Major: (These usually occur only with an overdose of calcium.)

Calcium contraindications

Calcium chloride is contraindicated for cardiac resuscitation in the presence of ventricular fibrillation or in patients with the risk of existing digitalis toxicity.

Chromium indications

Chromium 4 mcg/mL (Chromic Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for total parenteral nutrition (TPN). Administration helps to maintain Chromium serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.

Chromium dosage

Chromium 4 mcg/mL (Chromic Chloride Injection, USP) contains 4 mcg Chromium/mL and is administered intravenously only after dilution. The additive should be administered in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage is 10 to 15 mcg Chromium/day (2.5 to 3.75 mL/day). The metabolically stable adult with intestinal fluid loss may require 20 mcg Chromium/day (5 mL/day), with frequent monitoring of blood levels as a guideline for subsequent administration. For pediatric patients, the suggested additive dosage is 0.14 to 0.20 mcg/kg/day (0.035 to 0.05 mL/kg/day).

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Chromium side effects

None known.

Chromium contraindications

Direct IM or IV injection.

What is Copper?

• Copper is a copper-releasing system that is placed in your uterus by your healthcare provider to prevent pregnancy for up to 10 years.
• Copper can be removed by your healthcare provider at any time.
• Copper does not contain any hormones.
• Copper can be used whether or not you have given birth to a child.

Copper is a small, flexible plastic “T” shaped intrauterine system with copper wrapped around the stem and placed on arms of the “T”. Two thin white threads are attached to the stem (lower end) of Copper. The threads are the only part of Copper you can feel when Copper is in your uterus; however, unlike a tampon string, the threads do not extend outside of your body.

Copper does not protect against HIV infection (AIDS) or other sexually transmitted infections (STIs).

What if I need birth control for more than 10 years?

Copper must be removed on or before 10 years from the date of insertion. Your healthcare provider can place a new Copper during the same office visit if you choose to continue using Copper.

What if I want to stop using Copper?

Copper is intended for use up to 10 years, but you can stop using Copper at any time by asking your healthcare provider to remove it. You could become pregnant as soon as Copper is removed; however, if you do not want to become pregnant you should use another method of birth control. Talk to your healthcare provider about the best birth control methods for you.

What if I change my mind about birth control and want to become pregnant in less than 10 years?

Your healthcare provider can remove Copper at any time before the 10 years after placement. You may become pregnant as soon as Copper is removed.

Copper indications

Copper® is indicated for intrauterine contraception for up to 10 years. The pregnancy rate in clinical studies has been less than 1 pregnancy per 100 women each year.

Table 1: Percentage of women experiencing an unintended pregnancy during the first year of typical use and first year of perfect use of contraception and the percentage continuing use at the end of the first year: United States

1.

Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.

2.

Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any reason.

3.

Among couples attempting to avoid pregnancy, the percentage who continue to use a method for one year.

4.

The percents becoming pregnant in columns (2) and (3) are based on data from populations where contraception is not used and from women who cease using contraception in order to become pregnant. Among such populations, about 89% become pregnant within one year. This estimate was lowered slightly (to 85%) to represent the percentage who would become pregnant within one year among women now relying on reversible methods of contraception if they abandoned contraception altogether.

5.

Foams, creams, gels, vaginal suppositories, and vaginal film.

6.

Cervical mucus (ovulation) method supplemented by calendar in the pre-ovulatory and basal body temperature in the post-ovulatory phases.

7.

With spermicidal cream or jelly.

8.

Without spermicides.

9.

The treatment schedule is one dose within 72 hours after unprotected intercourse, and a second dose 12 hours after the first dose. Preven is the only dedicated product specifically marketed for emergency contraception. The Food and Drug Administration has also declared the following brands of oral contraceptive to be safe and effective for emergency contraception: Ovral (1 dose is 2 white pills), Alesse (1 dose is 5 pink pills), Nordette or Levlen (1 dose is 4 light-orange pills), Lo/Ovral (1 dose is 4 white pills), Triphasil or Tri-Levlen (1 dose is 4 yellow pills).

10.

However, to maintain effective protection against pregnancy, another method of contraception must be used as soon as menstruation resumes, the frequency or duration of breastfeeds is reduced, bottle feeds are introduced, or the baby reaches 6 months of age.

Uses of Copper in details

Use: Labeled Indications

Trace element added to parenteral nutrition (PN) to prevent copper deficiency; orally as a dietary supplement

Copper description

Copper has been designed for the demands of modern life. With a wide range of nutrients and trace minerals, Copper gives nutritional support to the area of health which are most relevance to women.

Each cap contains starflower oil 100 mg, evening primrose oil 100 mg, citrus bioflavonoids 10 mg, natural mixed carotenoids 2 mg, vitamin D (as D3 200 IU) 5 mcg, vitamin E 30 mg, vitamin C 60 mg, vitamin K 90 mcg, thiamin (vitamin B1) 10 mg, riboflavin (vitamin B2) 5 mg, niacin (vitamin B3) 36 mg, vitamin B6 10 mg, folic acid 400 mcg, vitamin B12 20 mcg, Copper 50 mcg, pantothenic acid 6 mg, magnesium 100 mg, iron 12 mg, zinc 12 mg, copper 1500 mcg, manganese 2.5 mg, selenium 100 mcg, Copper 50 mcg, para-aminobenzoic acid (PABA) 30 mg.

No artificial colours, gluten, presevatives, starch or sugar, salt or yeast.

Copper has not been tested on animals.

Copper dosage

Copper Dosage

Generic name: COPPER 313.4mg

Dosage form: intrauterine device

Medically reviewed by Drugs.com. Last updated on Sep 1, 2019.

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Important Dosage and Administration Instructions

• Copper should only be inserted by a healthcare provider trained in Copper’s insertion procedures, because insertion for Copper is different from that used for other intrauterine systems. Healthcare providers should become thoroughly familiar with the product, product educational materials, product insertion instructions, and prescribing information before attempting insertion of Copper.

• Insert one Copper at the fundus of the uterine cavity.

• Remove Copper on or before 10 years from the date of insertion.

• May replace Copper at the time of removal with a new Copper if continued contraceptive protection is desired.

• Before considering use of Copper, make sure that the female is an appropriate candidate for Copper. Exclude pregnancy (consider the possibility of ovulation and conception) prior to use.

Timing of Insertion

Refer to Table 1 for recommended timing of Copper insertion.

Preparation Instruction

Before insertion:

• Use strict aseptic techniques throughout preparation.

• Prepare placement tools (e.g., speculum, cotton swab, tenaculum, uterine sound, scissors, and forceps).

• Place the package containing Copper (face-up), sterile card, and solid white rod on a sterile field and open package from the bottom end where arrow says “open”.

Figure 1: Copper Intrauterine System (IUS) with Insertion Tube and Solid White Rod

• Consider the use of an analgesic

• Establish the size and position of the uterus by performing a bi-manual examination.

• Insert a speculum and, using a cotton swab, cleanse the cervix and vagina with an antiseptic solution.

• Apply a tenaculum to the cervix and use gentle traction to align the cervical canal with the uterine cavity.

• Gently insert a sterile uterine sound to measure the depth of the uterine cavity. The uterus should sound to a depth of 6 to 9 cm except when inserting Copper immediately postabortion or immediately postpartum.
  • Insertion of Copper may be associated with pain and/or bleeding or vasovagal reactions (e.g. syncope, bradycardia, or seizure) especially in patients with a predisposition to these symptoms. Insertion into a uterine cavity measuring less than 6 cm may increase the incidence of expulsion, bleeding, pain, and perforation.

  • If cervical stenosis is encountered, avoid undue force. Dilators and analgesia/local anesthesia may be helpful in this situation.

Insertion Procedure

• Use strict aseptic techniques throughout the insertion procedure. Using sterile gloves, bend the T-Arms of Copper by folding the two horizontal arms down against the stem.

• Slightly withdraw insertion tube, push arms down along the stem, slide insertion tube over the tips of the T-Arms. Only the tips of the T-Arms should be in the insertion tube. Do not advance beyond the copper collars. Insert solid white rod into bottom of insertion tube until it touches the bottom of the IUS. Do not leave the horizontal arms of Copper bent for more than 5 minutes, as the arms may not open properly.

Figure 2: Inserting Tips of T-Arms of Paraguard into Insertion Tube

• Although using sterile gloves is recommended, in situations where sterile gloves are not available, you can perform this step while Copper is in the sterile package. Place the package face up on a clean surface. Open from the bottom end where arrow says “open”. Pull the solid white rod from the package and put it back in the package laying it carefully alongside the insertion tube, making sure the distal end of the rod remains sterile. Place thumb and index finger on the outside of the package, on top of the ends of the horizontal arms. Use other hand to push insertion tube against arms of Copper (shown by arrow in Figure 3). This will start bending the T-Arms downward. Note that the arms of Copper should be folded downward to ensure proper insertion.

Figure 3: Bending T-Arms of Paraguard While in Sterile Packaging

• Bring the thumb and index finger closer together on the outside of the package to continue bending the arms until they are alongside the stem. Use the other hand to withdraw the insertion tube slightly so that the insertion tube can be pushed and rotated over the tips of the T-Arms. Only the tips of the T-Arms should be in the insertion tube. Do not advance beyond the copper collars. Insert solid white rod into bottom of the insertion tube until it touches the bottom of the IUS. Do not leave the horizontal arms of Copper bent for more than 5 minutes, as the arms may not open properly.

Figure 4: Inserting Tips of T-Arms of Paraguard into Insertion Tube While in Sterile Packaging

• Once the above steps are completed and Copper is in the insertion tube, grasp the insertion tube at the open end of the package; adjust the blue flange so that the distance from the top of the Copper insertion tube is the same as the uterine depth measured with the uterine sound or use the sterile card to adjust the blue flange according to the premeasured uterine depth.

• Rotate the blue flange so that the horizontal arms of Copper and the long axis of the blue flange lie in the same horizontal plane to ensure the arms open up in the proper direction.

• To orient the uterus in an axial position, apply gentle traction to the tenaculum. Then pass the loaded insertion tube through the cervical canal until Copper just touches the fundus of the uterus. The blue flange should be at the cervix in the horizontal plane.

Figure 5: Insertion Tube with Paraguard in Uterus

• Release the arms of Copper by holding the solid white rod steady and withdrawing the insertion tube no more than one centimeter. This releases the arms of Copper high in the uterine fundus.

Figure 6: Release of T-Arms of Paraguard in Uterus

• Gently and carefully move the insertion tube upward toward the fundus of the uterus, until slight resistance is felt. This will ensure placement of Copper at the highest possible position within the uterus. Do not use the white rod as a plunger to push or insert Copper.

Figure 7: Placement of Paraguard in Fundus of Uterus

• Hold the insertion tube steady and withdraw the solid white rod. Do not remove the solid white rod and the insertion tube at the same time to prevent accidental pulling of the threads.

Figure 8: Withdraw Solid White Rod from Uterus

• Gently and slowly withdraw the insertion tube from the cervical canal.

• Only the threads should be visible protruding from the cervix. Trim the threads so that 3 to 4 cm protrude into the vagina. Measure the length of protrusion of the threads.

• Recommend recording length of threads, date of placement and Copper lot number.

Figure 9: Appropriate Paraguard Placement in Uterus

If you suspect that Copper is not in the correct position, check placement (with ultrasound, if necessary). If Copper is not positioned completely within the uterus, remove it and replace it with a new Copper. Do not reinsert an expelled or partially expelled Copper.

Postplacement Management of Paraguard

Following placement:

• Examine the female after her first menses to confirm that Copper is still in place. You should be able to visualize or feel only the threads. The length of the visible threads may change with time. However, no action is needed unless you suspect partial expulsion, perforation, pregnancy, or breakage.

• If you cannot find the threads in the vagina, check that Copper is still in the uterus. The threads can retract into the uterus or break, or Copper can break, perforate the uterus, or be expelled. Gentle probing of the cavity, x-ray, or sonography may be required to locate Copper

• Remove Copper if it has been partially expelled or perforated the uterus.

Do not reinsert a used Copper.

2.6 Removal of Paraguard

Timing of Removal

• Copper can be removed at any time prior to 10 years after insertion.

• Remove Copper no later than 10 years after insertion. A new Copper can be inserted at the time of removal if continued contraceptive protection is desired.

Removal Instructions

• Use a speculum and visualize the cervix.

• Remove Copper with forceps, pulling gently on the exposed threads. The arms of Copper will fold upwards as it is withdrawn from the uterus.

• Breakage or embedment of Copper in the myometrium can make removal difficult. Analgesia, paracervical anesthesia, cervical dilation, alligator forceps or other grasping instrument, or hysteroscopy may assist in removing an embedded Copper.

• Make sure Copper is intact upon removal.

• Removal may be associated with some pain and/or bleeding or vasovagal reactions (e.g. syncope, bradycardia, seizures) especially in patients with a predisposition to these conditions.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

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Copper interactions

Ascorbic Acid: Copper may decrease the serum concentration of Ascorbic Acid. Management: To minimize the risk for ascorbic acid degradation, add multivitamin product to TPN solution immediately prior to infusion or administer multivitamin and copper in separate containers. Consider therapy modification

Copper side effects

See also:
What are the possible side effects of Copper?

Adverse Reactions

Generally well tolerated; excessive copper levels may result in the following adverse effect.

Hepatic: Hepatic insufficiency (including hepatic necrosis)

Copper contraindications

Copper® should not be placed when one or more of the following conditions exist:

1.

Pregnancy or suspicion of pregnancy

2.

Abnormalities of the uterus resulting in distortion of the uterine cavity

3.

Acute pelvic inflammatory disease, or current behavior suggesting a high risk for pelvic inflammatory disease

4.

Postpartum endometritis or postabortal endometritis in the past 3 months

5.

Known or suspected uterine or cervical malignancy

6.

Genital bleeding of unknown etiology

7.

Mucopurulent cervicitis

8.

Wilson’s disease

9.

Allergy to any component of Copper®

10.

A previously placed IUD that has not been removed

What is Folic acid?

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are usually available in the foods that you eat. Folic acid (vitamin B 9) is necessary for strong blood.

Lack of folic acid may lead to anemia (weak blood). Your health care professional may treat this by prescribing folic acid for you.

