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

Pharmacodynamics:The effect of the drug is due to the properties of its constituent vitamins and corresponds to the pharmacological effects of vitamin B1, vitamin B2, vitamin B6, vitamin B12, nicotinamide, folic acid, vitamin C, biotin, calcium, magnesium, iron, manganese, phosphorus, copper, zinc, molybdenum , Selena.

Retinol stimulates epithelization, is necessary for the growth of bones and cartilage, the synthesis of rhodopsin. Thiamine (vitamin B₁) as thiamine pyrophosphate catalyzes carbohydrate metabolism, affects the functioning of the nervous system.

Riboflavin (vitamin B₂) activates tissue respiration.

Cyanocobalamin (vitamin B₁₂) is involved 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 (vitamin B₆) in the body is phosphorylated into 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.

Vitamin D₃ (colcalciferol) - stimulation of absorption of Ca²⁺ and phosphorus from the small intestine (an essential element for absorption, utilization of Ca²⁺, calcification process). Regulation of phosphorus-calcium metabolism (along with PTH and calcitonin), stimulation of calcium mobilization from the bone. Binding of active metabolites to receptors, initiation of synthesis of calcium-binding protein, enhancement of reabsorption in distal tubules of the kidneys, increase in the capture of bone tissue, maintenance of normal Ca concentration²⁺ in the extracellular fluid.

Betacarotene - an antioxidant from the group of carotenoids - natural retinol-like substances. Beta-carotene has pronounced antioxidant properties and protects cells from damage by active oxygen and free radicals (fixing the active oxygen, interrupts the chain free radical reactions and protects the macromolecules and biomembranes of the cell from damage,thereby providing an increase in the resistance of the organism to various pathogenic influences). It is also a precursor of vitamin A.

Biotin (vitamin B₇, vitamin H) is a part of enzymes that regulate protein and fat metabolism, participates in the synthesis of glucokinase, promotes the assimilation of protein.

Calcium participates in the formation of bones and teeth, promotes normal clotting of blood.

Magnesium participates in the formation of muscle and bone tissue, and also takes part in the synthesis of protein.

Iron is an important constituent of hemoglobin, myoglobin, cofactor of basic enzymes (including cytochromes). Stimulation of erythropoiesis, participation in oxygen transport.

Phosphorus, along with calcium, is involved in the formation of bones and teeth, as well as in energy exchange processes.

Manganese promotes the correct mineralization of bones.

Copper is necessary for the normal function of red blood cells and iron metabolism.

Zinc is a part of about 70 enzymes involved in the synthesis and metabolism of hormones (mainly glucocorticosteroids), as well as the division and interaction of immunocompetent cells, provides insulin synthesis.

Molybdenum is part of the enzymes and coenzymes involved in many oxidation-reduction reactions in the body.

Selenium - a microelement that is part of all cells of the body, the most important element of antioxidant protection, has an immunomodulatory effect, participates in the regulation of the action of thyroid hormones.

Pharmacokinetics:

Pharmacokinetics corresponds to that of preparations of vitamin B1, vitamin B2, vitamin B6, vitamin B12, nicotinamide, folic acid, vitamin C, biotin, calcium, magnesium, iron, manganese, phosphorus, copper, zinc, molybdenum, selenium.

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).

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 concentration30-60 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 is 20-50% (with 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).

Kolekaltsiferol (vitamin D₃) - absorption of vitamin D occurs in the proximal part of the small intestine, necessarily in the presence of bile. Part of vitamin D is absorbed in the middle parts of the small intestine and a small part - in the ileum. After absorption, cholecalciferol is found in free-form chylomicrons and only partially in the form of an ester. In the blood, most of it is in a bound state with gamma globulins and albumins. Vitamin D is deposited mainly in adipose tissue. The main processes of biotransformation of vitamin D occur in the skin, liver and kidneys.In the skin, under the influence of ultraviolet irradiation, vitamin D3 from the precursors is formed. In the liver, vitamin D, hydroxylated, is converted to 25-oxycholecalciferol (25-OH-D3). The latter in the kidneys with the participation of parathyroid hormone passes into the most active metabolite of vitamin D - calcitriol, or 1,25-dihydroxycholecalciferol (1,25 (OH) 2-D3), which is considered to be a potent renal hormone of the steroid structure. 1,25- (OH) 2-D3 plays an important role in the regulation of the metabolism of Ca, P and divalent trace elements (Cd, Ni, Zn, Hg, Be, Sr). The half-life of vitamin D from the body is about 19 days. It is excreted by excretion with bile, initially into the intestine (15-30% of the administered dose during the day), where it undergoes enterohepatic circulation (re-absorption). The rest is deduced from the contents of the intestine. The rate of disappearance of the original vitamin from the blood plasma is 19-25 hours, but with accumulation in tissues, the time of its stay in the body can be up to 6 months.

Betacarotene - Absorption at ingestion is fast and complete. Absorption depends on the presence of bile and rises in the presence of fats.Biotransformation: 20-60% of betakaren is converted into retinol in the intestinal epithelium, a small part is metabolized in the liver with the formation of active forms of retinol (binds to the retinol-transporting protein and is delivered to various organs and tissues). In the presence of Zn²⁺ In the liver, inactive products are formed. Elimination is carried out by the kidneys and bile. The proportion of betakaren, which turns into vitamin A, decreases with increasing consumption of betacaren. High doses of beta-carotene do not lead to an increase in the concentration of vitamin A in the serum above normal. Unchanged betacarotene is distributed in various tissues, including adipose tissue, adrenal glands and ovaries.

