Vitalipid Novum Adult

Indications

• Vitamin K deficiency
• Coagulation disorders due to vitamin K deficiency
• Reversal of anticoagulation in patients on warfarin therapy
• Neonatal prophylaxis of vitamin K deficiency bleeding

Dosage

Adults: For adults, the typical dosage is 1-5 mg administered orally or via slow intravenous injection. Dosing may be adjusted based on clinical response and INR levels.

Mechanism of action

Vitamin K acts as a cofactor for the enzyme gamma-carboxylase, which catalyzes the carboxylation of specific glutamic acid residues on clotting factors II (prothrombin), VII, IX, and X. This carboxylation allows these factors to bind calcium ions, which is essential for their activation and subsequent role in the coagulation cascade. Additionally, vitamin K is involved in carboxylating matrix proteins in chondrocytes, possibly influencing bone density and vascular calcification.

Pharmacodynamics

Phytomenadione is indicated in the management of coagulation disorders resulting from vitamin K deficiency. It promotes the hepatic biosynthesis of prothrombin and other clotting factors, restoring normal clotting function. Its long duration of action and wide therapeutic index make it a safe option for patients requiring vitamin K supplementation, but monitoring of prothrombin time is essential during therapy. Hypersensitivity reactions may occur, especially with parenteral administration.

Pharmacokinetics

Phytomenadione is absorbed in the intestine and transported in the lymphatic system. It is then stored in the liver and released into circulation as needed for clotting factor synthesis. Vitamin K has a long half-life, allowing for sustained action, and is cycled in the body, contributing to its prolonged effects. The elimination occurs primarily through the hepatic pathway, and caution is advised in patients with hepatic impairment.

Contra-indications

• Hypersensitivity to phytomenadione or any of its excipients
• Severe hepatic impairment
• Hyperbilirubinaemia in neonates
• Known risk of hemolytic anemia in newborns

Adverse effects

• Anaphylactoid reactions (especially with intravenous use)
• Hypersensitivity reactions
• Flushing
• Rash
• Gastrointestinal disturbances

Interactions

• Anticoagulants (e.g., warfarin) - may require dose adjustment
• Cholestyramine - may reduce absorption of vitamin K
• Mineral oil - may interfere with absorption
• Antibiotics (e.g., cephalosporins) - may affect vitamin K synthesis by gut flora

Precautions

• Use with caution in patients with G6PD deficiency due to risk of hemolysis
• Monitor INR closely in patients with hepatic impairment
• Use intravenous preparations slowly to avoid vascular collapse
• Caution in elderly patients due to altered pharmacokinetics

Pregnancy

Use only if potential benefit outweighs risk, especially in late pregnancy due to risk of neonatal hemolytic anemia.

Breast-feeding

Present in breast milk; caution is advised if large doses are administered.

Storage

Store at room temperature, away from light and moisture. Protect from freezing.

Formulations

• Capsules (200 units, 400 units)
• Oral solutions
• Tablets (10 mg)
• Injectable solution for intravenous use

Indications

• Vitamin D deficiency
• Osteomalacia
• Rickets
• Hypoparathyroidism
• Certain types of osteoporosis
• Conditions leading to malabsorption of vitamin D

Dosage

Children: Refer to specific dosing guidelines in the BNF for Children.

Adults: Refer to specific dosing guidelines in the BNF.

Mechanism of action

Ergocalciferol is converted in the liver to 25-hydroxyergocalciferol, which is then converted in the kidneys to its active form, calcitriol (1,25-dihydroxyvitamin D2). Calcitriol binds to vitamin D receptors in various tissues, leading to increased intestinal absorption of calcium and phosphate, renal tubular reabsorption of these minerals, and mobilization of calcium from bone, thus contributing to maintaining adequate serum calcium levels.

Pharmacodynamics

Ergocalciferol influences the metabolism of calcium and phosphate, enhancing bone mineralization and influencing bone remodeling. Its effects are dose-dependent, with higher doses leading to increased serum calcium and phosphate levels, promoting bone health, and potentially reducing the risk of fractures in individuals with deficiency.

Pharmacokinetics

Ergocalciferol is absorbed in the intestines and its bioavailability can be affected by dietary fat. It is stored in adipose tissue and its half-life can vary widely; it may last from several days to weeks in the body. The metabolism of ergocalciferol involves conversion to its active forms in the liver and kidneys, and it is excreted primarily in bile and urine. The onset of action may take several weeks to achieve optimal serum levels.