Some conditions may increase your need for folic acid. These include:

• Alcoholism
• Anemia, hemolytic
• Diarrhea (continuing)
• Fever (prolonged)
• Hemodialysis
• Illness (prolonged)
• Intestinal diseases
• Liver disease
• Stress (continuing)
• Surgical removal of stomach

In addition, infants smaller than normal, breast-fed infants, or those receiving unfortified formulas (such as evaporated milk or goat's milk) may need additional folic acid.

Increased need for folic acid should be determined by your health care professional.

Some studies have found that folic acid taken by women before they become pregnant and during early pregnancy may reduce the chances of certain birth defects (neural tube defects).

Claims that folic acid and other B vitamins are effective for preventing mental problems have not been proven. Many of these treatments involve large and expensive amounts of vitamins.

Injectable folic acid is given by or under the direction of your health care professional. Another form of folic acid is available without a prescription.

Folic acid indications

Folic acid is used in the treatment and prevention of the folate deficiency state. It does not correct folate deficiency due to dihydrofolate reductase inhibitors. Folic acid is also used in women of child-bearing potential and pregnant women to protect against neural tube defects in their offspring. It is also used for the treatment of folate-deficient megaloblastic anaemia, chronic haemolytic states such as thalassaemia major or sickle-cell anaemia.

How should I use Folic acid?

Use folic acid as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Folic acid may be administered as an injection by your health care professional.
• If you are using folic acid at home, carefully follow the injection procedures taught to you by your health care provider. If the medicine contains particles, is discolored, or if the vial is cracked or damaged in any way, do not use it.
• Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor, nurse, or pharmacist to explain local regulations for selecting an appropriate container and properly disposing of the container when full.
• If you miss a dose of folic acid, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use folic acid.

Uses of Folic acid in details

Folic acid is the man-made form of folate. Folate is a B-vitamin naturally found in some foods. It is needed to form healthy cells, especially red blood cells.

Folic acid supplements may come in different forms (such as L-methylfolate, levomefolate, methyltetrahydrofolate). They are used to treat or prevent low folate levels. Low folate levels can lead to certain types of anemia. Conditions that can cause low folate levels include poor diet, pregnancy, alcoholism, liver disease, certain stomach/intestinal problems, kidney dialysis, among others. Women of childbearing age should receive adequate amounts of folic acid either through their diet or supplements to prevent infant spinal cord birth defects.

How to use Folic acid

Take this product by mouth with or without food as directed by your doctor, usually once daily. If you are taking the over-the-counter product, follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.

Dosage is based on your medical condition and response to treatment. Do not increase your dose or take this product more often than directed.

Take this product regularly to get the most benefit from it. To help you remember, take it at the same time each day. Follow the diet plan recommended by your doctor or dietician. See also Notes section.

If your condition persists or worsens, or if you think you may have a serious medical problem, get medical help right away.

Folic acid description

A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses (poaceae). Folic acid is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [PubChem]

Folic acid dosage

Folic Acid Dosage

Applies to the following strength(s): 1 mg; 0.4 mg; 5 mg/mL; 0.8 mg

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

• Megaloblastic Anemia
• Folic Acid Deficiency

Usual Pediatric Dose for:

• Folic Acid Deficiency
• Vitamin/Mineral Supplementation

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dose Adjustments
• Dialysis
• Other Comments

Usual Adult Dose for Megaloblastic Anemia

1 mg orally, intramuscularly, subcutaneously or IV once a day. May continue until clinical symptoms of folate deficiency and the hematological profile have normalized.

Usual Adult Dose for Folic Acid Deficiency

400 to 800 mcg orally, intramuscularly, subcutaneously or IV once a day.

Women of childbearing age, pregnant, and lactating women: 800 mcg orally, intramuscularly, subcutaneously or IV once a day.

Usual Pediatric Dose for Folic Acid Deficiency

Infant:

0.1 mg orally, intramuscularly, subcutaneously or IV once a day.

Child:

Less than 4 years: up to 0.3 mg orally, intramuscularly, subcutaneously or IV once a day.

4 years or older: 0.4 mg orally, intramuscularly, subcutaneously or IV once a day.

Usual Pediatric Dose for Vitamin/Mineral Supplementation

Recommended daily allowance (RDA):

Premature neonates: 50 mcg/day (15 mcg/kg/day).

Full-term neonates and infants 1 to 6 months: 25 to 35 mcg/day.

Children:

1 to 3 years: 150 mcg/day.

4 to 8 years: 200 mcg/day.

9 to 13 years: 300 mcg/day.

14 years and older: 400 mcg/day.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Rarely, a dosage of 2 mg/day may be required, particularly in patients with malabsorption, alcoholism, chronic hemolysis, chronic exfoliative skin disease or who are on concomitant anticonvulsant therapy.

Dialysis

Folic acid is removed by both hemodialysis and peritoneal dialysis. The amount removed varies with type equipment used.

Because folate may accumulate in patients with end-stage renal disease, side effects may be more likely in this patient who is undergoing dialysis. Once this patient's body stores of folate are replete, three times a week dosing may be just as beneficial as once daily dosing but should portend a lower risk of side effects.

Other Comments

The recommended daily allowance of folic acid for adult males and females ranges from 150 to 200 and 150 to 180 mcg/day, respectively.

There is a potential danger in administering folic acid to patients with undiagnosed anemia, since folic acid may obscure the diagnosis of pernicious anemia by alleviating the hematologic manifestations of the disease while allowing the neurologic complications to progress.

Severe megaloblastic anemia may require therapy for 4 to 5 weeks. Once stabilized, if dietary intake is inadequate, maintenance therapy can be started.

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Folic acid interactions

See also:
What other drugs will affect Folic acid?

Medications that interfere with your bodys ability to use folate may also increase the need for this vitamin. Medications can interfere with folate utilization, including: anticonvulsant medications (such as phenytoin, and primidone) metformin (sometimes prescribed to control blood sugar in type 2 diabetes) sulfasalazine (used to control inflammation associated with Crohns disease and ulcerative colitis) triamterene (a diuretic) Methotrexate There has been concern about the interaction between vitamin B12 and folic acid. Folic acid supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, folic acid will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage could theoretically occur if vitamin B12 deficiency is not treated. Therefore, intake of supplemental folic acid should not exceed 1000 micrograms (g, sometimes mcg) per day to prevent folic acid from masking symptoms of vitamin B12 deficiency. It is important for older adults to be aware of the relationship between folic acid and vitamin B12 because they are at greater risk of having a vitamin B12 deficiency. If you are 50 years of age or older, ask your physician to check your B12 status before you take a supplement that contains folic acid.

Folic acid side effects

See also:
What are the possible side effects of Folic acid?

Allergic sensitization has been reported following both oral and parenteral administration of Folic Acid.

Folic Acid is relatively nontoxic in man. Rare instances of allergic responses to Folic Acid preparations have been reported and have included erythema, skin rash, itching, general malaise, and respiratory difficulty due to bronchospasm. One patient experienced symptoms suggesting anaphylaxis following injection of the drug. Gastrointestinal side effects, including anorexia, nausea, abdominal distention, flatulence, and a bitter or bad taste, have been reported in patients receiving 15 mg Folic Acid daily for 1 month. Other side effects reported in patients receiving 15 mg daily include altered sleep patterns, difficulty in concentrating, irritability, overactivity, excitement, mental depression, confusion, and impaired judgment. Decreased vitamin B12 serum levels may occur in patients receiving prolonged Folic Acid therapy.

In an uncontrolled study, orally administered Folic Acid was reported to increase the incidence of seizures in some epileptic patients receiving phenobarbital, primidone, or diphenylhydantoin. Another investigator reported decreased diphenylhydantoin serum levels in folate-deficient patients receiving diphenylhydantoin who were treated with 5 mg or 15 mg of Folic Acid daily.

CALL YOUR DOCTOR FOR MEDICAL ADVICE ABOUT SIDE EFFECTS. YOU MAY REPORT SIDE EFFECTS TO THE FDA AT 1-800-FDA-1088 OR LEADING PHARMA, LLC AT 844-740-7500.

Folic acid contraindications

See also:
What is the most important information I should know about Folic acid?

Because it may mask the hematologic abnormalities while neurological damage progresses, folic acid should not be used in the therapy of patients with vitamin B12 deficiency of any cause, unless there is associated folate deficiency. The folic acid content of one tablet a day however, is unlikely to mask pernicious anemia should this condition be present. Also, pregnancy during pernicious anemia is very rare.

What is Iodine?

There are many brands and forms of povidone iodine topical available. Not all brands are listed on this leaflet.

Iodine is used on the skin to treat or prevent skin infection in minor cuts, scrapes, or burns. Iodine is also used in a medical setting to help prevent infection and promote healing in skin wounds, pressure sores, or surgical incisions.

Some forms of povidone iodine topical are used inside the mouth to provide temporary relief of minor mouth pain or irritation, sore throat, or canker sore pain.

Iodine may also be used for purposes not listed in this medication guide.

Iodine indications

Intramuscular

Iodine deficiency disorders

Adult: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): Up to 45 yr: 380 mg iodine, as single IM doses to provide adequate protection from iodine deficiency for up to 3 yr. Pregnant patient: Moderate to severe: 480 mg iodine each yr.

Child: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): 380 mg iodine, as single IM doses to provide adequate protection from iodine deficiency for up to 3 yr. Infants up to 1 yr: 190 mg iodine, as iodised oil (480 mg/ml iodine).

Oral

Grave's disease

Child: Neonates: 1 drop of strong iodine solution every 8 hr.

Oral

Radiation protection against radioactive iodine

Adult: As potassium iodide: 100-150 mg 24 hr before procedure and daily for up to 10 days after procedure.

Child: As potassium iodide: Infants from birth to 1 mth with a predicted thyroid exposure of ≥5 centigrays (cGy): 16 mg. >1 mth to 3 yr with a predicted thyroid exposure of ≥5 cGy: 32 mg. >3 yr to 18 yr (except adolescents approaching adult size) with a predicted thyroid exposure of ≥5 cGy: 65 mg. Do not exceed once-daily doses.

Oral

Preoperative reduction of vascularity of the thyroid gland

Adult: As potassium iodide: 50-250 mg (approx 1-5 drops of a solution containing 1 g/ml) tid for 10-14 days before surgery.

Child: As potassium iodide: 50-250 mg (approx 1-5 drops of a solution containing 1 g/ml) tid for 10-14 days before surgery. As strong iodine solution: 0.1-0.3 ml (or approx 3-5 drops) tid.

Oral

Cutaneous or lymphocutaneous sporotrichosis

Adult: As potassium iodide solution containing 1 g/mL: Initially, 1 mL tid, should continue for at least 1 mth after disappearance or stabilisation of the lesions.

Child: As potassium iodide: Initially, 250 mg (approx 5 drops of a solution containing 1 g/ml) tid. Max: 1.25-2 g (approx 25-40 drops) tid. Duration: 3-6 mth.

Oral

Thyroid storm

Adult: As potassium iodide: Up to 500 mg every 4 hr.

Oral

Iodine deficiency disorders

Adult: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): 400 mg iodine once yrly. Pregnant patient: 200 mg iodine as a single dose. Moderate to severe: 300-480 mg iodine each yr or 100-300 mg iodine every 6 mth and for at least 1 yr postpartum.

Child: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): Infants up to 1 yr: Single dose of 100 mg iodine; 1-5 yr: 200 mg iodine; >6 yr: 400 mg iodine.

Topical/Cutaneous

Cleaning wet ulcers and wounds

Adult: As 0.9% topical gel: Apply to clean wound. Max: 50 g/application and 150 g/wk. Change dressing about 3 times/wk and reduce applications as exudate decreases. Do not use for >3 mth and stop treatment when wound is free of exudate.

Child: As 0.9% topical gel: Apply to clean wound. Max: 50 g/application and 150 g/wk. Change dressing about 3 times/wk and reduce applications as exudate decreases. Do not use for >3 mth and stop treatment when wound is free of exudate.

Topical/Cutaneous

Minor, superficial skin wounds

Adult: As 2% or 2.5% solution/ointment: Apply small amount to the affected area 1-3 times daily.

Child: As 2% or 2.5% solution/ointment: Apply small amount to the affected area 1-3 times daily.

How should I use Iodine?

Use exactly as directed on the label, or as prescribed by your doctor.

Iodine is available in many different forms, such as a liquid, ointment, aerosol powder, cream, spray, swab, and soap. Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

Always follow directions on the medicine label about using this medicine on a child. Some forms of povidone iodine topical should not be used in children of certain ages.

Iodine is usually applied to the skin as needed. First clean the area to be treated.

Shake Iodine spray well just before each use.

Allow the medicine to dry completely on the skin before applying a bandage. Do not apply a tight bandage.

Do not use this medicine on deep wounds, puncture wounds, animal bites, or serious burns. Do not apply over large skin areas.

When treating an infection, you may be given antibiotic medication to take by mouth. Use all medicines for the full prescribed length of time, even if your symptoms quickly improve.

Iodine used in the mouth may be used up to 4 times per day. How often you can use this medicine depends on what form you use. Follow all directions on the medicine label.

Do not use Iodine in the mouth if you are using a form that is made for use only on the skin.

To use Iodine spray in the mouth, spray directly into the mouth or throat. Leave the medicine in place for 15 seconds, then spit it out. Avoid swallowing the spray. Use once every 2 hours as needed.

To use Iodine as a mouth rinse, gargle or swish the liquid for 30 seconds, then spit it out. Do not swallow the liquid. Use up to 4 times per day.

You should not use Iodine for longer than 7 days without medical advice.

Call your doctor if your sore throat is severe or ongoing after 2 days, or if you also have a high fever, headache, nausea, and vomiting.

If you are using Iodine on your skin, seek medical advice if you have new or worsening symptoms of pain, redness, swelling, rash, or fever.

Store at room temperature away from moisture and heat. Do not freeze.

Each Iodine swab is for one use only.

Iodine can stain skin, teeth, and fabric. You may use rubbing alcohol to remove staining from your skin. Avoid getting alcohol onto a wound or irritated skin. Stains on fabric can be removed by rinsing with ammonia diluted with water. Avoid getting the medicine on jewelry, especially silver.

Iodine spray is flammable. Do not use near high heat or open flame. Do not smoke until the gel has completely dried on your skin.

Uses of Iodine in details

Use: Labeled Indications

Used topically as an antiseptic in the management of minor, superficial skin wounds and has been used to disinfect the skin preoperatively

Iodine description

Iodine as oral and topical/cutaneous formulations is prescribed for the treatment of iodine deficiency disorders, pre-operative reduction of vascularity of thyroid glands, protection against radioactive iodine, cutaneous or lymphocutaneous sporotrichosis, Grave’s disease, cleaning of minor or superficial wounds, thyroid storm and cleaning of wet wounds and ulcers.

