VITA PLUS

Indications

• Low blood volume
• Hypovolemic shock
• Burns
• Cardiopulmonary bypass

Dosage

Children: Initially 10-20 mL per kilogram. Adjust according to the patient's condition and response, using 3.5-4% solution. Use under specialist supervision to mitigate the risk of fluid overload.

Adults: Dose according to requirements, typically administered intravenously. Consult product literature for specific dosing guidance.

Mechanism of action

Gelatin acts as a plasma expander by increasing the oncotic pressure in the vascular compartment, which helps to retain fluid within the bloodstream and restore circulating blood volume. This mechanism aids in maintaining blood pressure and improving tissue perfusion.

Pharmacodynamics

Gelatin solutions increase blood volume and improve hemodynamic stability in patients experiencing hypovolemic conditions. By drawing water into the vascular space, they help to counteract the effects of low blood volume, such as hypotension and compromised organ perfusion.

Pharmacokinetics

Gelatin is administered intravenously, and its effects can be observed relatively quickly. The half-life and the metabolic clearance depend on the formulation and concentration of the solution. Gelatin is gradually metabolized by macrophages and eliminated by the renal system. Close monitoring of fluid balance is essential, particularly in patients with cardiac or renal impairment.

Contra-indications

• Severe liver disease
• History of circulatory disease
• Severe cardiac disease

Adverse effects

• Fever
• Flushing
• Nausea
• Urticaria
• Rare or very rare shock

Interactions

• Calcium salts

Precautions

• Monitor cardiovascular and respiratory function
• Correct dehydration when administering
• Administer slowly to avoid rapid rise in blood pressure and cardiac failure
• Increased capillary permeability

Pregnancy

Consult product literature for specific guidance regarding use in pregnancy.

Breast-feeding

Consult product literature for specific guidance regarding use in breastfeeding.

Storage

Store at controlled room temperature, protect from light. Refer to product-specific storage instructions.

Formulations

• 5% solution for infusion
• 20% solution for infusion
• Concentrated solution (15-25% protein)
• Isotonic solution (3.5-5% protein)

Indications

• Vitamin C deficiency
• Scurvy
• As an adjunct in the treatment of iron deficiency anemia
• Support for immune function
• Antioxidant therapy

Dosage

Adults: Refer to the BNF for specific

Mechanism of action

Ascorbic acid functions primarily as a reducing agent, donating electrons to various biochemical reactions. It is involved in the hydroxylation of proline and lysine residues in collagen synthesis, which is essential for maintaining connective tissue integrity. As an antioxidant, it also helps to regenerate other antioxidants, such as vitamin E, thereby protecting cells from oxidative damage. Furthermore, it enhances the absorption of non-heme iron from the gastrointestinal tract, promoting better iron utilization in the body.

Pharmacodynamics

Ascorbic acid is crucial for metabolic processes, including the synthesis of collagen and certain neurotransmitters. Its antioxidant properties help mitigate oxidative stress, which can lead to cellular damage and various diseases. The vitamin's role in iron absorption is particularly significant in preventing iron-deficiency anemia. The therapeutic effects of ascorbic acid are dose-dependent, with higher doses often resulting in more pronounced antioxidant effects.

Pharmacokinetics

Ascorbic acid is readily absorbed in the small intestine, with peak plasma concentrations occurring within 2 to 4 hours after oral administration. The bioavailability of ascorbic acid decreases at higher doses due to saturation of the transport mechanisms. It is distributed throughout bodily fluids and tissues, with highest concentrations found in the adrenal glands, pituitary gland, and leukocytes. The elimination half-life varies, typically ranging from 8 to 40 days, depending on the dose and the individual's renal function. Ascorbic acid is excreted primarily through the kidneys, with renal clearance being influenced by plasma concentration and renal health.

Interactions

• ascorbic acid + iron chelators: Unknown (increases risk of cardiovascular adverse effects)
• ascorbic acid + deferiprone: Unknown (increases risk of cardiovascular adverse effects)
• ascorbic acid + desferrioxamine: Unknown (increases risk of cardiovascular adverse effects)

Pregnancy

Ascorbic acid is generally considered safe during pregnancy but should be used with caution and only when necessary.

Breast-feeding

Ascorbic acid is excreted in breast milk and is generally considered safe during breastfeeding.

Storage

Store at room temperature, away from light and moisture.

Indications

• Gastroesophageal reflux disease
• Peptic ulcer disease
• Heartburn
• Indigestion

Dosage

Children: Refer to the BNF for Children for specific pediatric dosing guidelines, as it can vary based on age and formulation.

Adults: Refer to the BNF for specific adult dosing recommendations based on the formulation of magnesium used.

Mechanism of action

Magnesium acts as a gastric acid neutralizer. It reacts with hydrochloric acid in the stomach to form magnesium chloride and water, thereby increasing the pH of gastric contents. This action helps alleviate symptoms associated with excess stomach acid. Additionally, magnesium may have a laxative effect by attracting water into the intestines and stimulating peristalsis.

