Multivitamins - instructions for use, doses, side effects, contraindications

The effect of the drug is due to the properties of its constituent vitamins and corresponds to the pharmacological effects of retinol, thiamine, riboflavin, pyridoxine, cyanocobalamin, nicotinamide, rutoside, vitamin E, folic acid, calcium pantothenate, ascorbic acid.

Retinol stimulates epithelization, is necessary for the growth of bones and cartilage, the synthesis of rhodopsin. Thiamine as thiamine pyrophosphate catalyzes carbohydrate metabolism, affects the functioning of the nervous system. Riboflavin activates tissue respiration; pyridoxine - exchange of amino acids, histamine, neurotransmitters. Cyanocobalamin participates in the process of hematopoiesis, myelin synthesis; nicotinamide - in the processes of tissue respiration, carbohydrate and fat metabolism; ascorbic acid - in oxidation-reduction processes, the formation of corticosteroids, hemoglobin, maturation of red blood cells, collagen, dentin, blood coagulation, increases nonspecific immunoresistance, along with routine reduces permeability of tissues. Tocopherol has antioxidant activity, stimulates the synthesis of heme and proteins, processes of tissue respiration and proliferation. Folic acid provides a normal course of amino acid, nucleic acid, choline metabolism, is necessary for normal hematopoiesis; calcium pantothenate - for the synthesis of coenzyme acetylation. Pyridoxine in the body phosphorylated in pyridoxal-5-phosphate - coenzyme reactions of decarboxylation, transamination and deamination of amino acids. Replenishes vitamin B deficiency₆: participates in the exchange of tryptophan, methionine, cysteine, glutamic acid, glycine, γ-aminobutyric acid, histamine, serotonin and others; ensures the normal functioning of the central and peripheral nervous system. Normalizes lipid metabolism. Rutozid - derivative routine; effects on capillaries and veins, a decrease in the rate of water filtration in capillaries and permeability of microvasculature vessels for proteins, a reduction in the spacing between endothelial cells, inhibition of aggregation, and an increase in the degree of deformability of erythrocytes.

Pharmacokinetics:

Pharmacokinetics corresponds to that of retinol, thiamine, riboflavin, pyridoxine, cyanocobalamin, nicotinamide, rutoside, vitamin E, folic acid, calcium pantothenate, ascorbic acid.

Retinol: atSucks in the duodenum and ileum require the presence of bile acids, protein lipases and fat. Biotransformation in the liver.Linkage to plasma proteins <5% (65% - with increased consumption). Elimination with feces, excess - kidneys. It accumulates in the liver, kidneys and lungs.

Thiamine: aAbsorption full (in the duodenum), alcohol hampers the absorption of vitamin B₁. The connection with plasma proteins is low. Biotransformation (phosphorylation) in the liver; active metabolite - thiamine pyrophosphate (cocarboxylase). Elimination by the kidneys (metabolites and unchanged) and with feces.

Riboflavin: absorption rapid (in the duodenum). Relationship with plasma proteins 60%. Biotransformation in the liver. Half-life66-84 min. Elimination of the kidneys in the form of metabolites, in high doses - in unchanged form.

Pyridoxine: metabolized in the liver with the formation of pharmacologically active metabolites (pyridoxalphosphate and pyridoxamino phosphate). Distribution is predominantly in the muscles, liver and CNS. Penetrates through the placenta and into the mother's milk. It is excreted by the kidneys (with intravenous injection with bile - 2%).

Cyanocobalamin: absorption occurs in the distal ileum after binding to the internal factor in the presence of calcium ions and at pH> 5.4.Exposed to hepatic intestinal recirculation. The connection with plasma proteins (transcobalamins) is very high. The main reserves are in the liver (90%), in part - in the kidneys. Biotransformation in the liver. The half-life is6 days. Elimination with feces. When the drug is prescribed in an amount exceeding the daily requirement, it is displayed mainly unchanged.

Nicotinamide: Absorption is fast and complete, 60-70% of the dose taken internally. Low fat foods increase bioavailability. Biotransformation in the liver. Half-life45 min. Elimination by the kidneys (in the form of a metabolite, to a lesser extent - unchanged).

Rutozid: after the application of the gel, the active substances penetrate through the skin and are determined in it after 30 minutes, in the subcutaneous fatty tissue - after 2-5 hours. The time to reach the maximum concentrationafter ingestion 1-9 h. Elimination is carried out mainly with feces and, to a lesser extent, kidneys. Half-lifewhen administered 10-25 hours.