Contra-indications

• Hypercalcemia
• Vitamin D toxicity
• Severe renal impairment
• Hypersensitivity to ergocaliferol or any component of the formulation

Adverse effects

• Nausea
• Vomiting
• Constipation
• Weakness
• Fatigue
• Headache
• Dry mouth
• Metallic taste
• Hypercalcemia
• Renal impairment

Interactions

• Anticonvulsants (e.g., phenytoin, phenobarbital) may reduce ergocaliferol levels
• Glucocorticoids may reduce the effectiveness of ergocaliferol
• Thiazide diuretics may increase the risk of hypercalcemia

Precautions

• Monitor serum calcium and phosphorus levels during treatment
• Use with caution in patients with a history of kidney stones
• Assess the risk of vitamin D deficiency in malabsorption syndromes

Pregnancy

Ergocaliferol is classified as Category C. Use only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

Ergocaliferol is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

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

Formulations

• Capsules
• Tablets
• Oral solutions

Mechanism of action

Excessive palmitoylcarnitine formation and exhausted L-carnitine stores lead to energy depletion, which, along with attenuated acetylcholine synthesis and oxidative stress, are main mechanisms behind palmitate-induced neuronal loss. High levels of palmitate exposure are suggested to contribute to diabetic neuropathy and gastrointestinal dysregulation. Additionally, palmitate negatively regulates acetyl-CoA carboxylase, thereby preventing further palmitate generation.

Pharmacodynamics

Palmitate is the first fatty acid generated during lipogenesis and serves as a precursor for the synthesis of longer fatty acids. The presence of palmitate inhibits acetyl-CoA carboxylase, reducing the conversion of acetyl-ACP to malonyl-ACP, which subsequently decreases the synthesis of new palmitate. This feedback mechanism is crucial for maintaining lipid homeostasis within the body.

Pharmacokinetics

Palmitate is absorbed from dietary sources and can also be synthesized endogenously in the liver and adipose tissue. Once in circulation, it is transported via chylomicrons or albumin. The metabolism of palmitate occurs primarily in the mitochondria through fatty acid oxidation, generating acetyl-CoA, which can enter the citric acid cycle for energy production. The overall kinetics of palmitate are influenced by dietary intake, metabolic demand, and hormonal regulation.

Pregnancy

Palmitate is classified as a category C drug. Animal reproduction studies have not been conducted, and there are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breast-feeding

There are no data on the excretion of palmitate in human milk. Caution should be exercised when administering to nursing mothers.

Storage

Store at room temperature, away from light and moisture. Keep the container tightly closed.

Formulations

• Palmitate 500 mg softgel
• Palmitate 1000 mg softgel

Indications

• Vitamin A deficiency
• Night blindness
• Impaired wound healing
• Epithelial disorders

Dosage

Children: Refer to BNF for Children for specific paediatric dosing information.

Adults: Refer to BNF for specific adult dosing information.

Mechanism of action

Retinol is converted in the retina to 11-cis-retinal, which is crucial for the conversion of light into neural signals necessary for vision. It binds to opsin in rhodopsin, facilitating the isomerization to all-trans-retinal upon exposure to light, thus triggering visual signaling. Additionally, retinol interacts with retinoic acid receptors (RARs) and retinoid-X receptors (RXRs) as transcription factors, modulating gene expression related to cellular differentiation and growth.

Pharmacodynamics

Vitamin A is effective in treating Vitamin A deficiency, which can lead to vision impairment and other health issues. It plays a critical role in various biological processes including vision, cellular differentiation, reproduction, and immune system function. Its deficiency can cause symptoms such as night blindness and impaired wound healing, while adequate levels support growth and development.

Pharmacokinetics

Retinol is absorbed from the gastrointestinal tract and stored in the liver, where it can be mobilized as needed. It undergoes metabolism primarily in the liver, where it is converted to retinal and retinoic acid, the active forms of Vitamin A. The elimination half-life varies, but retinol is generally excreted in urine and bile. The bioavailability can be affected by dietary fat intake.

Adverse effects

• Nausea
• Vomiting
• Headache
• Dizziness
• Fatigue
• Irritability
• Dry skin
• Peeling of skin
• Itching
• Blurred vision

Precautions

• Use with caution in patients with liver disease due to potential hepatotoxicity.
• Monitor for signs of vitamin A toxicity, especially in patients on high doses or prolonged therapy.
• Caution in patients with a history of alcohol abuse, as it may exacerbate liver conditions.

Pregnancy

Retinol should be used with caution during pregnancy due to the risk of teratogenic effects. High doses of vitamin A can lead to fetal malformations.

Breast-feeding

Retinol is generally considered safe during breastfeeding, but excessive intake should be avoided to prevent potential adverse effects on the infant.

Storage

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

Formulations

• Capsules
• Tablets
• Oral solutions
• Topical preparations

Indications

• Prevention of vitamin E deficiency
• Antioxidant therapy
• Support in conditions related to oxidative stress

Dosage

Children: Refer to BNF for Children for specific dosage guidelines.

