pregnancy, but supplementation should be monitored to avoid overload.

Breast-feeding

Iron supplementation may be necessary for exclusively breast-fed infants if maternal iron stores are low.

Storage

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

Formulations

• Solution for injection (Iron as Iron sucrose 20 mg per 1 ml)
• Capsules containing iron formulations

Indications

• Papulopustular rosacea
• Inflammatory acne vulgaris

Dosage

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

Adults: For papulopustular rosacea, apply daily for up to 4 months. The treatment course may be repeated; discontinue if no improvement is observed after 3 months. For inflammatory acne vulgaris, apply twice daily, reduced to once daily or alternate days if irritation occurs.

Mechanism of action

Nicotinamide exhibits anti-inflammatory effects by inhibiting the release of pro-inflammatory cytokines and enhancing the barrier function of the skin. It is also involved in the NAD salvage pathway, which is essential for maintaining cellular energy levels and promoting cell repair mechanisms. Additionally, nicotinamide contributes to the synthesis of coenzymes involved in metabolic processes, including the conversion of niacin into NAD+.

Pharmacodynamics

Nicotinamide is known for its ability to improve skin hydration and reduce transepidermal water loss. It has been shown to decrease the appearance of acne lesions and rosacea by modulating inflammatory responses and accelerating cell turnover. Its antioxidant properties also help to protect the skin from oxidative stress and UV damage.

Pharmacokinetics

When applied topically, nicotinamide is absorbed through the skin layers, with minimal systemic absorption. Its peak plasma concentrations are generally low, and the drug has a half-life that varies depending on the route of administration. The metabolism of nicotinamide occurs primarily in the liver, where it is converted into its active forms, including NAD+. The elimination route is via the kidneys, with metabolites excreted in urine.

Contra-indications

• Pregnancy
• Severe acne involving large areas
• Severe skin reactions

Adverse effects

• Sunburn
• Skin reactions (common or very common)
• Cheilitis
• Eyelid oedema
• Flushing
• Dry skin
• Eye irritation
• Photosensitivity reactions
• Transient skin pigmentation changes

Interactions

• Clindamycin
• Topical retinoids
• Abrasive cleaners
• Comedogenic cosmetics

Precautions

• Avoid exposure to UV light, including sunlight and sunlamps
• Wash hands immediately after use
• Avoid contact with eyes and mucous membranes
• Use moisturizers to reduce the risk of skin irritation
• Discontinue treatment if severe irritation occurs

Pregnancy

Avoid use during pregnancy due to potential risks, as limited information is available regarding toxicity.

Breast-feeding

Amount of drug in milk after topical application is probably too small to be harmful; ensure infant does not come in contact with treated areas.

Storage

Store at room temperature away from moisture and light.

Formulations

• Cream
• Gel

Indications

• Iron-deficiency anemia (therapeutic)
• Iron-deficiency anemia (prophylactic)

Dosage

Children: For children aged 1 month to 11 years: 0.25 mL/kilogram twice daily. For children aged 12 to 17 years: 10 mL once daily.

Adults: 280 mg twice daily.

Mechanism of action

Ferrous sulfate acts as a source of iron, which is essential for the synthesis of hemoglobin, the protein in red blood cells that carries oxygen. Iron is absorbed in the intestines, where it is converted into a form that can be incorporated into hemoglobin. The mechanism involves transport proteins that facilitate iron uptake and incorporation into the heme group of hemoglobin.

Pharmacodynamics

The pharmacodynamic effect of ferrous sulfate is the increase in hemoglobin levels and improvement in symptoms of anemia, such as fatigue and weakness. Iron supplementation leads to increased erythropoiesis (red blood cell production) in the bone marrow, effectively correcting the deficit in iron stores and enhancing oxygen-carrying capacity.

Pharmacokinetics

Ferrous sulfate is absorbed in the gastrointestinal tract, particularly in the duodenum and proximal jejunum. The bioavailability of iron from ferrous sulfate can be affected by dietary factors, with enhanced absorption in acidic environments. Peak plasma concentrations typically occur within 2 to 6 hours post-administration. Iron is primarily stored in the liver and bone marrow, and any excess iron is excreted through feces, urine, and sweat.