Vitamin A E (tocopherol): when taken orally, the absorption is 50%; in the process of absorption forms a complex with lipoproteins (intracellular carriers of tocopherol).Absorption requires the presence of bile acids. Associated with alpha₁- and beta-lipoproteins, in part - with serum albumin. If there is a violation of protein metabolism, transport is difficult. Maximum concentrationis achieved after 4 hours. It is deposited in the adrenal glands, pituitary gland, testes, adipose and muscle tissue, erythrocytes, liver. More than 90% is excreted with bile, 6% - with kidneys.

Folic acid: the connection with plasma proteins is high. Deposited in the liver, where the biotransformation takes place (the active form is tetrahydrofolic acid). Maximum concentration is achieved through 30-60 min. Elimination by the kidneys (unchanged appearance, metabolites). Removed during hemodialysis.

Calcium pantothenate: well absorbed in the digestive tract. It is distributed in various tissues of the body (mainly as coenzyme A). The highest concentrations are in the liver, adrenal gland, heart and kidneys. It is not metabolized. Elimination - kidneys (70% unchanged) and with feces (30%).

Ascorbic acid: absorbed in the duodenum, in part - in the ileum (suction decreases with increasing dose). Absorption of 20-50% (when taking a dose exceeding 200 mg).Stocks in the body are about 1.5 g. Depot: leukocytes, platelets, endocrine glands, liver, ocular epithelium, lungs, kidneys, intestinal wall, heart, muscles. Connection with plasma proteins - 25%. Biotransformation in the liver. Elimination by the kidneys (in the form of metabolites).

Indications:

Use of antibiotics
Hypovitaminosis
Improvement of metabolism and general condition in old age
The recovery period after the diseases
With increased physical and mental stress

ICD-10

IV.E50-E64 Other types of malnutrition

IV.E50-E64.E63.1 Unbalanced intake of food items

XXI.Z40-Z54.Z54 Condition of recovery

XXI.Z70-Z76.Z73.0 Overwork

XXI.Z70-Z76.Z73.3 Stress condition, not elsewhere classified

Contraindications:

Hypersensitivity
Age to 10 years
Hypervitaminosis A and D
Pregnancy
Lactation

Retinol: Gallstone disease, chronic pancreatitis (possibly exacerbation of the disease), I trimester of pregnancy.

Riboflavin: nephrolithiasis.

Cyanocobalamin: thromboembolism, erythremia, erythrocytosis.

HIcotinamide: severe forms of hypertension and angina pectoris.

Rutozide: I trimester of pregnancy

Carefully:

Diseases of the liver, peptic ulcer of the stomach and duodenum.

Retinol: use with caution in acute and chronic nephritis, with cardiac decompensation.

Tocopherol: with caution should be used in severe cardiosclerosis, myocardial infarction, with an increased risk of thromboembolism.

Pyridoxine: from use caution in case of peptic ulcer of stomach and duodenum, CHD.

With severe liver damage pyridoxine in high doses can cause deterioration of its function.

Pregnancy and lactation:

Category FDA not determined. Do not use when pregnant and breast-feeding.

Dosing and Administration:

Orally after eating 2 tablets 3 times a day. The course of treatment is 20-30 days, repeated course after 1-3 months.

For preventive purposes - 1 tablet 2-3 times a day.

Side effects:

Allergic reactions.

Thiamine: sweating, tachycardia.

Riboflavin: impaired renal function, impaired vision.

Pyridoxine: hypersecretion of hydrochloric acid

Cyanocobalamin: state of excitement, pain in the heart, tachycardia.

Nicotinamide: at long appointment in high doses - development of fatty dystrophy of a liver.

Rutozide: Dyspeptic symptoms, headache, hot flashes; rarely - skin rash.

Vitamin A E (tocopherol): diarrhea, epigastric pain.

Calcium pantothenate: nausea, vomiting, heartburn.

Ascorbic acid: headache, fatigue, insomnia. Spasms of the stomach, nausea and vomiting. Hyperoxaluria and the formation of kidney stones from calcium oxalate. Feeling hot.

Overdose:

Not described, treatment is symptomatic.

Interaction:

Retinol: while simultaneous application with neomycin, a decrease in the absorption of retinol is possible.