Iodine dosage

Oral

Preoperative reduction of vascularity of the thyroid gland

Adult: As potassium iodide: 50-250 mg (approx 1-5 drops of a solution containing 1 g/ml) tid for 10-14 days before surgery.

Child: As potassium iodide: 50-250 mg (approx 1-5 drops of a solution containing 1 g/ml) tid for 10-14 days before surgery. As strong iodine solution: 0.1-0.3 ml (or approx 3-5 drops) tid.

Reconstitution: Administer potassium iodide oral solution in a large quantity (240 ml) of water, or in fruit juice, milk formula or broth.

Oral

Grave's disease

Child: Neonates: 1 drop of strong iodine solution every 8 hr.

Oral

Radiation protection against radioactive iodine

Adult: As potassium iodide: 100-150 mg 24 hr before procedure and daily for up to 10 days after procedure.

Child: As potassium iodide: Infants from birth to 1 mth with a predicted thyroid exposure of ≥5 centigrays (cGy): 16 mg. >1 mth to 3 yr with a predicted thyroid exposure of ≥5 cGy: 32 mg. >3 yr to 18 yr (except adolescents approaching adult size) with a predicted thyroid exposure of ≥5 cGy: 65 mg. Do not exceed once-daily doses.

Reconstitution: 130-mg Tablet: Place 1 tablet in a small bowl and pulverise using a metal spoon. Add 20 ml of water to the powder and mix until the powder dissolves. Then add 20 ml of the selected drink and mix. Resulting concentration: 6.25 mg potassium iodide per 5 ml. 65-mg Tablet: Place 1 tablet in a small bowl and pulverise. Add 20 ml of water to the powder and mix until the powder dissolves. Then add 20 ml of the selected drink and mix. Resulting concentration: 8.125 mg potassium iodide per 5 ml.

Oral

Cutaneous or lymphocutaneous sporotrichosis

Adult: As potassium iodide solution containing 1 g/mL: Initially, 1 mL tid, should continue for at least 1 mth after disappearance or stabilisation of the lesions.

Child: As potassium iodide: Initially, 250 mg (approx 5 drops of a solution containing 1 g/ml) tid. Max: 1.25-2 g (approx 25-40 drops) tid. Duration: 3-6 mth.

Reconstitution: Administer potassium iodide solution in a large quantity (240 ml) of water, fruit juice, milk formula or broth.

Oral

Iodine deficiency disorders

Adult: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): 400 mg iodine once yrly. Pregnant patient: 200 mg iodine as a single dose. Moderate to severe: 300-480 mg iodine each yr or 100-300 mg iodine every 6 mth and for at least 1 yr postpartum.

Child: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): Infants up to 1 yr: Single dose of 100 mg iodine; 1-5 yr: 200 mg iodine; >6 yr: 400 mg iodine.

Oral

Thyroid storm

Adult: As potassium iodide: Up to 500 mg every 4 hr.

Intramuscular

Iodine deficiency disorders

Adult: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): Up to 45 yr: 380 mg iodine, as single IM doses to provide adequate protection from iodine deficiency for up to 3 yr. Pregnant patient: Moderate to severe: 480 mg iodine each yr.

Child: As iodised oil (poppyseed/peanut/rapeseed oil containing about 38% w/w or 480 mg/ml of iodine): 380 mg iodine, as single IM doses to provide adequate protection from iodine deficiency for up to 3 yr. Infants up to 1 yr: 190 mg iodine, as iodised oil (480 mg/ml iodine).

Topical/Cutaneous

Minor, superficial skin wounds

Adult: As 2% or 2.5% solution/ointment: Apply small amount to the affected area 1-3 times daily.

Child: As 2% or 2.5% solution/ointment: Apply small amount to the affected area 1-3 times daily.

Topical/Cutaneous

Cleaning wet ulcers and wounds

Adult: As 0.9% topical gel: Apply to clean wound. Max: 50 g/application and 150 g/wk. Change dressing about 3 times/wk and reduce applications as exudate decreases. Do not use for >3 mth and stop treatment when wound is free of exudate.

Child: As 0.9% topical gel: Apply to clean wound. Max: 50 g/application and 150 g/wk. Change dressing about 3 times/wk and reduce applications as exudate decreases. Do not use for >3 mth and stop treatment when wound is free of exudate.

Iodine interactions

See also:
What other drugs will affect Iodine?

There is a potential risk of interaction with lithium, resulting in an increased possibility of hypothyroidism.

this medicineshould not be used concomitantly with mercurial antiseptics, e.g. mercurochrome and thiomersal.

Since iodine may be absorbed systemically, the result of tests of the thyroid function can be influenced.

Iodine side effects

See also:
What are the possible side effects of Iodine?

Iodine and iodides, whether applied topically or given systemically, can give rise to hypersensitivity reactions which may include urticaria, angioedema, cutaneous haemorrhage or purpuras, fever, arthralgia, lymphadenopathy, and eosinophilia.

Inhalation of iodine vapour is very irritating to mucous membranes.

Iodine and iodides have variable effects on the thyroid and can produce goitre and hypothyroidism as well as hyperthyroidism (the Iod-Basedow or Jod-Basedow phenomenon). Goitre and hypothyroidism have also occurred in infants born to mothers who had taken iodides during pregnancy.

Prolonged use may lead to a range of adverse effects, often called ’iodism’, some of which may again be due to hypersensitivity. Adverse effects include metallic taste, increased salivation, burning or painful mouth; there may be acute rhinitis, coryza-like symptoms, and swelling and inflammation of the throat. Eyes may be irritated and swollen and there may be increased lachrymation. Pulmonary oedema, dyspnoea, and bronchitis may develop. Skin reactions include acneform or, more rarely, severe eruptions (iododerma). Other reported effects include depression, insomnia, impotence, headache, and gastrointestinal disturbances, notably nausea, vomiting, and diarrhoea.

Iodine contraindications

Allergy to iodine,

- Class III patients with Okuda

- Extrahepatic metastases,

- Respiratory or renal insufficiencies severe

- Cons-indications for hepatic arteriography,

- Leukopenia below 1500/mm3 or thrombocytopenia less 50000/mm3,

- Pregnant woman: Iodine should not be administered to pregnant women. In women of childbearing age, suspicion of pregnancy must be excluded before the administration of Iodine. Contraception must be instituted and prosecuted in the administration at least a year.

- Breastfeeding: Breastfeeding should be stopped.

What is Iron?

Carbonyl iron is an iron replacement product. You normally get iron from the foods you eat. Iron helps your body produce red blood cells that carry oxygen through your blood to tissues and organs.

Carbonyl iron is used to treat or prevent iron deficiency and iron deficiency anemia.

Carbonyl iron may also be used for purposes not listed in this medication guide.

Iron indications

Film-Coated Tablet: Treatment of iron deficiency. Prevention of iron deficiency during pregnancy.

Syrup: All cases of iron deficiency and iron deficiency anaemia.

Drops: General: Hypochromic or masked iron deficiency anaemias. General weakness. Convalescence. Blood losses. Tropical microcytic anaemia. Anaemias due to infections. For maintenance therapy in pernicious anaemia. As an adjuvant in treating chronically ill or undernourished patients.

Women: Iron deficiency due to menstruation. During and after pregnancy and lactation. Menorrhagia.

Children: All types of hypochromic anaemias and masked iron deficiencies. Inappetence. Retarded growth. Weakness. Unsound dietary habits. To speed up restoration of depleted iron reserves.

How should I use Iron?

Use Iron as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Iron is absorbed better on an empty stomach but may be taken with food if it upsets your stomach. Some foods (eg, eggs, whole grain breads, cereal, dairy products, coffee, tea) may decrease the amount of iron absorbed by your body. Talk with your doctor about the best way to take Iron with food if it upsets your stomach.
• Shake well before using.
• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• Take Iron with a full glass (8 oz [240 mL]) of water.
• Do not lie down for 30 minutes after taking Iron.
• If you take an antacid, a bisphosphonate (eg, alendronate), cefdinir, eltrombopag, methyldopa, penicillamine, a quinolone antibiotic (eg, ciprofloxacin), or a tetracycline (eg, minocycline), ask your doctor or pharmacist how to take it with Iron.
• If you miss a dose of Iron, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Iron.

Iron description

Each 5 mL syrup contains: Diastase (1:50) 135 mg, pepsin 50 mg, papain BPC 50 mg, vitamin B₁ 5 mg, vitamin B₂ 2 mg, vitamin B₆ 2 mg, vitamin B₁₂ 5 mcg, Iron pantothenate 1 mg and nicotinamide 20 mg.

Iron is a pleasantly flavoured syrup, containing digestive enzymes and vitamins of the B-complex group. Abdominal cramps, flatulence, heartburn and nausea can occur as a result of indigestion. Iron is the ideal cure to facilitate digestion and to strengthen the GIT.

Iron's balanced formulation provides an ideal supplementation that meets the demands and replenishes vitamins stores in the body.

Iron dosage

Usual Adult Dose for Iron Deficiency Anemia

50 mg orally three times a day.

Usual Pediatric Dose for Iron Deficiency Anemia

Premature neonates:

2 to 4 mg elemental iron/kg/day divided every 12 to 24 hours (maximum daily dose = 15 mg).

Infants and children <12 years:

Prophylaxis: 1 to 2 mg elemental iron/kg/day (maximum 15 mg) in 1 to 2 divided doses.

Mild to moderate iron deficiency anemia:

3 mg elemental iron/kg/day in 1 to 2 divided doses.

Severe iron deficiency anemia:

4 to 6 mg elemental iron/kg/day in 3 divided doses.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Data not available

Other Comments

Carbonyl iron may cause darkening of urine and stools. Avoid administering iron products within 2 hours of tetracyclines or fluoroquinolones. Do not administer with milk or antacids.

Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6 years. Keep this product out of reach of children. In case of accidental overdose, call a physician or poison control center immediately.

Iron interactions

See also:
What other drugs will affect Iron?

Drug interactions were not noted and were not studied in clinical studies.

Feridex I.V. (ferumoxides injectable solution) administration provides elemental iron. In patients who are receiving supplemental iron orally or parenterally, the dose of supplemental iron may need to be decreased.

The effect of concomitant parenteral iron on Feridex I.V. dosing is not known.

Laboratory Test Findings

Serum iron levels may be above the normal range following Feridex I.V. (ferumoxides injectable solution) administration. Transient increases in serum iron of 15–100% of baseline were observed 18 to 24 hours after Feridex I.V. (ferumoxides injectable solution) administration, and returned to normal in most patients by 7 days after administration. Increases in serum ferritin levels were seen 1 to 7 days after administration.

In a Phase 1 study in normal subjects, PTT was statistically significantly increased; however, all values were within the normal range and no subjects had a more than 40% increase from baseline. In clinical trials of patients who had baseline hematologic abnormalities associated with underlying liver disease, an effect of Feridex I.V. (ferumoxides injectable solution) on platelet or PTT was not demonstrated. In patients with low hematocrit and hemoglobin, over a period of 48 hours to 7 days after Feridex I.V. (ferumoxides injectable solution), the serum iron, the hematocrit and hemoglobin levels increase slightly.

Iron side effects

See also:
What are the possible side effects of Iron?

Applies to carbonyl iron: suspension

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; darkened or green stools; diarrhea; loss of appetite; nausea; stomach cramps, pain, or upset; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking carbonyl iron (the active ingredient contained in Iron)

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black or tarry stools; blood or streaks of blood in the stool; fever; severe or persistent nausea, stomach pain, or vomiting; vomit that looks like blood or coffee grounds.

Iron contraindications

See also:
What is the most important information I should know about Iron?

All cases of iron overload and disturbances in utilization of iron.

Film-Coated Tablet: Allergy to iron (III)-hydroxide polymaltose complex or any of the other ingredients of Iron.

An iron overload in the body.

Disturbed use of iron by the body.

Reduced number of red blood cells (anaemia), not caused by iron deficiency, such as due to increased red blood cell breakdown, vitamin B₁₂ deficiency.

What is Magnesium?

Magnesium is used as a dietary supplement for individuals who are deficient in magnesium. Although a balanced diet usually supplies all the magnesium a person needs, magnesium supplements may be needed by patients who have lost magnesium because of illness or treatment with certain medicines.

Lack of magnesium may lead to irritability, muscle weakness, and irregular heartbeat.

Injectable magnesium is given only by or under the supervision of a health care professional. Some oral magnesium preparations are available only with a prescription. Others are available without a prescription.

Magnesium indications

Magnesium Sulfate Injection, USP is suitable for replacement therapy in Magnesium deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. In such cases, the serum Magnesium (Mg++) level is usually below the lower limit of normal (1.5 to 2.5 mEq/liter) and the serum Magnesium (Ca++) level is normal (4.3 to 5.3 mEq/liter) or elevated.

In total parenteral nutrition (TPN), Magnesium sulfate may be added to the nutrient admixture to correct or prevent hypomagnesemia which can arise during the course of therapy.

Magnesium Sulfate Injection, USP is also indicated for the prevention and control of seizures (convulsions) in pre-eclampsia and eclampsia, respectively.

How should I use Magnesium?

Use magnesium as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take magnesium by mouth with food.
• If you miss a dose of magnesium and are using it regularly, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use magnesium.

Uses of Magnesium in details

This medication is a mineral supplement used to prevent and treat low amounts of magnesium in the blood. Magnesium is very important for the normal functioning of cells, nerves, muscles, bones, and the heart. Usually, a well-balanced diet provides normal blood levels of magnesium. However, certain situations cause your body to lose magnesium faster than you can replace it from your diet. These situations include treatment with "water pills" (diuretics such as furosemide, hydrochlorothiazide), a poor diet, alcoholism, or other medical conditions (e.g., severe diarrhea/vomiting, stomach/intestinal absorption problems, poorly controlled diabetes).

How to use Magnesium

Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

It is best to take magnesium supplements with a meal to reduce stomach upset and diarrhea unless otherwise directed by the product instructions or your doctor.

Take each dose with a full glass (8 ounces or 240 milliliters) of water unless your doctor directs you otherwise. Swallow extended-release capsules and delayed-release/enteric coated tablets or capsules whole. Do not crush or chew extended-release or delayed-release/enteric coated capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

If you are using a liquid product, use a medication measuring device to carefully measure the dose. Do not use a household spoon because you may not get the correct dose. If you are using a suspension, shake the bottle well before each dose.