Adults: Refer to BNF for specific dosage guidelines.

Mechanism of action

Tocopherol acts as a radical scavenger, primarily functioning as an antioxidant for lipid bilayers. It donates hydrogen atoms to free radicals, trapping them and preventing cellular damage. Its effectiveness is influenced by its location within the membrane and its interaction with cytosolic reductants like ascorbate. Tocopherol can trap multiple radicals, including alkyl and peroxy radicals.

Pharmacodynamics

The antioxidant properties of tocopherol lead to significant pharmacodynamic effects, including the inhibition of cell death through modulation of protein kinase C (PKC). Tocopherol also exhibits anti-inflammatory effects, which can be attributed to its influence on cytokines, prostaglandins, prostanoids, and thromboxanes. These interactions may contribute to its protective effects in various pathological conditions.

Pharmacokinetics

Tocopherol is absorbed in the intestines and its bioavailability can be influenced by dietary fat intake. It is transported in the plasma primarily bound to lipoproteins. Tocopherol is stored in adipose tissue and the liver, and its elimination occurs through bile and urine. The half-life of tocopherol can vary depending on the individual's nutritional status and other factors.

Pregnancy

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

Breast-feeding

Tocopherol is excreted in breast milk, and while it is considered safe, a healthcare provider should be consulted for specific recommendations.

Storage

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

Mechanism of action

Vitamin K is a cofactor of gamma-carboxylase. Gamma carboxylase attaches carboxylic acid functional groups to glutamate, allowing precursors of factors II, VII, IX, and X to bind calcium ions. Binding of calcium ions converts these clotting factors to their active form, which are then secreted from hepatocytes into the blood, restoring normal clotting function. Vitamin K may also carboxylate matrix proteins in chondrocytes, inhibiting calcification of joints, and may increase type II collagen. The role of vitamin K in osteroarthritis, bone density, and vascular calcification is currently under investigation. Vit k is necessary for formation of prothrombinogen & other blood clotting factors in liver. During clotting, circulating prothrombin is required for production of thrombin; in turn, thrombin converts fibrinogen to fibrin, network of which constitutes clot. /vit k/ In normal animals and man, phyltonadione ... /is/ virtually devoid of pharmacodynamic activity. In Animals and man deficient in vitamin k, the pharmacological action of vitamin k is identical to its normal physiological function, that is, to promote hepatic biosynthesis of prothrombin (factor ii), proconvertin (factor vii), plasma thromboplastin component (ptc, christmas factor, factor ix), and Stuart factor (factor x). On the basis of studies of microsomal metabolism in vitro and studies in rats and mice in vivo, /it was suggested/ that vitamin K may be mutagenic by affecting the mixed-function oxidase system which metabolizes benzo(a)pyrene. Phylloquinone at a high concentration (200 umol/l) inhibited the conversion of benzo(a)pyrene to its more polar metabolites, ... . Paradoxically, at a lower concentration of phylloquinone (25 umol/l), ... the metabolism of benzo(a)pyrene was increased. In this system, therefore, .... phylloquinone could either potentiate or inhibit it, depending on the concentration. This overall weaker inhibitory effect of phylloquinone could be due to the low solubility of this lipophilic compound, but it is difficult to explain the mechanism of the enhanced metabolism of benzo(a)pyrene at lower concentrations of phylloquinone.

Pharmacodynamics

Phylloquinone is a vitamin K indicated in the treatment of coagulation disorders due to faulty formation of coagulation factors II, VII, IX, and X caused by deficiency or interference in the activity of vitamin K. It has a long duration of action as vitamin K is cycled in the body, and a wide therapeutic index as large doses can be tolerated. Patients should have their prothrombin time monitored during therapy and healthcare professionals should be aware of the increased risk of hypersensitivity reactions with parenteral administration.

Mechanism of action

... Excessive palmitoylcarnitine formation and exhausted L-carnitine stores leading to energy depletion, attenuated acetylcholine synthesis and oxidative stress to be main mechanisms behind PA-induced neuronal loss.High PA exposure is suggested to be a factor in causing diabetic neuropathy and gastrointestinal dysregulation. ... First phase insulin release response was lost in these islets. FFAs slightly increased the insulin output of normal fresh pancreas beta-cells. However, chronic exposure to FFAs resulted in loss of first phase insulin release and blunted insulin secretion response to various levels of D-glucose stimulation.