Thiamine: ethanol sharply reduces the absorption of thiamine (concentration in the blood can decrease by 30%). Long-term treatment with anticonvulsant drugs can lead to a thiamine deficiency. Thiamine completely disintegrates in solutions containing sulfites. Thiamine is unstable in alkaline and neutral solutions; the appointment with carbonates, citrates, barbiturates, copper preparations is not recommended.

Riboflavin: With simultaneous use with m-holinoblokatorami increases absorption and bioavailability of riboflavin (due to decreased intestinal peristalsis).

With simultaneous use with thyroid hormones, metabolism of riboflavin is accelerated.

With simultaneous use decreases the activity of doxycycline, tetracycline, oxytetracycline, erythromycin and lincomycin.

Riboflavin is not compatible with streptomycin.

With simultaneous use, the side effects of chloramphenicol are reduced and prevented (violation of hemopoiesis, optic neuritis).

With simultaneous application chlorpromazine, amitriptyline due to blockade of flavinokinase, the incorporation of riboflavin into flavinadenine mononucleotide and flavinadenine dinucleotide is disrupted and its excretion in the urine is increased.

Tocopherol: when used simultaneously with tocopherol, the effects of warfarin and dicumarol may change.

There are reports of a decrease in the effectiveness of simultaneous treatment with iron in children.

With simultaneous application of tocopherol with cyclosporin, the absorption of cyclosporin increases.

Pyridoxine: the physiological function of vitamins B₁ and B₆is the potentiation of the actions of each other, manifested in a positive effect on the nervous, muscular and cardiovascular systems.

With simultaneous use with hormonal contraceptives, an increase in the concentration of pyridoxine in the blood plasma is possible.

With simultaneous use, potentiates the action of diuretics.

When combined with levodopa, the effects of levodopa are reduced or completely inhibited.

With simultaneous use with isonicotinhydrazide, penicillamine, cycloserine, a decrease in the effectiveness of pyridoxine is possible.

With simultaneous use with phenytoin, phenobarbital, the concentrations in the blood plasma of phenytoin and phenobarbital may decrease.

Cyanocobalamin: With simultaneous use with hormonal contraceptives for oral administration, a decrease in the concentration of cyanocobalamin in the blood plasma is possible.

With simultaneous use with anticonvulsants, the absorption of cyanocobalamin from the intestine is reduced.

With simultaneous use with neomycin, aminosalicylic acid, colchicine, cimetidine, ranitidine, potassium preparations, the absorption of cyanocobalamin from the intestine decreases.

When parenteral application chloramphenicol can reduce the hematopoietic effect of cyanocobalamin in anemia.

Nicotinamide: with alcohol - skin rashes and itching are possible.

Rutozide: the effect is enhanced by ascorbic acid.

Folic acid: with simultaneous use with oral contraceptives, a decrease in the concentration of folic acid in the blood plasma is possible.

With simultaneous application with sulfasalazine, a decrease in the absorption of folic acid is possible.

With simultaneous use, it is possible to reduce the concentration in the blood plasma of phenytoin, phenobarbital, primidone and decrease their anticonvulsant activity.

Calcium pantothenate: increases the cardiotonic effect of cardiac glycosides, reduces the toxic effect of streptomycin and other antituberculous drugs.

Ascorbic acid: when applied simultaneously with barbiturates, primidone, excretion of ascorbic acid with urine increases.

With the simultaneous use of oral contraceptives, the concentration of ascorbic acid in the blood plasma decreases.

When used simultaneously with iron preparations ascorbic acid, thanks to its reducing properties, converts trivalent iron into bivalent iron, which improves its absorption.

Ascorbic acid in high doses can lower the pH of urine,that at simultaneous application reduces tubular reabsorption of amphetamine and tricyclic antidepressants.

With simultaneous application acetylsalicylic acid reduces absorption of ascorbic acid by about a third.

With simultaneous use with warfarin, the effects of warfarin may be reduced.

With simultaneous application ascorbic acid increases the excretion of iron in patients receiving deferoxamine.

With simultaneous use with tetracycline, the excretion of ascorbic acid with urine increases. It is possible to increase the concentration of ethinyl estradiol in blood plasma when it is used simultaneously in oral contraceptives.

Special instructions:

Do not take concomitantly with other vitamin preparations.

It is possible to stain the urine yellow, which is explained by the presence of riboflavin in the preparation. Do not take concomitantly with other vitamin preparations.

Impact on the ability to drive vehicles and manage mechanisms not found.

Instructions

Multivitamins (Multivitamins)