Take this medication regularly in order to get the most benefit from it. Remember to take it at the same time(s) each day. Dosage is based on your medical condition and response to treatment. Do not increase your dose or take it more often than directed on the product package or by your doctor. Too much magnesium in the blood can cause serious side effects.

Tell your doctor if symptoms of low magnesium blood levels (e.g., muscle cramps, tiredness, irritability, depression) persist or worsen. If you think you may have a serious medical problem, seek immediate medical attention.

Magnesium dosage

Usual Adult Dose for Hypomagnesemia

500 to 1000 mg magnesium gluconate (27 to 54 mg elemental magnesium) orally 3 times a day.

Usual Adult Dose for Dietary Supplement

500 to 1000 mg magnesium gluconate (27 to 54 mg elemental magnesium) orally once a day.

Usual Pediatric Dose for Hypomagnesemia

10 to 20 mg/kg of elemental magnesium per dose orally 4 times a day. Use magnesium gluconate oral liquid preparations for more accurate measurement of dose.

Renal Dose Adjustments

Do not use without physician supervision in patients with renal impairment due to increased risk of hypermagnesemia. The use of magnesium salts are generally contraindicated in patients with severe renal dysfunction.

Liver Dose Adjustments

Data not available

Dose Adjustments

May increase by 500 to 1,000 mg/day (27 to 54 mg elemental magnesium) in order to achieve a normal serum magnesium level. Daily doses > 1,000 mg (54 mg elemental magnesium) should be given in 2 to 3 divided doses.

Precautions

Because magnesium is primarily eliminated by the kidney, there is significant risk of hypermagnesemia in patients with renal dysfunction.

Dialysis

Data not available; however, use of magnesium salts is generally contraindicated in renal failure.

Other Comments

Magnesium supplements are often used with "low normal" serum magnesium levels in patients predisposed to hypomagnesemia (e.g., patients on diuretics).

Magnesium interactions

See also:
What other drugs will affect Magnesium?

Alfacalcidol: May increase the serum concentration of Magnesium Salts. Consider therapy modification

Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Consider therapy modification

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification

Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Consider therapy modification

Magnesium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Magnesium Channel Blockers. Monitor therapy

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification

Dolutegravir: Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Consider therapy modification

Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification

Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Consider therapy modification

Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Consider therapy modification

Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Consider therapy modification

Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Consider therapy modification

Mycophenolate: Magnesium Salts may decrease the serum concentration of Mycophenolate. Management: Separate doses of mycophenolate and oral magnesium salts. Monitor for reduced effects of mycophenolate if taken concomitant with oral magnesium salts. Consider therapy modification

Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification

Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification

Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification

Raltegravir: Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Avoid combination

Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Exceptions: Eravacycline. Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification

Magnesium side effects

See also:
What are the possible side effects of Magnesium?

The adverse effects of parenterally administered Magnesium usually are the result of Magnesium intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Hypocalcemia with signs of tetany secondary to Magnesium sulfate therapy for eclampsia has been reported.

Magnesium contraindications

See also:
What is the most important information I should know about Magnesium?

Do NOT use Magnesium Carbonate/Magnesium Carbonate if:

you are allergic to any ingredient in Magnesium Carbonate/Magnesium Carbonate

you have an increased Magnesium level in your blood

Contact your doctor or health care provider right away if any of these apply to you.

What is Manganese?

Manganese supplements are used to prevent or treat manganese deficiency.

The body needs manganese for normal growth and health. For patients who are unable to get enough manganese in their regular diet or who have a need for more manganese, manganese supplements may be necessary. Manganese helps your body break down fats, carbohydrates, and proteins. It does so as part of several enzymes.

Manganese deficiency has not been reported in humans. Lack of manganese in animals has been found to cause improper formation of bone and cartilage, may decrease the body's ability to use sugar properly, and may cause growth problems.

Injectable manganese supplements are given by or under the supervision of a health care professional.

Manganese indications

Manganese 0.1 mg/mL (Manganese Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for total parenteral nutrition (TPN).

Administration helps to maintain Manganese serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.

Uses of Manganese in details

Use: Labeled Indications

Trace element added to parenteral nutrition (PN) to prevent manganese deficiency; orally as a dietary supplement

Manganese description

Manganese is a transition metal with a molar mass of 54.94g/mol. Manganese is considered critical for human health, and plays important roles in development, metabolism, and the antioxidant system. That said, excessive manganese intake is associated with manganism, a neurodegenerative disorder that causes dopaminergic neuronal death and parkinsonian-like symptoms.

Manganese dosage

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule,

Oral, as chelated:

MN-50: Elemental manganese 16.67 mg

Solution,

Intravenous, as chloride:

Generic: Elemental manganese 0.1 mg/mL (10 mL)

Solution,

Intravenous, as sulfate [preservative free]:

Generic: Elemental manganese 0.1 mg/mL (10 mL)

Tablet,

Oral, as aspartate:

Generic: 93 mg [elemental manganese 25 mg]

Tablet,

Oral, as chelated:

Manganese: Elemental manganese 10 mg [corn free, rye free, wheat free]

Generic: Elemental manganese 15 mg [DSC], Elemental manganese 50 mg

Tablet,

Oral, as gluconate:

Generic: 50 mg [elemental manganese 5.7 mg]

Dosing: Adult

Parenteral nutrition, maintenance requirement:

Expert recommendations favor the use of lower doses in the range of 60 to 100 mcg/day to avoid neurotoxicity with routine use and those with cholestatic jaundice. However, these recommendations are difficult to follow with the current sources of parenteral manganese (ASPEN [Vanek 2012]).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Parenteral nutrition, maintenance requirement:

Expert recommendations suggest decreasing the daily dose for infants and children to 1 mcg/kg/day (up to a maximum of 50 mcg/day). However, these recommendations are difficult to follow with the current sources of parenteral manganese (ASPEN [Vanek 2012]).

Note: Use caution in premature neonates; manganese chloride solution for injection contains aluminum.

Manganese interactions

There are no known significant interactions.

Manganese side effects

None known.

Manganese contraindications

There are no contraindications listed within the manufacturer's US labeling.

What is Niacinamide?

Treating acne.

Niacinamide is a vitamin B supplement. Exactly how Niacinamide works is unknown.

How should I use Niacinamide?

Use Niacinamide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Wash the affected area with a mild cleanser or other cleansing product prescribed by your doctor and completely dry.
• Apply a thin layer of the medicine to the affected area twice daily or as directed by your doctor. Gently rub the medicine in until it is evenly distributed.
• Wash your hands immediately after using Niacinamide.
• If you miss a dose of Niacinamide, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Niacinamide.

Uses of Niacinamide in details

To treat Hartnup disease (light sensitive skin rashes), inflammatory skin disease, vitamin deficiency, anxiety and Alzheimer’s disease (disorder that causes mental confusion and forgetfulness). It is also used in combination with intravenous vitamin C therapy for cancer.

Niacinamide description

Niacinamide, also called as nicotinamide (vitamin B3), is prescribed for the treatment of niacin deficiency disorders including pellagra. Niacinamide should not be used for treatment of hyperlipidemia.

Niacinamide dosage

Niacinamide Dosage

Applies to the following strengths: 100 mg; 500 mg

Usual Adult Dose for:

• Niacin Deficiency
• Pemphigus

Usual Pediatric Dose for:

• Niacin Deficiency
• Pemphigus

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dialysis
• Other Comments

Usual Adult Dose for Niacin Deficiency

Recommended Daily Allowances (RDA):

Males: 19 mg orally each day

Females: 13 mg orally each day

Initial dose: 100 mg orally 3 times a day, with or after meals

Maintenance dose: 100 to 500 mg orally up to 3 times a day, with or after meals

Niacinamide has toxic potential at adult doses in excess of 3 g/day.

Niacinamide may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for adults contain 40 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients 11 years and older requiring parenteral vitamins.

Usual Adult Dose for Pemphigus

Recommended Daily Allowances (RDA):

Males: 19 mg orally each day

Females: 13 mg orally each day

Initial dose: 100 mg orally 3 times a day, with or after meals

Maintenance dose: 100 to 500 mg orally up to 3 times a day, with or after meals

Niacinamide has toxic potential at adult doses in excess of 3 g/day.

Niacinamide may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for adults contain 40 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients 11 years and older requiring parenteral vitamins.

Usual Pediatric Dose for Niacin Deficiency

Recommended Daily Allowances (RDA):

0 to 6 months: 5 mg orally each day

6 months to 1 year: 6 mg orally each day

1 to 3 years: 9 mg orally each day

4 to 6 years: 12 mg orally each day

7 to 10 years: 13 mg orally each day

Males:

11 to 14 years: 17 mg orally each day

15 to 18 years: 20 mg orally each day

19 to 50 years: 19 mg orally each day

Females:

11 to 50 years: 13 mg orally each day

Niacinamide may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for children contain 17 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients under 11 years of age.

Usual Pediatric Dose for Pemphigus

Recommended Daily Allowances (RDA):

0 to 6 months: 5 mg orally each day

6 months to 1 year: 6 mg orally each day

1 to 3 years: 9 mg orally each day

4 to 6 years: 12 mg orally each day

7 to 10 years: 13 mg orally each day

Males:

11 to 14 years: 17 mg orally each day

15 to 18 years: 20 mg orally each day

19 to 50 years: 19 mg orally each day

Females:

11 to 50 years: 13 mg orally each day

Niacinamide may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for children contain 17 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients under 11 years of age.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Because niacinamide is primarily metabolized by the liver and because of the risk of hepatotoxicity, niacinamide in not recommended in patients with liver dysfunction.

Dialysis

Data not available

Other Comments

Taking niacinamide with food may reduce stomach upset.

Niacinamide should not be taken with hot drinks.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

More about niacinamide

• Niacinamide Side Effects
• During Pregnancy
• Drug Interactions
• Support Group
• 1 Review
• Drug class: vitamins

Consumer resources

• Niacinamide
• Niacinamide Extended-Release Tablets

Related treatment guides

• Niacin Deficiency
• Pemphigus

Niacinamide side effects

See also:
What are the possible side effects of Niacinamide?

Applies to niacinamide: tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; dizziness; headache; itching; nausea; stomach upset; temporary feeling of warmth or flushing of the skin.

Seek medical attention right away if any of these SEVERE side effects occur while taking niacinamide:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry, or bloody stools; changes in vision; dark urine; decreased urination; fast or irregular heartbeat; loss of appetite; muscle pain or weakness; numbness or persistent tingling of the skin; persistent nausea, vomiting, or general "unwell" feeling; severe or prolonged flushing of the skin; stomach pain; swelling of the hands, legs, or feet; vomit that looks like coffee grounds; yellowing of the skin or eyes.

What is the most important information I should know about Niacinamide?

• Niacinamide is for external use only. Avoid getting Niacinamide in your eyes. If you get Niacinamide in your eyes, rinse thoroughly with cool tap water.
• Follow up with your doctor after 8 to 12 weeks to monitor your progress.
• Do not use any other medicines or special cleansers on your skin unless your doctor instructs you otherwise. Makeup and other acne medicines may be applied over Niacinamide as directed by your doctor.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Niacinamide while you are pregnant. It is not known if Niacinamide is found in breast milk after topical use. If you are or will be breast-feeding while you use Niacinamide, check with your doctor. Discuss any possible risks to your baby.

What is Potassium?

Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

Potassium citrate is used to treat a kidney stone condition called renal tubular acidosis.

Potassium citrate may also be used for other purposes other than those listed in this medication guide.

Potassium indications

1. For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxication, and in patients with hypokalemic familial periodic paralysis. If hypokalemia is the result of diuretic therapy, consideration should be given to the use of a lower dose of diuretic, which may be sufficient without leading to hypokalemia.

2. For the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop, eg, digitalized patients or patients with significant cardiac arrhythmias.

The use of potassium salts in patients receiving diuretics for uncomplicated essential hypertension is often unnecessary when such patients have a normal dietary pattern and when low doses of the diuretic are used. Serum potassium should be checked periodically, however, and if hypokalemia occurs, dietary supplementation with potassium-containing foods may be adequate to control milder cases. In more severe cases, and if dose adjustment of the diuretic is ineffective or unwarranted, supplementation with potassium salts may be indicated.

Uses of Potassium in details

Potassium is essential for the proper functioning of the heart, kidneys, muscles, nerves, and digestive system.

Potassium description

Potassium is the major cation (positive ion) inside animal cells, while sodium is the major cation outside animal cells. The concentration differences of these charged particles causes a difference in electric potential between the inside and outside of cells, known as the membrane potential. The balance between potassium and sodium is maintained by ion pumps in the cell membrane. The cell membrane potential created by potassium and sodium ions allows the cell generate an action potential—a "spike" of electrical discharge. The ability of cells to produce electrical discharge is critical for body functions such as neurotransmission, muscle contraction, and heart function. Potassium is also an essential mineral needed to regulate water balance, blood pressure and levels of acidity.

Potassium dosage

Dosing Instructions

Treatment with extended release Potassium Citrate should be added to a regimen that limits salt intake (avoidance of foods with high salt content and of added salt at the table) and encourages high fluid intake (urine volume should be at least two liters per day). The objective of treatment with Potassium Citrate extended-release tablets is to provide Potassium Citrate in sufficient dosage to restore normal urinary citrate (greater than 320 mg/day and as close to the normal mean of 640 mg/day as possible), and to increase urinary pH to a level of 6 or 7.

Monitor serum electrolytes (sodium, potassium, chloride and carbon dioxide), serum creatinine and complete blood counts every four months and more frequently in patients with cardiac disease, renal disease or acidosis. Perform electrocardiograms periodically. Treatment should be discontinued if there is hyperkalemia, a significant rise in serum creatinine or a significant fall in blood hemocrit or hemoglobin.

Severe Hypocitraturia

In patients with severe hypocitraturia (urinary citrate < 150 mg/day), therapy should be initiated at a dosage of 60 mEq/day (30 mEq two times/day or 20 mEq three times/day with meals or within 30 minutes after meals or bedtime snack). Twenty-four hour urinary citrate and/or urinary pH measurements should be used to determine the adequacy of the initial dosage and to evaluate the effectiveness of any dosage change. In addition, urinary citrate and/or pH should be measured every four months. Doses of Potassium Citrate extended-release tablets greater than 100 mEq/day have not been studied and should be avoided.