Pharmacodynamics

Palmitic acid is the first fatty acid produced during lipogenesis (fatty acid synthesis) and from which longer fatty acids can be produced. Palmitate negatively feeds back on acetyl-CoA carboxylase (ACC) which is responsible for converting acetyl-ACP to malonyl-ACP on the growing acyl chain, thus preventing further palmitate generation

Mechanism of action

Vision:Vitamin A (all-<i>trans</i> retinol) is converted in the retina to the 11-<i>cis</i>-isomer of retinaldehyde or 11-<i>cis</i>-retinal. 11-<i>cis</i>-retinal functions in the retina in the transduction of light into the neural signals necessary for vision. 11-<i>cis</i>-retinal, while attached to opsin in rhodopsin is isomerized to all-<i>trans</i>-retinal by light. This is the event that triggers the nerve impulse to the brain which allows for the perception of light. All-<i>trans</i>-retinal is then released from opsin and reduced to all-<i>trans</i>-retinol. All-<i>trans</i>-retinol is isomerized to 11-<i>cis</i>-retinol in the dark, and then oxidized to 11-<i>cis</i>-retinal. 11-<i>cis</i>-retinal recombines with opsin to re-form rhodopsin. Night blindness or defective vision at low illumination results from a failure to re-synthesize 11-<i>cis</i> retinal rapidly. Epithelial differentiation: The role of Vitamin A in epithelial differentiation, as well as in other physiological processes, involves the binding of Vitamin A to two families of nuclear retinoid receptors (retinoic acid receptors, RARs; and retinoid-X receptors, RXRs). These receptors function as ligand-activated transcription factors that modulate gene transcription. When there is not enough Vitamin A to bind these receptors, natural cell differentiation and growth are interrupted. Topical vitamin A can reverse the impairment of wound healing seen in patients receiving corticosteroids, perhaps by restoring the normal inflammatory reaction in the wound. The possibility has been suggested that systemic vitamin A could inhibit the anti-inflammatory effect of systemic corticosteroids. Retinol arrested proliferation of cultured neuroblastoma cells at concentrations of 50 um. A correlation existed between inhibition of growth and inhibition of ornithine decarboxylase in both neuroblastoma cells and glioma cells with retinol. In rats exptl-hypervitaminosis A has been shown ... to produce severe damage of the retina, mainly in the pigment epithelium according to electron microscopy. Alcohol dehydrogenase activity was shown to disappear in the pigment epithelium and visual cells ... . /The authors/ have shown that in an experimental cell culture system consisting of carcinogen-treated 10T1/2 cells, both retinoids and all dietary carotenoids examined can reversibly inhibit neoplastic transformation in the post-initiation phase of carcinogenesis. This activity strongly correlates with their ability to increase gap junctional intercellular communication by up-regulating the expression of the gene CX43 (connexin43). Connexins comprise the structural unit of gap junctions, organelles which allow direct transfer of signals, nutrients and waste products between contacting cells. CX43 is the most widely expressed member of the gap junction family of genes, and we have demonstrated that its expression is strongly down-regulated in human cancers and in several premalignant conditions. When several human tumour cell lines were genetically engineered to conditionally express CX43 under the influence of a tetracycline promoter, their neoplastic phenotype was strongly attenuated. Specifically, induced cells were inhibited from growing in an anchorage-independent manner and, additionally, growth as xenografts in immunocompromised animals was also strongly attenuated. Growth inhibition in suspension was associated both with increased G(1) cell-cycle arrest and with increased apoptosis. /The authors/ propose a model whereby junctional communication allows the transfer of growth inhibitory signals from normal to neoplastic cells and that retinoids and carotenoids, by increasing signal transfer, act to prevent cancer.

Pharmacodynamics

Vitamin A is effective for the treatment of Vitamin A deficiency. Vitamin A refers to a group of fat-soluble substances that are structurally related to and possess the biological activity of the parent substance of the group called all-<i>trans</i> retinol or retinol. Vitamin A plays vital roles in vision, epithelial differentiation, growth, reproduction, pattern formation during embryogenesis, bone development, hematopoiesis and brain development. It is also important for the maintenance of the proper functioning of the immune system.

Mechanism of action

Tocopherol acts as a radical scavenger. It mainly acts as an antioxidant for lipid bilayers. Tocopherol's functions depend on the H-atom donating ability, location, and movement within the membrane, as well as the efficiency in the radical recycling by some cytosolic reductants such as ascorbate. Tocopherol actions are related to the trap of radicals, and it has been shown that even in the absence of substituents in the ortho-positions, tocopherol can trap more than two radicals. The type of radicals available for tocopherol are alkyl and peroxy.

Pharmacodynamics

The antioxidant effects of tocopherol can be translated into different changes at the pharmacodynamic level. In vitro studies have shown that this antioxidant activity can produce modification in protein kinase C (PKC) which will later be translated into an inhibition of cell death. Some other derivate effects are the anti-inflammatory properties of tocopherol which can be related to the modulation of cytokines or prostaglandins, prostanoids and thromboxanes.