Biotin - absorption of free biotin begins already in the upper part of the small intestine. The degree of binding of biotin to plasma proteins is 80%. Biotin is excreted in the urine (6 to 50 μg per day) and feces unchanged (about 50%), and also in the form of biologically inert exchange products. The half-life period depends on the amount of the administered dose and is about 26 hours after the application of a dose of 100 μg / kg of body weight. In patients with biotinidase deficiency half-life after the administration of the same dose decreases to 10-14 hours.

Indications:

Hypovitaminosis
Improvement of metabolism and general condition in old age
The recovery period after the diseases
Iron-deficiency anemia
Inadequate and unbalanced nutrition, including dietary
Increased physical and mental loads
Complex therapy of chronic alcoholism
Complex treatment for the prescription of antibiotic therapy, chemotherapy.

ICD-10

IV.E40-E46.E46 Protein-energy insufficiency, unspecified

IV.E50-E64 Other types of malnutrition

IV.E50-E64.E56.9 Insufficiency of vitamins, unspecified

IV.E50-E64.E61.7 Insufficiency of many cells

IV.E50-E64.E61.9 Insufficiency of cells, unspecified

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

V.F10-F19.F10.2 Mental and behavioral disorders caused by alcohol use - addiction syndrome

XI.K55-K63.K63 Other bowel diseases

XX.Y40-Y59.Y40 Antibiotics of systemic action

XXI.Z40-Z54.Z51.1 Chemotherapy for neoplasm

XXI.Z40-Z54.Z54 Condition of recovery

XXI.Z40-Z54.Z54.2 Condition of recovery after chemotherapy

XXI.Z70-Z76.Z72.1 Alcohol consumption

XXI.Z70-Z76.Z73.0 Overwork

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

Contraindications:

Phenylketonuria
Hypersensitivity
Idiosyncrasy to iron preparations
Hemosiderosis
Hemochromatosis
Hemolytic anemia
Hypervitaminosis A or D
Hypercalcemia
Renal insufficiency
Period of treatment with retinoids

Additionally for coated tablets - hypersensitivity to lactose.

Retinol: cholelithiasis, 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.

Colocalciferol: hypercalciemia, hypercalciuria, calcium nephrourolythiasis, prolonged immobilization (large doses), renal osteodystrophy with hyperphosphatemia, sarcoidosis, active form of pulmonary tuberculosis.

Carefully:

Enteritis
Ulcerative colitis
Stomach ulcer and duodenal ulcer
Pregnancy and lactation
Severe liver damage

Pregnancy and lactation:

Category FDA not determined. It can be taken during pregnancy and during breastfeeding, provided that the recommended daily dose is observed. There are no data indicating the risk to the fetus in the case of taking the drug at recommended doses during pregnancy.

Dosing and Administration:

Inside after breakfast, without chewing, squeezed a little water.

1-2 capsules per day, treatment course 30 days.

Side effects:

Allergic reactions, vomiting, nausea, constipation, dyspeptic disorders, discomfort in the epigastrium, staining the teeth in a dark color.

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.

Kolekaltsiferol: Headache, gastrointestinal disorders, kidney irritation, exacerbation of the tuberculous process in the lungs.

Overdose:

If the above dose of the drug is exceeded, the symptoms of retinol hypervitaminosis are clinically significant.

Symptoms of overdose: severe headache, dizziness, facial flushing, nausea, vomiting, decreasing heart rate, vision impairment possible.

Treatment: washing the stomach, ingestion of activated carbon.

In case of an overdose colcalciferol hypercalcaemia, hypercalciuria and the symptoms caused by them (heart rhythm disturbance, nausea, vomiting, headache, weakness, irritability, weight loss, severe thirst, frequent urination, kidney stones, nephrocalcinosis, calcification of soft tissues, anorexia, hypertension , constipation, kidney failure).

With chronic poisoning - demineralization of bones, calcium deposition in the kidneys, blood vessels, heart, lungs, intestines, organ dysfunction, which can lead to death.

Treatment: elimination of colcalciferol, administration of corticosteroids, vitamin E, preparations of magnesium, potassium, ascorbic acid, retinol, thiamine.

Interaction:

The effect reduces diphenin, colestramine, toxicity - vitamin A. Biotransformation rate is increased by barbiturates.

Vitamin B₆ reduces the severity of the action of levodopa.

If you need to take other medications in combination with multivitamins, there should be an interval of about 2 hours between taking.

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: when used simultaneously 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 reduce the pH of the urine, which, when used at the same time, reduces the 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. Vitamin C enhances the effect and side effects of antimicrobial agents from the group of sulfonamides (including the appearance of crystals in the urine). 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.

The effervescent tablet contains about 300 mg of sodium (equivalent to 700 mg of table salt). Patients who follow a diet with a minimum intake of salt are advised to take dragees.

The effervescent tablet contains about 1000 mg of crystalline sugar (sucrose); tablet coated with 300 mg. When taking the recommended daily dose, this amount is negligible even if it is necessary to observe an anti-diabetic diet (1 g of crystalline sugar corresponds to 0.1 HE).

In case of hypersensitivity to lactose, multivitamins in the form of effervescent tablets.

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

Instructions

Multivitamins + Minerals (Multivitamins + Multimineral)