Mild to Moderate Hypocitraturia

In patients with mild to moderate hypocitraturia (urinary citrate > 150 mg/day) therapy should be initiated at 30 mEq/day (15 mEq two times/day or 10 mEq three times/day with meals or within 30 minutes after meals or bedtime snack). Twenty-four hour urinary citrate and/or urinary pH measurements should be used to determine the adequacy of the initial dosage and to evaluate the effectiveness of any dosage change. Doses of Potassium Citrate extended-release tablet greater than 100 mEq/day have not been studied and should be avoided.

Potassium interactions

Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Monitor therapy

Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Aluminum Hydroxide: Citric Acid Derivatives may increase the absorption of Aluminum Hydroxide. Monitor therapy

Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Monitor therapy

Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Consider therapy modification

Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy

Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Citrate. Avoid combination

Drospirenone: Potassium Salts may enhance the hyperkalemic effect of Drospirenone. Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification

Heparin: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Monitor therapy

Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Avoid coadministration of a potassium-sparing diuretic and a potassium salt. This combination should only be used in cases of significant hypokalemia, and only if serum potassium can be closely monitored. Consider therapy modification

QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Monitor therapy

Potassium side effects

Applies to potassium citrate: oral patch extended release, oral solution, oral tablet, oral tablet extended release

As well as its needed effects, potassium citrate may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking potassium citrate, check with your doctor immediately:

Incidence not known:

• Abdominal or stomach discomfort
• diarrhea
• nausea
• vomiting

If any of the following symptoms of overdose occur while taking potassium citrate, get emergency help immediately:

Symptoms of overdose:

• Abdominal or stomach pain
• confusion
• difficult breathing
• irregular heartbeat
• nervousness
• numbness or tingling in the hands, feet, or lips
• shortness of breath
• weakness or heaviness of the legs

Potassium contraindications

Potassium supplements are contraindicated in patients with hyperkalemia since a further increase in serum potassium concentration in such patients can produce cardiac arrest. Hyperkalemia may complicate any of the following conditions: chronic renal failure, systemic acidosis, such as diabetic acidosis, acute dehydration, extensive tissue breakdown as in severe burns, adrenal insufficiency, or the administration of a potassium-sparing diuretic (eg, spironolactone, triamterene, amiloride).

Controlled-release formulations of Potassium Chloride have produced esophageal ulceration in certain cardiac patients with esophageal compression due to enlarged left atrium. Potassium supplementation, when indicated in such patients, should be given as a liquid preparation or as an aqueous (water) suspension of Potassium Chloride.

All solid oral dosage forms of Potassium Chloride are contraindicated in any patient in whom there is structural, pathological (eg, diabetic gastroparesis), or pharmacologic (use of anticholinergic agents or other agents with anticholinergic properties at sufficient doses to exert anticholinergic effects) cause for arrest or delay in tablet passage through the gastrointestinal tract.

What is Selenium?

Selenium is mineral that is found in soil and occurs naturally in certain foods (such as whole grains, Brazil nuts, sunflower seeds, and seafood). Selenium is not produced in the body, but it is needed for proper thyroid and immune system function.

Selenium is used to treat or prevent selenium deficiency.

Selenium has been used in alternative medicine as an aid to treat Hashimoto's thyroiditis (an autoimmune disorder of the thyroid), and to treat high cholesterol.

Not all uses for selenium have been approved by the FDA. Selenium should not be used in place of medication prescribed for you by your doctor.

Selenium may also be used for purposes not listed in this product guide.

Selenium indications

Oral

Selenium deficiency

Adult: 100-500 mcg of selenium daily.

Intramuscular

Selenium deficiency

Adult: 100-500 mcg of selenium daily.

Intravenous

Selenium deficiency

Adult: 100-500 mcg of selenium daily.

How should I use Selenium?

Use Selenium as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Shake well before each use.
• Remove jewelry before using Selenium.
• Do not use on broken or inflamed skin or scalp.
• To use Selenium on the scalp - Massage 1 or 2 teaspoonfuls of the medicine on the wet scalp. Leave on the scalp for 2 to 3 minutes. Rinse scalp thoroughly. Wash hands well after treatment. If you are using Selenium before or after bleaching, tinting, or permanent waving of hair, rinse hair for at least 5 minutes in cool running water.
• To use Selenium on the skin - Apply a sufficient amount to cover affected areas of the body. Lather well with a small amount of water. Leave the medicine on the skin for 10 minutes. Rinse thoroughly in the shower. Wash hands well after treatment.
• If you miss a dose of Selenium, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once

Ask your health care provider any questions you may have about how to use Selenium.

Uses of Selenium in details

Selenium is used as a dietary supplement mainly in the treatment of selenium deficiency affecting young women and children with Keshan disease. It is also used for treatment of osteoarthiritis associated with poor selenium levels in body called Kashin-Beck Disease. Selenium supplements are also used in patients with HIV/ AIDS to maintain the adequate selenium levels.

Selenium dosage

Selenium Injection provides 40 mcg selenium/mL. For metabolically stable adults receiving TPN, the suggested additive dosage level is 20 to 40 mcg selenium/day. For pediatric patients, the suggested additive dosage level is 3 mcg/kg/day.

In adults, selenium deficiency states resulting from long-term TPN support, selenium as selenomethionine or selenious acid, administered intravenously at 100 mcg/day for a period of 24 and 31 days, respectively, has been reported to reverse deficiency symptoms without toxicity.

Aseptic addition of Selenium Injection to the TPN solution under laminar flow hood is recommended. Selenium is physically compatible with the electrolytes and other trace elements usually present in amino-acid/dextrose solution used for TPN. Frequent monitoring of plasma selenium levels is suggested as a guideline for subsequent administration. The normal whole blood range for selenium is approximately 10 to 37 mcg/100 mL.

Parenteral drug products should be inspected visually for particulate matter and discoloration, whenever solution and container permit.

Selenium interactions

See also:
What other drugs will affect Selenium?

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification

Dolutegravir: Selenium may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral selenium. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral selenium. Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification

Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Consider therapy modification

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification

Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification

Selenium side effects

See also:
What are the possible side effects of Selenium?

Applies to selenium sulfide topical: topical cream, topical foam, topical lotion, topical shampoo, topical suspension

As well as its needed effects, selenium sulfide topical may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking selenium sulfide topical, check with your doctor or nurse as soon as possible:

Less common or rare:

• Skin irritation

Minor Side Effects

Some selenium sulfide topical side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common:

• Unusual dryness or oiliness of hair or scalp

• Increase in normal hair loss

Selenium contraindications

See also:
What is the most important information I should know about Selenium?

Selenium Injection should not be given undiluted by direct injection into a peripheral vein because of the potential for infusion phlebitis.

Silicon indications

Relief of painful symptoms and pressure of excess gas in digestive tract; adjunct in treatment of many conditions in which gas retention may be problem, such as postoperative gaseous distention and pain, endoscopic examination, air swallowing, functional dyspepsia, peptic ulcer, spastic or irritable colon, diverticulosis.

Unlabeled Uses

Treatment of infant colic.

Silicon interactions

None well documented

Silicon side effects

None well documented.

Silicon contraindications

Standard considerations.

What is Vitamin A?

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are usually available in the foods that you eat. Vitamin A is needed for night vision and for growth of skin, bones, and male and female reproductive organs. In pregnant women vitamin A is necessary for the growth of a healthy fetus.

Lack of vitamin A may lead to a rare condition called night blindness (problems seeing in the dark), as well as dry eyes, eye infections, skin problems, and slowed growth. Your health care professional may treat these problems by prescribing vitamin A for you.

Some conditions may increase your need for vitamin A. These include:

• Diarrhea
• Eye diseases
• Intestine diseases
• Infections (continuing or chronic)
• Measles
• Pancreas disease
• Stomach removal
• Stress (continuing)

In addition, infants receiving unfortified formula may need vitamin A supplements.

Vitamin A absorption will be decreased in any condition in which fat is poorly absorbed.

Increased need for vitamin A should be determined by your health care professional.

Claims that vitamin A is effective for treatment of conditions such as acne or lung diseases, or for treatment of eye problems, wounds, or dry or wrinkled skin not caused by lack of vitamin A have not been proven. Although vitamin A is being used to prevent certain types of cancer, some experts feel there is not enough information to show that this is effective, particularly in well-nourished individuals.

Injectable vitamin A is given by or under the supervision of a health care professional. Other forms of vitamin A are available without a prescription.

Vitamin A indications

Vitamin A injection is effective for the treatment of vitamin A deficiency.

The parenteral administration is indicated when the oral administration is not feasible as in anorexia, nausea, vomiting, pre- and postoperative conditions, or it is not available as in the "Malabsorption Syndrome" with accompanying steatorrhea.

Pediatric Use: Vitamin A treatment for deficiency states has been recognized as an especially effective and important therapy in the pediatric population.

Vitamin A supplementation for deficiency states in this population has been addressed by the Committee on Clinical Practice Issues of the American Society for Clinical Nutrition, by the American Society for

Parenteral and Enteral Nutrition, and by the World Health Organization.

Uses of Vitamin A in details

Vitamin A is used to prevent or treat low levels of the vitamin in people who do not get enough of it from their diets. Most people who eat a normal diet do not need extra vitamin A. However, some conditions (such as protein deficiency, diabetes, hyperthyroidism, liver/pancreas problems) can cause low levels of vitamin A. Vitamin A plays an important role in the body. It is needed for growth and bone development and to maintain the health of the skin and eyesight. Low levels of vitamin A may cause vision problems (such as night blindness) and permanent eye damage.

How to use Vitamin A

Take this vitamin by mouth with or without food, usually once daily. Follow all directions on the product package, or take as directed by your doctor. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Dosage is based on your age, medical condition, and response to treatment.

Use this vitamin regularly to get the most benefit from it. To help you remember, take it at the same time each day. Do not increase your dose or use this vitamin more often than recommended. Your condition will not improve any faster, and your risk of side effects will increase.

Tell your doctor if your condition persists or worsens. If you think you may have a serious medical problem, seek immediate medical attention.

Vitamin A description

Vitamin A (Glucoenergan, Reactivan) is a stimulant which was developed in the 1960s as an appetite suppressant, but was later withdrawn for this application due to problems with dependence and abuse. It is around half the potency of dexamphetamine, and is prescribed at a dose of 10-60mg, although abusers of the drug tend to rapidly develop tolerance and escalate their dose. Reactivan is still rarely used for treating depressive day-time fatigue, lack of concentration and lethargy, particularly in individuals who have chronic medical conditions, as its favourable safety profile makes it the most suitable drug in some cases.

Vitamin A dosage

Vitamin A Dosage

Generic name: VITAMIN A PALMITATE 15mg in 1mL

Dosage form: injection, solution

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

For intramuscular use.

I.

Adults

100,000 Units daily for three days followed by 50,000 Units daily for two weeks.

II.

Pediatric patients 1 to 8 years old

17,500 to 35,000 Units daily for 10 days.

III.

Infants

7,500 to 15,000 Units daily for 10 days.

Follow-up therapy with an oral therapeutic multivitamin preparation, containing 10,000 to 20,000 Units vitamin A for adults and for pediatric patients over 8 years old, and 5,000 to 10,000 Units for infants and other pediatric patients under 8 years old, is recommended daily for two months. Low birth-weight infants may require additional vitamin A though the exact dosing in these pediatric patients has not been established. In malabsorption, the parenteral route must be used for an equivalent preparation.

Poor dietary habits should be corrected and an abundant and well-balanced dietary intake should be prescribed.

More about Vitamin A (vitamin a)

• Side Effects
• Dosage Information
• Drug Interactions
• Support Group
• En Espanol
• 0 Reviews - Add your own review/rating

Consumer resources

• Vitamin A
• Vitamin A (Advanced Reading)

• Other brands: A/Fish Oil, Vitamin A

Professional resources

• Vitamin A (AHFS Monograph)
• Vitamin A (FDA)

Related treatment guides

• Vitamin A Deficiency

Vitamin A interactions

See also:
What other drugs will affect Vitamin A?

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this vitamin include: acitretin, alitretinoin, bexarotene, cholestyramine, isotretinoin, tretinoin, other products that contain vitamin A (such as multivitamins), warfarin.

Avoid taking vitamin A at the same time as you take neomycin, orlistat, and mineral oil. If you take any of these medications, separate your doses from your dose of vitamin A by at least 2 hours.

This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

Vitamin A side effects

See also:
What are the possible side effects of Vitamin A?

This vitamin usually has no side effects when used in recommended doses. If you have any unusual effects, contact your doctor or pharmacist promptly.

A very serious allergic reaction to this vitamin is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Vitamin A contraindications

See also:
What is the most important information I should know about Vitamin A?

The intravenous administration. Hypervitaminosis A. Sensitivity to any of the ingredients in this preparation. Use in Pregnancy: Safety of amounts exceeding 6,000 Units of vitamin A daily during pregnancy has not been established at this time. The use of vitamin A in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with overdosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin A in excess of the recommended dietary allowance is contraindicated in women who are or may become pregnant. If vitamin A is used during pregnancy, or if the patient becomes pregnant while taking vitamin A, the patient should be apprised of the potential hazard to the fetus.

What is Vitamin B1?

Thiamine is vitamin B1. Thiamine is found in foods such as cereals, whole grains, meat, nuts, beans, and peas. Thiamine is important in the breakdown of carbohydrates from foods into products needed by the body.

Thiamine is used to treat or prevent vitamin B1 deficiency. Thiamine injection is used to treat beriberi, a serious condition caused by prolonged lack of vitamin B1.

Thiamine taken by mouth (oral) is available without a prescription. Injectable thiamine must be given by a healthcare professional.

Thiamine may also be used for purposes not listed in this medication guide.

Vitamin B1 indications

Vitamin B1 deficiency

Vitamin B1 description

3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2- hydroxyethyl)-4-methylthiazolium chloride.

Vitamin B1 interactions

Interactions for vitamin B1

Loop Diuretics,

Oral Contraceptives, Stavudine, Tricyclic Antidepressants

Vitamin B1 side effects

Applies to thiamine: capsule, solution, tablet, tablet enteric coated

As well as its needed effects, thiamine (the active ingredient contained in Vitamin B1) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking thiamine, check with your doctor immediately:

Rare - Soon after receiving injection only

• Coughing
• difficulty in swallowing
• hives
• itching of skin
• swelling of face, lips, or eyelids
• wheezing or difficulty in breathing

Vitamin B1 contraindications

Contraindications for vitamin B1

Hypersensitivity to vitamin B1 or any component of a product containing vitamin B1.