Contra-indications

• Hypersensitivity to ferrous sulfate or any of its excipients
• Hemochromatosis
• Hemosiderosis
• Thalassemia
• Other anemias not due to iron deficiency

Adverse effects

• Gastrointestinal disturbances (nausea, constipation, diarrhea, abdominal pain)
• Dark stools
• Staining of teeth (with liquid formulations)
• Allergic reactions (rare)

Interactions

• Antacids may reduce the absorption of iron
• Tetracycline antibiotics may interfere with iron absorption
• Ascorbic acid (vitamin C) may enhance iron absorption
• Certain foods and beverages (e.g., tea, coffee, dairy) can decrease iron absorption

Precautions

• Use with caution in patients with peptic ulcer disease
• Monitor for signs of iron overload
• Assess the cause of anemia before initiation of therapy
• Keep out of reach of children to prevent accidental overdose

Pregnancy

Ferrous sulfate is generally considered safe for use during pregnancy to prevent or treat iron-deficiency anemia.

Breast-feeding

Ferrous sulfate is excreted in breast milk in small amounts but is considered safe for breastfeeding mothers.

Storage

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

Formulations

• Ferrous sulfate 200 mg tablets
• Ferrous sulfate 325 mg modified-release tablets
• Ferrous sulfate oral solution 140 mg/5 mL
• Ferrous sulfate drops

Indications

• Iron deficiency anemia
• Iron deficiency due to inadequate dietary intake
• Anemia associated with chronic disease
• Pregnancy-related anemia

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations based on age and weight.

Adults: Refer to the BNF for specific dosing recommendations, generally, adults may require 100-200 mg of elemental iron daily divided into several doses.

Mechanism of action

Ferrous ions (Fe2+) play a vital role in hemoglobin production by participating in the synthesis of heme, the iron-containing compound essential for oxygen transport in the blood. In addition, iron is a cofactor for various enzymes involved in metabolic pathways, including those related to DNA synthesis and energy production.

Pharmacodynamics

The pharmacodynamic effects of ferrous include increased hemoglobin synthesis, improved oxygen transport, and enhanced cellular energy metabolism. Supplementation leads to an increase in serum ferritin levels and replenishment of iron stores in the body, which is particularly beneficial in cases of iron deficiency anemia.

Pharmacokinetics

Ferrous iron is absorbed primarily in the duodenum and upper jejunum of the small intestine. The absorption rate can be influenced by various factors, including the presence of food, the form of iron, and individual patient characteristics. Once absorbed, ferrous is transported in the bloodstream bound to transferrin, and it is stored in the liver, spleen, and bone marrow as ferritin. The elimination half-life of iron is not well-defined as it is not excreted directly but rather recycled in the body.

Pregnancy

Not contraindicated, but iron supplementation should be done under medical supervision.

Breast-feeding

Iron is excreted in breast milk, but supplementation is generally considered safe.

Storage

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

Indications

• Detoxification support
• Support for metabolic processes
• Treatment of certain metabolic disorders

Dosage

Children: Refer to specific clinical guidelines or pharmacological references for dosing information.

Adults: Refer to specific clinical guidelines or pharmacological references for dosing information.

Mechanism of action

Sulphate functions as a cofactor in enzymatic reactions, particularly in the conjugation processes that enhance the solubility and excretion of drugs and other xenobiotics. It plays a role in the sulfation pathway, where it is involved in the transformation of catecholamines, steroids, and other compounds, aiding in their metabolism and clearance from the body.

Pharmacodynamics

Sulphate contributes to the detoxification processes by facilitating the conversion of lipophilic substances into more hydrophilic metabolites, which can be readily excreted via urine or bile. It also plays a role in cellular signaling and the synthesis of glycosaminoglycans, which are important for maintaining structural integrity in connective tissues.

Pharmacokinetics

Sulphate is produced endogenously and is generally present in various body fluids. Its availability can be influenced by dietary intake of sulfur-containing amino acids, such as methionine and cysteine. The excretion of sulphate occurs primarily through the kidneys, and its levels can be affected by renal function.

Pregnancy

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

Breast-feeding

Consult a healthcare provider before use during breastfeeding as safety data may be limited.

Storage

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

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

Iron is necessary for the production of hemoglobin. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia.

Pharmacodynamics

The major activity of supplemental iron is in the prevention and treatment of iron deficiency anemia. Iron has putative immune-enhancing, anticarcinogenic and cognition-enhancing activities.

Mechanism of action

Iron is necessary for the production of hemoglobin. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia.

Pharmacodynamics

The major activity of supplemental iron is in the prevention and treatment of iron deficiency anemia. Iron has putative immune-enhancing, anticarcinogenic and cognition-enhancing activities.