Pharmacodynamics

Magnesium's pharmacodynamic properties are related to its ability to neutralize gastric acid and its role in various physiological processes. By increasing gastric pH, magnesium reduces the acidity of the stomach contents, which can provide symptomatic relief from gastroesophageal reflux disease (GERD) and peptic ulcers. The mineral also plays a role in neuromuscular transmission and muscle contraction, contributing to muscle relaxation and reducing muscle cramps.

Pharmacokinetics

Magnesium is absorbed primarily in the small intestine. The absorption rate can vary based on the form of magnesium and the presence of other dietary components. Once absorbed, magnesium is distributed throughout the body, with significant concentrations in bones, muscles, and soft tissues. The kidneys regulate magnesium excretion, and any excess is typically eliminated through urine. The half-life of magnesium can vary based on the individual's renal function and overall magnesium status.

Interactions

• magnesium+roxadustat: Unknown (decreases exposure)

Pregnancy

Magnesium is generally considered safe during pregnancy. It is important to consult a healthcare provider for individual assessment.

Breast-feeding

Magnesium is excreted in breast milk, but it is typically considered safe for breastfeeding mothers. Consultation with a healthcare provider is recommended.

Storage

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

Formulations

• Oral tablets
• Liquid formulations

Indications

• Acne vulgaris
• Atopic dermatitis
• Psoriasis
• Skin aging
• Hyperpigmentation

Dosage

Children: Refer to BNF for Children for appropriate dosing guidelines.

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

Mechanism of action

Nicotinamide acts as a precursor to NAD and NADP, which are vital for redox reactions in cellular metabolism. It influences cellular processes through the modulation of sirtuins, a family of proteins that regulate cellular health, as well as by inhibiting the activity of certain enzymes involved in inflammatory pathways, thus reducing inflammation and promoting skin healing.

Pharmacodynamics

Nicotinamide exhibits anti-inflammatory effects by inhibiting the production of pro-inflammatory cytokines and enhancing the skin's barrier function. It also has photoprotective properties and can suppress the activity of melanocytes, thereby reducing hyperpigmentation. The compound is well-absorbed when applied topically and can enhance the overall appearance and texture of the skin.

Pharmacokinetics

Nicotinamide is rapidly absorbed and distributed throughout the body following oral administration or topical application. It is metabolized primarily in the liver through various pathways, including methylation and conjugation. The elimination half-life is variable, depending on the route of administration, and it is excreted mainly via urine as metabolites.

Adverse effects

• Nausea
• Vomiting
• Diarrhea
• Headache
• Dizziness
• Skin rashes

Interactions

• May interact with anticoagulants, increasing the risk of bleeding
• Potentially enhances the effects of certain antidiabetic medications

Precautions

• Use with caution in patients with liver disease
• Monitor for signs of hypersensitivity reactions
• Consider caution in patients with a history of peptic ulcers

Pregnancy

Nicotinamide is generally considered safe during pregnancy, but consult a healthcare provider for individual assessment.

Breast-feeding

Nicotinamide is excreted in breast milk; consult a healthcare provider to weigh benefits and risks.

Storage

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

Formulations

• Topical cream
• Oral tablets
• Injectable solution

Indications

• Pantothenate deficiency
• Support in energy metabolism
• Adjuvant therapy in chronic conditions requiring enhanced energy production

Dosage

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

Adults: Refer to the BNF for specific dosing information, generally 5-10 mg daily for adults.

Mechanism of action

Pantothenate functions primarily as a precursor to coenzyme A (CoA), which is vital for various biochemical reactions in the body. CoA is involved in the metabolism of fatty acids, the synthesis of cholesterol and steroid hormones, and the acetylation of various substrates, which is crucial for energy production and metabolic processes.

Pharmacodynamics

Pantothenate plays a significant role in energy metabolism, cellular respiration, and the biosynthesis of fatty acids. It facilitates the transfer of acyl groups, which is critical for the metabolism of carbohydrates and fats, thereby influencing the overall energy production in cells. Adequate levels of pantothenate are necessary for maintaining metabolic homeostasis and supporting growth and development.

Pharmacokinetics

Pantothenate is well absorbed from the gastrointestinal tract, with a bioavailability of approximately 70%. Once absorbed, it is widely distributed throughout the body, particularly in the liver, adrenal glands, and kidneys. The vitamin is metabolized primarily in the liver, where it is converted to coenzyme A. Excess pantothenate is excreted in the urine as pantothenic acid and its metabolites. The half-life of pantothenate in the body is not well-defined but is generally considered to be relatively short due to its water-soluble nature.

Pregnancy

Pantothenic acid (Vitamin B5) is generally regarded as safe during pregnancy. It is important to maintain adequate levels for fetal development.

Breast-feeding

Pantothenic acid is excreted in breast milk in small amounts. Adequate intake is important for breastfeeding mothers, but supplementation is typically not necessary.

Storage

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

Formulations

• Pantothenate tablets
• Pantothenic acid capsules
• Pantothenate injections

Dosage

Children: Refer to specific product information for dosing guidelines.

Adults: Refer to specific product information for dosing guidelines.

Pregnancy

Consult a healthcare professional before use. The effects of Soft during pregnancy are not well-documented.

Breast-feeding

Consult a healthcare professional before use. The safety of Soft during breastfeeding is not well-established.

Storage

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

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'}