What is Vitamin B12?

Cyanocobalamin is a man-made form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.

Cyanocobalamin may also be used for purposes not listed in this medication guide.

Vitamin B12 indications

Pernicious anemia, both uncomplicated and accompanied by nervous system involvement.

Dietary deficiency of Vitamin B12, occurring in strict vegetarians and in their breast-fed infants. (Isolated vitamin B12 deficiency is very rare).

Malabsorption of vitamin B12, resulting from structural or functional damage to the stomach, where intrinsic factor is secreted or to the ileum, where intrinsic factor facilitates vitamin B12 absorption. These conditions include tropical sprue, and nontropical sprue (idiopathic steatorrhea, gluten-induced enteropathy). Folate deficiency in these patients is usually more severe than vitamin B12 deficiency.

Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy). Total gastrectomy always produces vitamin B12 deficiency.

Structural lesions leading to vitamin B12 deficiency include regional ileitis, ileal resections, malignancies, etc.

Competition for Vitamin B12 by intestinal parasites or bacteria.

The fish tapeworm (Diphyilobothrium latum) absorbs huge quantities of vitamin B12 and infested patients often have associated gastric atrophy. The blind-loop syndrome may produce deficiency of Vitamin B12 or folate.

Inadequate utilization of vitamin B12. This may occur if antimetabolites for the vitamin are employed in the treatment of neoplasia.

For the Schilling Test.

Vitamin B12 description

Vitamin B12 (commonly known as Vitamin B12) is the most chemically complex of all the vitamins. Vitamin B12's structure is based on a corrin ring, which, although similar to the porphyrin ring found in heme, chlorophyll, and cytochrome, has two of the pyrrole rings directly bonded. The central metal ion is Co (cobalt). Vitamin B12 cannot be made by plants or by animals, as the only type of organisms that have the enzymes required for the synthesis of cyanocobalamin are bacteria and archaea. Higher plants do not concentrate cyanocobalamin from the soil and so are a poor source of the substance as compared with animal tissues. Vitamin B12 is naturally found in foods including meat (especially liver and shellfish), eggs, and milk products.

Vitamin B12 dosage

Vitamin B12 is used as injections SC, IV, IM, intralumbar, and also oral. With anemia associated with vitamin B12 deficiency is introduced on 100-200 mcg in 2 days. In anemia with symptoms of funicular myelosis and megalocytic anemia with diseases of the nervous system - 400-500 micrograms in the first 7 days daily, then 1 time every 5-7 days. In the period of remission in the absence of events funicular myelosis maintenance dose - 100 mcg 2 times a month, in the presence of neurological symptoms - at 200-400 mcg 2-4 times a month. In acute post-hemorrhagic anemia and iron anemia by 30-100 mcg 2-3 times a week. When aplastic anemia (especially in children) - 100 micrograms before clinical improvement. When nutritional anemia in infants and preterm - 30 mcg / day during 15 days.

In diseases of the central and peripheral nervous system and neurological diseases with a pain syndrome is administered in increasing doses - 200-500 mcg, with the improvement in the state - 100 mcg / day. The course of treatment with Vitamin B12 is 2 weeks. In traumatic lesions of peripheral nervous system - at 200-400 mcg every other day for 40-45 days.

When hepatitis and cirrhosis - 30-60 mcg / day or 100 mg every other day for 25-40 days.

Dystrophy in young children, Down syndrome and cerebral palsy - by 15-30 mcg every other day.

When funicular myelosis, amyotrophic lateral sclerosis can be introduced into the spinal canal at 15-30 mcg, gradually increasing the dose of 200-250 micrograms.

In radiation sickness, diabetic neuropathy, sprue - by 60-100 mcg daily for 20-30 days.

When deficiency of vitamin B12 to prevent - IV or IM for 1 mg 1 time a month; for treatment - IV or IM for 1 mg daily for 1-2 weeks, the maintenance dose is 1-2 mg IV or IM from 1 per week, up to 1 per month. Duration of treatment is determined individually.

Vitamin B12 interactions

In an application of Vitamin B12 Atlantic Laboratories with hormonal contraceptives for oral administration may decrease the concentration of cyanocobalamin in plasma.

In an application with anticonvulsant drugs decreased cyanocobalamin absorption from the gut.

In an Vitamin B12 Atlantic Laboratories application with neomycin, aminosalicylic acid, colchicine, cimetidine, ranitidine, drugs Vitamin B12 decreased cyanocobalamin absorption from the gut.

Cyanocobalamin may exacerbate allergic reactions caused by thiamine.

When parenteral application of chloramphenicol may decrease the hematopoietic effects of cyanocobalamin with anemia.

Vitamin B12 side effects

See also:
What are the possible side effects of Vitamin B12?

Applies to cyanocobalamin: intramuscular solution

Other dosage forms:

• nasal gel/jelly, nasal spray

As well as its needed effects, cyanocobalamin (the active ingredient contained in Vitamin B12) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking cyanocobalamin, check with your doctor or nurse immediately:

Incidence not known:

• Abdominal or stomach pain
• bleeding from the gums or nose
• blue lips and fingernails
• chest pain
• cough
• coughing that sometimes produces a pink frothy sputum
• decreased urine output
• difficult, fast, noisy breathing, sometimes with wheezing
• difficulty with swallowing
• dilated neck veins
• dizziness
• extreme fatigue
• eye pain
• fast heartbeat
• headache
• hives, itching, or skin rash
• increased sweating
• irregular breathing
• irregular heartbeat
• pale skin
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• ringing in the ears
• swelling of the face, fingers, feet, or lower legs
• tightness in the chest
• unusual tiredness or weakness
• weight gain

Minor Side Effects

Some cyanocobalamin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known:

• Diarrhea
• skin rash with a general disease

Vitamin B12 contraindications

Hypersensitivity to the components of the formula. History of allergy to the cobalamins (vitamin B12 and similar substances). Malignant tumors. By stimulating the growth of tissues, the Cobamamide could increase the high rate of cell multiplication. Sensitivity to cobalt. History of allergies to cobalamin (vitamin B12 and related substances).

- Malignant tumor: Due to the action of vitamin B12 on the growth of tissue cell multiplication rate high, the risk of exacerbation should be taken into account.

- Children under 6 years because of the dosage form

What is Vitamin B2?

Riboflavin is vitamin B2. Vitamins are naturally occurring substances necessary for many processes in the body. Riboflavin is important in the maintenance of many tissues of the body.

Riboflavin is used to prevent and to treat deficiencies of riboflavin.

Riboflavin may also be used for other purposes not listed in this medication guide.

Vitamin B2 indications

vitamin b2 deficiency

Uses of Vitamin B2 in details

Vitamin B2 (riboflavin) supplementation is used to prevent and treat riboflavin deficiency. Vitamin B2 may prevent migraine headaches at high doses and be useful for prevention of eye conditions such as cataract, glaucoma and tired eyes (fatigue). Vitamin B2 is also used for boosting of immune system, and maintenance of healthy hair, skin, nails and mucous membranes.

Vitamin B2 description

Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as flavin mononucleotide and flavin-adenine dinucleotide.

Vitamin B2 interactions

Interactions for vitamin B2

Alcohol - impairs the intestinal absorption of riboflavi

Antidepressants (tricyclics or phenothiazines) - requirements for riboflavin may be increased in patients receiving these medications

Probenecid - concurrent use decreases gastrointestinal absorption of riboflavin; requirements for riboflavin may be increased in patients receiving probenecid.

Vitamin B2 side effects

Genitourinary

Yellow-orange discoloration of urine.

Vitamin B2 contraindications

None well documented.

What is Vitamin B6?

Pyridoxine is vitamin B6. Vitamins occur naturally in foods such as meat, poultry, nuts, whole grains, bananas, and avocados. Vitamin B6 is important for many processes in the body.

Pyridoxine is used to treat or prevent vitamin B6 deficiency. It is also used to treat a certain type of anemia (lack of red blood cells). Pyridoxine injection is also used to treat some types of seizure in babies.

Pyridoxine taken by mouth (oral) is available without a prescription. Injectable pyridoxine must be given by a healthcare professional.

Pyridoxine may also be used for purposes not listed in this medication guide.

Vitamin B6 indications

* Sideroblastic anaemia

* Treatment and prophylaxis of vitamin B6 deficiency states

How should I use Vitamin B6?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Pyridoxine tablets are taken by mouth. Injectable pyridoxine is injected into a muscle or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

The recommended dietary allowance of pyridoxine increases with age. Follow your healthcare provider's instructions. You may also consult the Office of Dietary Supplements of the National Institutes of Health, or the U.S. Department of Agriculture (USDA) Nutrient Database (formerly "Recommended Daily Allowances") listings for more information.

Pyridoxine is only part of a complete program of treatment that may also include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

Store at room temperature away from moisture and heat.

Uses of Vitamin B6 in details

It is used for the treatment and prevention of vitamin B6 deficiency. It is important for the breakdown of protein, fats, and carbohydrates from foods.

Vitamin B6 description

The 4-methanol form of vitamin B 6 which is converted to pyridoxal phosphate which is a coenzyme for synthesis of amino acids, neurotransmitters (serotonin, norepinephrine), sphingolipids, aminolevulinic acid. Although pyridoxine and Vitamin B 6 are still frequently used as synonyms, especially by medical researchers, this practice is erroneous and sometimes misleading (EE Snell; Ann NY Acad Sci, vol 585 pg 1, 1990).

Vitamin B6 interactions

Interactions for vitamin B6

Amiodarone: Concomitant use of vitamin B6 and amiodarone may enhance amiodarone-induced photosensitivity reactions. Doses of vitamin B6 greater than 5-10 milligrams/day should be avoided by those taking amiodarone Carbamazepine: Chronic use of carbamazepine may result in a significant decrease in plasma pyridoxal 5-phosphate levels Cycloserine: Cycloserine may react with pyridoxal 5-phosphate to form a metabolically inactive oxime, which may result in a functional vitamin B6 deficiency Ethionamide: The use of ethionamide may increase vitamin B6 requirements Fosphenytoin: High doses of vitamin B6 may lower plasma levels of phenytoin. Fosphenytoin is a prodrug of phenytoin Hydralazine: The use of hydralazine may increase vitamin B6 requirements Isoniazid: (isonicotinic acid, INH). Isoniazid reacts with pyridoxal 5-phosphate to form a metabolically inactive hydrazone, which may result in functional vitamin B6 deficiency Levodopa: Concomitant use of levodopa and vitamin B6 in doses of 5 milligrams or more daily may reverse the therapeutic effects of levodopa. Vitamin B6 does not reverse the therapeutic effects of levodopa if levodopa is taken concurrently with the levodopa decarboxylase inhibitor carbidopa. Levodopa is typically administered as a combination product with carbidopa

Oral contraceptives: The use of oral contraceptives may increase vitamin B6 requirements. This was more the case with the older oral contraceptive agents with high-dose estrogen/progestin. It appears to be less the case with the newer low-dose estrogen/progestin products Penicillamine: Penicillamine may react with pyridoxal 5-phosphate to form a metabolically inactive thiazolidine, which may result in a functional vitamin B6 deficiency Phenelzine: Phenelzine may react with pyridoxal 5-phosphate to yield a metabolically inactive hydrazone compound Phenobarbital: High doses of vitamin B6 may lower plasma levels of phenobarbital Phenytoin: High doses of vitamin B6 may lower plasma levels of phenytoin Theophylline: Theophylline may react with pyridoxal 5-phosphate leading to low plasma levels of the coenzyme. This may increase the risk of theophylline-induced seizures Valproic acid: Chronic use of valproic acid may result in a significant decrease in plasma pyridoxal 5-phosphate levels.

Vitamin B6 side effects

Applies to pyridoxine: capsule, injectable, solution, tablet, tablet enteric coated, tablet extended release

As well as its needed effects, pyridoxine (the active ingredient contained in Vitamin B6) may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking pyridoxine, check with your doctor or nurse as soon as possible:

With large doses

• Clumsiness
• numbness of hands or feet

Vitamin B6 contraindications

Contraindications for vitamin B6

Vitamin B6 is contraindicated in those hypersensitive to any component of a vitamin B6-containing product.

What is Vitamin C?

Ascorbic acid (vitamin C) occurs naturally in foods such as citrus fruit, tomatoes, potatoes, and leafy vegetables. Vitamin C is important for bones and connective tissues, muscles, and blood vessels. Vitamin C also helps the body absorb iron, which is needed for red blood cell production.

Ascorbic acid is used to treat and prevent vitamin C deficiency.

Ascorbic acid may also be used for purposes not listed in this medication guide.

Vitamin C indications

For systemic use of Vitamin C: prevention and treatment of hypo- and avitaminosis of vitamin C; providing increased need for vitamin C during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in winter with an increased risk of infectious diseases.

For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal microflora.

Uses of Vitamin C in details

Ascorbic acid (vitamin C) is used to prevent or treat low levels of vitamin C in people who do not get enough of the vitamin from their diets. Most people who eat a normal diet do not need extra ascorbic acid. Low levels of vitamin C can result in a condition called scurvy. Scurvy may cause symptoms such as rash, muscle weakness, joint pain, tiredness, or tooth loss.

Vitamin C plays an important role in the body. It is needed to maintain the health of skin, cartilage, teeth, bone, and blood vessels. It is also used to protect your body's cells from damage. It is known as an antioxidant.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This vitamin may also be used with other vitamins for a certain eye condition (macular degeneration).

How to use Vitamin C

Take this vitamin by mouth with or without food, usually 1 to 2 times daily. Follow all directions on the product package, or take as directed by your doctor.

If you are taking the extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Take this product with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise.

If you are taking the wafers or chewable tablets, chew them thoroughly and then swallow. If you are taking the lozenges, place the lozenge in your mouth and allow it to slowly dissolve.

If you are taking the powder, mix it thoroughly in the proper amount of liquid and stir well. Drink all of the liquid right away. Do not prepare a supply for future use. If you are using the liquid form of this vitamin, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Dosage is based on your medical condition and response to treatment.

Use this vitamin regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If you think you may have a serious medical problem, seek immediate medical attention.

Vitamin C description

A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, vitamin C, functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C is considered an antioxidant.

Vitamin C dosage

This medication administered orally, IM, IV, intravaginally.

For the prevention of deficiency conditions Vitamin C dose is 25-75 mg / day, for the treatment - 250 mg / day or more in divided doses.

For intravaginal used ascorbic acid drugs in appropriate dosage forms.

Vitamin C interactions

In an application with barbiturates, primidone increases the excretion of ascorbic acid in the urine.

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

In an application of Vitamin C with iron preparations ascorbic acid, due to its regenerative properties, transforms ferric iron in the bivalent, which improves its absorption.

Ascorbic acid in high doses can decrease urine pH that while the application reduces the tubular reabsorption of amphetamine and tricyclic antidepressants.

With the simultaneous use of aspirin reduces the absorption of ascorbic acid by about a third.

Vitamin C in an application with warfarin may decrease effects of warfarin.

With the simultaneous application of ascorbic acid increases the excretion of iron in patients receiving deferoxamine. In the application of ascorbic acid at a dose of 500 mg / day possibly left ventricular dysfunction.

In an application with tetracycline is increased excretion of ascorbic acid in the urine.

There is a described case of reducing the concentration of fluphenazine in plasma in patients treated with ascorbic acid 500 mg 2 times / day.

May increase the concentration of ethinyl estradiol in the blood plasma in its simultaneous application in the oral contraceptives.

Vitamin C side effects

Applies to ascorbic acid: oral capsule, oral capsule extended release, oral capsule liquid filled, oral granule, oral liquid, oral lozenge/troche, oral powder, oral powder for solution, oral powder for suspension, oral solution, oral syrup, oral tablet, oral tablet chewable, oral tablet extended release, oral wafer

As well as its needed effects, ascorbic acid (the active ingredient contained in Vitamin C) may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking ascorbic acid, check with your doctor or nurse as soon as possible:

Less common or rare: - with high doses

• Side or lower back pain

Minor Side Effects

Some ascorbic acid side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Less common or rare: - with high doses

• Diarrhea
• dizziness or faintness (with the injection only)
• flushing or redness of skin
• headache
• increase in urination (mild)
• nausea or vomiting
• stomach cramps

Vitamin C contraindications

AV-block II and III degree, sinoatrial block, SSS, bradycardia (HR < 40 bpm), hypotension (in case of myocardial infarction, systolic blood pressure less than 100 mm Hg), cardiogenic shock, congestive heart failure IIB-III stages, acute heart failure, Prinzmetal's angina, lactation, concomitant use of MAO inhibitors, hypersensitivity to atenolol.

What is Vitamin D?

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are available in the foods that you eat. Vitamin D is necessary for strong bones and teeth.

Lack of vitamin D may lead to a condition called rickets, especially in children, in which bones and teeth are weak. In adults it may cause a condition called osteomalacia, in which Vitamin D is lost from bones so that they become weak. Your doctor may treat these problems by prescribing vitamin D for you. Vitamin D is also sometimes used to treat other diseases in which Vitamin D is not used properly by the body.

Ergocalciferol is the form of vitamin D used in vitamin supplements.

Some conditions may increase your need for vitamin D. These include:

• Alcoholism
• Intestine diseases
• Kidney disease
• Liver disease
• Overactivity of the parathyroid glands with kidney failure
• Pancreas disease
• Surgical removal of stomach

In addition, individuals and breast-fed infants who lack exposure to sunlight, as well as dark-skinned individuals, may be more likely to have a vitamin D deficiency. Increased need for vitamin D should be determined by your health care professional.

Alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are forms of vitamin D used to treat hypocalcemia (not enough Vitamin D in the blood). Alfacalcidol, calcifediol, and calcitriol are also used to treat certain types of bone disease that may occur with kidney disease in patients who are undergoing kidney dialysis.

Claims that vitamin D is effective for treatment of arthritis and prevention of nearsightedness or nerve problems have not been proven. Some psoriasis patients may benefit from vitamin D supplements; however, controlled studies have not been performed.

Injectable vitamin D is given by or under the supervision of a health care professional. Some strengths of ergocalciferol and all strengths of alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are available only with your doctor's prescription. Other strengths of ergocalciferol are available without a prescription. However, it may be a good idea to check with your health care professional before taking vitamin D on your own. Taking large amounts over long periods may cause serious unwanted effects.

Vitamin D indications

This medicine is indicated in all conditions where there is a disturbance of Vitamin D metabolism due to impaired 1-α hydroxylation such as when there is reduced renal function. The main indications are:

a) Renal osteodystrophy

b) Hyperparathyroidism (with bone disease)

c) Hypoparathyroidism

d) Neonatal hypocalcaemia

e) Nutritional and malabsorptive rickets and osteomalacia

f) Pseudo-deficiency (D-dependent) rickets and osteomalacia

g) Hypophosphataemic vitamin D resistant rickets and osteomalacia

Uses of Vitamin D in details

Use: Labeled Indications

Dietary supplement: As a vitamin D dietary supplement

Off Label Uses

Hypoparathyroidism

Since parathyroid hormone (PTH) is required for the conversion of vitamin D (ergocalciferol or cholecalciferol) to the active metabolite of vitamin D (1,25-dihydroxyvitamin D), alternative vitamin D preparations not dependent on this conversion (eg, alfacalcidol, calcitriol) are recommended for routine use. Based on the Endocrine Society guidelines for the Management of Hypoparathyroidism, active vitamin D preparations (ie, alfacalcidol, calcitriol) in conjunction with Vitamin D supplementation is the standard therapy for hypoparathyroidism. Addition of native vitamin D (eg, cholecalciferol or ergocalciferol) may be considered for supplemental therapy.

Osteoporosis, prevention

Based on the National Osteoporosis Foundation (NOF) Clinician

Vitamin D dosage

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule,

Oral:

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Decara: 1.25 MG (50000 UT) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), soybean oil]

Decara: 250 MCG (10000 UT) [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, gelatin (bovine)]

Decara: 625 MCG (25000 UT) [contains soybean oil]

Dialyvite Vitamin D 5000: 125 MCG (5000 UT)

Pronutrients Vitamin D3: 25 MCG (1000 UT) [contains soybean oil]

Weekly-D: 1.25 MG (50000 UT) [contains fd&c red #40]

Generic: 1.25 MG (50000 UT), 250 MCG (10000 UT)

Capsule,

Oral [preservative free]:

D-3-5: 125 MCG (5000 UT) [dairy free, dye free, egg free, gluten free, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Generic: 10,000 units, 125 MCG (5000 UT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Liquid,

Oral:

Aqueous Vitamin D: 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains corn oil, methylparaben, polysorbate 80]

Bio-D-Mulsion: 10 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

Bio-D-Mulsion Forte: 50 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

BProtected Pedia D-Vite: 10 mcg/mL (50 mL) [alcohol free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; cherry flavor]

D-Vi-Sol: 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains polysorbate 80]

D-Vita: 10 mcg/mL (50 mL [DSC]) [alcohol free, gluten free, lactose free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; fruit flavor]

D-Vite Pediatric: 10 mcg/mL (50 mL) [alcohol free, gluten free, lactose free, no artificial color(s), sugar free; contains disodium edta, polysorbate 80, propylene glycol, saccharin sodium, sodium benzoate]

D3 Vitamin: 10 mcg/mL (50 mL) [contains polysorbate 80, sodium benzoate]

Generic: 10 mcg/mL (50 mL, 52 mL)

Liquid,

Oral [preservative free]:

Generic: 125 mcg/mL (52 mL)

Liquid, Sublingual:

Generic: 5000 units/mL (60 mL)

Tablet,

Oral:

Delta D3: 10 MCG (400 UNIT) [gelatin free, gluten free, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Dialyvite Vitamin D3 Max: 1.25 MG (50000 UT) [scored]

Vitamin D3 Super Strength: 50 MCG (2000 UT) [gluten free]

Vitamin D3 Ultra Potency: 1.25 MG (50000 UT)

Generic: 10 MCG (400 UNIT), 125 MCG (5000 UT), 20 MCG (800 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT), 75 MCG (3000 UT)

Tablet,

Oral [preservative free]:

Generic: 5000 units, 10 MCG (400 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Tablet Chewable,

Oral:

Generic: 10 MCG (400 UNIT)

Tablet Chewable,

Oral [preservative free]:

Generic: 50 MCG (2000 UT)

Dosing: Adult

Note: 1 mcg = 40 units

Hypoparathyroidism (off-label use): Note: Active vitamin D preparations (ie, alfacalcidol, calcitriol) in conjunction with Vitamin D supplementation are recommended therapy. Addition of cholecalciferol (or ergocalciferol) may be considered for supplemental therapy (Endocrine Society [Brandi 2016]).

Osteoporosis, prevention (off-label use): Adults ≥50 years of age:

Oral: 800 to 1,000 units/day is recommended, through dietary sources and/or supplementation if needed (NOF [Cosman 2014]).

Vitamin D insufficiency/deficiency treatment (off-label use): Note: Repletion strategies may vary depending on desired target serum 25(OH)D levels as well as the clinical status of the patient. The optimal serum 25(OH)D level is controversial; the Institute of Medicine recommends a 25(OH)D level >20 ng/mL as sufficient in nearly all persons (IOM 2011), whereas others have suggested targeting a level of ~30 ng/mL to minimize the risk of fractures, particularly in patients with osteoporosis (AACE [Camacho 2016]; NOF [Cosman 2014]). However, some data suggest levels >40 ng/mL (median level in one trial: ~48 ng/mL) are associated with increased risk of falls in postmenopausal women (Sanders 2010; Smith 2017).

Therefore, some experts recommend a range of 20 to 40 ng/mL as a reasonable target in most patients (Dawson-Hughes 2018). In patients with normal absorption, for every 100 units/day of cholecalciferol, the serum 25(OH)D level is expected to increase by ~0.7 to 1 ng/mL after a few weeks (ASPEN [McKeever 2017]; Dawson-Hughes 2018). The dose-response declines as the 25(OH)D concentration increases above 40 ng/mL (100 nmol/L) (Dawson-Hughes 2018). The following recommendations are based primarily on expert opinion and clinical experience:

Initial dosing (according to baseline serum 25(OH)D level):

Serum 25(OH)D 20 to 30 ng/mL: Initial: Supplementation dosing:

Oral: 600 to 800 units once daily; a repeat serum 25(OH)D level is not required (Dawson-Hughes 2018) or 1,000 to 2,000 units once daily; may consider a repeat serum 25(OH)D level in ~3 months to determine if the target level has been achieved (Khan 2010).

Serum 25(OH)D 10 to <20 ng/mL: Initial:

Supplementation dosing:

Oral: 800 to 1,000 units once daily (Dawson-Hughes 2018)

OR

Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Serum 25(OH)D <10 ng/mL or in patients with deficiency symptoms: Initial: Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Maintenance dosing: Maintenance dosing is highly patient specific and dependent on target 25(OH)D level, and may range from: 600 to 800 units/day (Dawson-Hughes 2018) to 1,000 to 2,000 units/day (AACE [Camacho 2016]; NOF [Cosman 2014]).

Special populations (obese patients, patients on medications known to affect vitamin D metabolism, patients with malabsorption syndromes or gastrectomy): Higher doses or longer durations may be necessary for adequate repletion (AACE [Camacho 2016]; Dawson-Hughes 2018).

Vitamin D deficiency/insufficiency in patients with chronic kidney disease (off-label use):

Oral:

Note: In patients without severe and progressive hyperparathyroidism, including chronic kidney disease stages G3 to G5 and dialysis or transplant patients, KDIGO guidelines recommend correcting vitamin D deficiency and insufficiency with treatment strategies recommended for the general population using cholecalciferol (or ergocalciferol) while avoiding hypercalcemia and ensuring phosphate levels are in the normal range. An individualized monitoring approach to direct treatment is also recommended (KDIGO 2009; KDIGO 2017). In patients in whom serum parathyroid hormone levels are progressively rising and remain persistently elevated despite correction of modifiable factors (eg, hyperphosphatemia, vitamin D deficiency), calcitriol or vitamin D analogs are suggested instead of cholecalciferol (or ergocalciferol) (KDOQI commentary [Uhlig 2010]).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Vitamin D deficiency, prevention (eg, Rickets prevention): (AAP [Folsom 2017]; AAP [Wagner 2008]; Munns 2016):

Oral:

Breast-fed infants (fully or partially):

Oral: 400 units/day beginning in the first few days of life. Continue supplementation until infant is weaned to ≥1,000 mL/day or 1 qt/day of vitamin D-fortified formula or whole milk (after 12 months of age)

Formula-fed infants ingesting <1,000 mL of vitamin D-fortified formula:

Oral: 400 units/day

Children and Adolescents without adequate intake:

Oral: 400 to 600 units/day.

Vitamin D deficiency, treatment:

Oral:

Infants:

Oral: 2,000 units daily for 6 weeks to achieve a serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 400 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Children and Adolescents:

Oral: 2,000 units daily for 6 to 8 weeks to achieve serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 600 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Vitamin D deficiency in cystic fibrosis, prevention and treatment:

Oral:

CF guidelines (Tangricha [CF Foundation] 2012):

Recommended initial daily intake to maintain serum 25(OH)D level ≥30 ng/mL:

Infants:

Oral: 400 to 500 units/day

Children ≤10 years:

Oral: 800 to 1,000 units/day

Children >10 years and Adolescents:

Oral: 800 to 2,000 units/day

Dosing adjustment for serum 25(OH)D level between 20 to 30 ng/mL and patient adherence established (Step 1 increase):

Infants:

Oral: 800 to 1,000 units/day

Children ≤10 years:

Oral: 1,600 to 3,000 units/day

Children >10 years and Adolescents:

Oral: 1,600 to 6,000 units/day

Dosing adjustment for serum 25(OH)D level <20 ng/mL or persistently between 20 to 30 ng/mL and patient adherence established (Step 2 increase):

Infants: Increase up to a maximum 2,000 units/day

Children ≤10 years: Increase to a maximum of 4,000 units/day

Children >10 years and Adolescents: Increase to a maximum of 10,000 units/day

Alternate dosing (Hall 2010):

Initial dose: Serum 25(OH)D level ≤30 ng/mL

Infants:

Oral: 8,000 units/

Children and Adolescents:

Oral: 800 units/day

Medium-dose regimen: Serum 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units/week for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units/week for 12 weeks

High-dose regimen: Repeat 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units twice weekly for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units twice weekly for 12 weeks

Vitamin D insufficiency or deficiency associated with CKD (stages 2 to 5, 5D), treatment; serum 25 hydroxyvitamin D [25(OH)D] level ≤30 ng/mL (KDOQI Guidelines 2009):

Oral:

Serum 25(OH)D level 16 to 30 ng/mL: Infants, Children, and Adolescents: 2,000 units/day for 3 months or 50,000 units every month for 3 months

Serum 25(OH)D level 5 to 15 ng/mL: Infants, Children, and Adolescents: 4,000 units/day for 12 weeks or 50,000 units every other week for 12 weeks

Serum 25(OH)D level <5 ng/mL: Infants, Children, and Adolescents: 8,000 units/day for 4 weeks then 4,000 units/day for 2 months for total therapy of 3 months or 50,000 units/week for 4 weeks followed by 50,000 units 2 times/month for a total therapy of 3 months

Maintenance dose [once repletion accomplished; serum 25(OH)D level >30 ng/mL]: Infants, Children, and Adolescents: 200 to 1,000 units/day

Nutritional rickets, treatment: Limited data available (Munns 2016): Administer in combination with Vitamin D supplementation:

Daily therapy (preferred):

Infants:

Oral: 2,000 units daily for ≥3 months, followed by maintenance dose of 400 units daily

Children:

Oral: 3,000 to 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Adolescents:

Oral: 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Single-dose therapy:

Infants ≥3 months:

Oral: 50,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 400 units daily

Children:

Oral: 150,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

Adolescents:

Oral: 300,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

Vitamin D interactions

Aluminum Hydroxide: Vitamin D Analogs may increase the serum concentration of Aluminum Hydroxide. Specifically, the absorption of aluminum may be increased, leading to increased serum aluminum concentrations. Avoid combination

Bile Acid Sequestrants: May decrease the serum concentration of Vitamin D Analogs. More specifically, bile acid sequestrants may impair absorption of Vitamin D Analogs. Management: Avoid concomitant administration of vitamin D analogs and bile acid sequestrants (eg, cholestyramine). Separate administration of these agents by several hours to minimize the potential risk of interaction. Monitor plasma Vitamin D concentrations. Consider therapy modification

Vitamin D Salts: May enhance the adverse/toxic effect of Vitamin D Analogs. Monitor therapy

Cardiac Glycosides: Vitamin D Analogs may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

Danazol: May enhance the hypercalcemic effect of Vitamin D Analogs. Monitor therapy

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Consider therapy modification

Mineral Oil: May decrease the serum concentration of Vitamin D Analogs. More specifically, mineral oil may interfere with the absorption of Vitamin D Analogs. Management: Avoid concomitant, oral administration of mineral oil and vitamin D analogs. Consider separating the administration of these agents by several hours to minimize the risk of interaction. Monitor plasma Vitamin D concentrations. Consider therapy modification

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Vitamin D Analogs. Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Vitamin D Analogs. Avoid combination

Orlistat: May decrease the serum concentration of Vitamin D Analogs. More specifically, orlistat may impair absorption of Vitamin D Analogs. Management: Monitor clinical response (including serum Vitamin D) to oral vitamin D analogs closely if used with orlistat. If this combination must be used, consider giving the vitamin D analog at least 2 hrs before or after orlistat. Consider therapy modification

Sucralfate: Vitamin D Analogs may increase the serum concentration of Sucralfate. Specifically, the absorption of aluminum from sucralfate may be increased, leading to an increase in the serum aluminum concentration. Avoid combination

Thiazide and Thiazide-Like Diuretics: May enhance the hypercalcemic effect of Vitamin D Analogs. Monitor therapy

Vitamin D Analogs: May enhance the adverse/toxic effect of other Vitamin D Analogs. Avoid combination

Vitamin D side effects

• Metabolism and Nutrition Disorders

Hypercalcaemia

Hyperphosphataemia

• Skin and Subcutaneous Tissue Disorders

Pruritus

Rash

Urticaria

• Renal and Urinary Disorders

Nephrocalcinosis

Renal impairment

Vitamin D contraindications

OTC labeling: Replesta products only: When used for self-medication, do not use if you have hypercalcemia, primary hyperparathyroidism, sarcoidosis, hypervitaminosis D, Williams syndrome, or are pregnant.

Documentation of allergenic cross-reactivity for vitamin D is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

What is Vitamin E?

Vitamin E is an antioxidant that occurs naturally in foods such as nuts, seeds, and leafy green vegetables. Vitamin E is a fat-soluble vitamin important for many processes in the body.

Vitamin E is used to treat or prevent vitamin E deficiency. People with certain diseases may need extra vitamin E.

Vitamin E may also be used for purposes not listed in this medication guide.

Vitamin E indications

Oral

Vitamin E deficiency

Adult: 40-50 mg of d-α tocopherol daily.

Child: Neonate: 10 mg/kg once daily; 1 mth-18 yr: 2-10 mg/kg/day, up to 20 mg/kg.

Oral

Supplementation in cystic fibrosis

Adult: 100-200 mg daily of dl-α-tocoferil acetate or 67-135 mg daily of d-α-tocopherol.

Child: As α- tocopheryl acetate: 1 mth-1 yr 50 mg once daily; 1-12 yr 100 mg once daily; 12-18 yr 200 mg once daily. Dose to be adjusted as needed.

Oral

Abetalipoproteinaemia

Adult: 50-100 mg/kg daily of dl-α-tocoferil acetate or about 33-67 mg/kg daily of d-α-tocopherol.

Child: Neonate: 100 mg/kg once daily; 1 mth-18 yr: 50-100 mg/kg once daily.

Uses of Vitamin E in details

This supplement is used to prevent or treat a lack of vitamin E in the body. A low body level of vitamin E is rare. Most people who eat a normal diet do not need extra vitamin E. However, vitamin E supplements are used in premature newborns and in people who have problems absorbing enough vitamin E from their diets. Vitamin E is important in protecting your body's cells from damage. It is known as an antioxidant.

How to use Vitamin E

Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using a liquid form of this product, carefully measure your dose using a medication-measuring device or spoon. Do not use a household spoon because you may not get the correct dose. If your liquid form is a suspension, shake the bottle well before each dose.

Dosage is based on your medical condition and response to treatment. Do not increase your dose or take it more often than recommended. Taking too much vitamin E may increase your risk of side effects.

High doses of vitamin E (400 units or more per day) may increase the chance of rare but very serious side effects. There is no proof that high doses of vitamin E help to prevent or treat heart disease. There is very little evidence that it helps prevent or treat Alzheimer's disease. In some people, taking these high doses may even be harmful. Talk to your doctor or pharmacist and discuss the risks and benefits before taking vitamin E supplements.

If your doctor prescribes this product for vitamin E deficiency, use it regularly to get the most benefit from it. To help you remember, take it at the same time each day. You should see improvement of symptoms such as numbness/tingling of the hands/feet and weakness. If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

Vitamin E description

A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Vitamin E&

Vitamin E dosage

Vitamin E Dosage

Applies to the following strength(s): with mixed tocopherols 400 intl units; alpha 100 intl units; with mixed tocopherols 200 intl units; with mixed tocopherols 1000 intl units; 600 intl units; 400 intl units; 100 intl units; 15 intl units/0.3 mL; 200 intl units; 1000 intl units; alpha 1000 intl units; dl-alpha 400 intl units; d-alpha 200 intl units; d-alpha 400 intl units; dl-alpha 600 intl units; d-alpha tocopherol with tocopherols and tocotrienols

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for:

• Vitamin E Deficiency
• Tardive Dyskinesia
• Sickle Cell Anemia
• Alzheimer's Disease
• Dietary Supplement

Usual Pediatric Dose for:

• Vitamin E Deficiency
• Retinopathy Prophylaxis
• Cystic Fibrosis
• Dietary Supplement

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Precautions
• Dialysis
• Other Comments

Usual Adult Dose for Vitamin E Deficiency

Treatment: 60 to 75 units orally once daily.

Prevention: 30 units orally once daily.

Usual Adult Dose for Tardive Dyskinesia

600 to 1600 units orally per day.

Usual Adult Dose for Sickle Cell Anemia

450 units orally per day.

Usual Adult Dose for Alzheimer's Disease

1000 units orally twice daily.

Usual Adult Dose for Dietary Supplement

Oral liquid formulation (Vitamin E): 200 units (10 mL) orally once daily.

Usual Pediatric Dose for Vitamin E Deficiency

1 unit/kg/day orally of water-miscible vitamin E.

Usual Pediatric Dose for Retinopathy Prophylaxis

Prevention of retinopathy of prematurity or Bronchopulmonary dysplasia (BPD) secondary to oxygen therapy: 15 to 30 units/kg/day to maintain plasma levels between 1.5 to 2 mcg/mL (may need as high as 100 units/kg/day). Note: AAP considers this use investigational and routine use is not recommended.

Usual Pediatric Dose for Cystic Fibrosis

100 to 400 units/day orally.

Usual Pediatric Dose for Dietary Supplement

Dosing: 1 unit vitamin E = 1 mg dl-alpha-tocopherol acetate.

Oral:

Adequate Intake (AI):

1 to less than 6 months: 4 units daily

6 to less than 12 months: 5 units daily

Recommended Daily Allowance (RDA):

1 to 3 years: 6 units daily

4 to 8 years: 7 units daily

9 to 13 years: 11 units daily

13 years and Older: 15 units daily

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Although no longer available in the U.S., vitamin E injectable administered intravenously to premature infants may result in a potentially fatal syndrome consisting of thrombocytopenia, hepatomegaly, splenomegaly, ascites, and renal, hepatic, and pulmonary dysfunction.

Oral administration of large doses (200 mg per day) of a hyperosmolar vitamin E preparation to low-birthweight infants has been associated with the development of necrotizing enterocolitis.

Dialysis

Data not available

Other Comments

The oral liquid formulation (Vitamin E [R]) is intended to enhance absorption in patients with conditions associated with malabsorption (e.g., Crohn's disease, ulcerative colitis ) or for patients who have difficulty swallowing capsules.

The oral liquid formulation (Vitamin E [R]) may be taken directly or mixed with water or other beverage. It must be shaken well prior to each use and refrigerated after opening.

More about vitamin e

• Side Effects
• During Pregnancy
• Dosage Information
• Drug Interactions
• Support Group
• 4 Reviews - Add your own review/rating

Consumer resources

• Vitamin E
• Vitamin e (Advanced Reading)

• Other brands: Alpha E, E-400 Clear, Aquasol E, E-Gems, More (5) »

Professional resources

• Vitamin E (AHFS Monograph)

Related treatment guides

• Nocturnal Leg Cramps
• Anemia, Sickle Cell
• Dietary Supplementation
• Alzheimer's Disease
• Cystic Fibrosis
• More (3) »

Vitamin E interactions

See also:
What other drugs will affect Vitamin E?

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.): Vitamin E (Systemic) may enhance the antiplatelet effect of Agents with Antiplatelet Properties. Monitor therapy

Anticoagulants: Vitamin E (Systemic) may enhance the anticoagulant effect of Anticoagulants. Monitor therapy

CycloSPORINE (Systemic): Vitamin E (Systemic) may decrease the serum concentration of CycloSPORINE (Systemic). Monitor therapy

Ibrutinib: Vitamin E (Systemic) may enhance the antiplatelet effect of Ibrutinib. Monitor therapy

Orlistat: May decrease the serum concentration of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or after the administration of orlistat. Similar precautions do not apply to parenterally administered fat soluble vitamins. Consider therapy modification

Tipranavir: May enhance the adverse/toxic effect of Vitamin E (Systemic). Management: Patients taking tipranavir oral solution are advised to avoid taking additional vitamin E, beyond the amounts contained in a multivitamin product. This interaction does not apply to tipranavir capsules. Consider therapy modification

Vitamin E side effects

See also:
What are the possible side effects of Vitamin E?

Applies to vitamin e: oral capsule, oral capsule liquid filled, oral liquid, oral powder for solution, oral solution, oral tablet, oral tablet chewable

In addition to its needed effects, some unwanted effects may be caused by vitamin e (the active ingredient contained in Vitamin E). In the event that any of these side effects do occur, they may require medical attention.

Severity: Moderate

If any of the following side effects occur while taking vitamin e, check with your doctor or nurse as soon as possible:

With doses greater than 400 Units a day and long-term use

• Blurred vision
• diarrhea
• dizziness
• headache
• nausea or stomach cramps
• unusual tiredness or weakness

Vitamin E contraindications

See also:
What is the most important information I should know about Vitamin E?

Hypersensitivity to vitamin E or any component of the formulation

What is Zinc?

Zinc is a naturally occurring mineral. Zinc is important for growth and for the development and health of body tissues.

Zinc sulfate is used to treat and to prevent zinc deficiency.

Zinc sulfate may also be used for purposes not listed in this medication guide.

Zinc indications

Patients with deficiency of B-complex vitamins, Zinc and zinc or where supplementation of these vitamins and zinc can be beneficial. Such patients and conditions include: Patients who are on prolonged antibiotic therapy; those who are suffering from infection, injuries, burns, fever, illness; patients with diarrhoea and GI disorders; patients who have undergone surgical operations; patients on diet restrictions eg, in diabetes, anorexia and alcoholism and in elderly persons; pregnant and lactating women due to increased nutritional needs.

Zinc description

Zinc Capsule: Each capsule contains zinc sulphate monohydrate 54.93 mg, thiamine nitrate 10 mg, riboflavin 10 mg, pyridoxine hydrochloride 3 mg, Zinc (coated) equivalent to cyanocobalamin 15 mcg, ascorbic acid 150 mg, Zinc 1 mg, nicotinamide 50 mg and Zinc pantothenate 12.5 mg.

Zinc Syrup: Each 5 mL contains zinc gluconate 34.9 mg, thiamine mononitrate 2.5 mg, riboflavin 2.5 mg, pyridoxine hydrochloride 1 mg, cyanocobalamin 3 mcg, ascorbic acid 50 mg, d-panthenol 12.5 mg and Zinc 25 mg in a flavoured liquid glucose sorbitol syrup base.

Zinc dosage

Zinc 1 mg/mL (Zinc Chloride Injection, USP) contains 1 mg zinc/mL and is administered intravenously only after dilution. The additive should be diluted prior to administration in a volume of fluid not less than 100 mL. For the metabolically stable adult receiving TPN, the suggested intravenous dosage is 2.5 to 4 mg zinc/day (2.5 to 4 mL/day). An additional 2 mg zinc/day (2 mL/day) is suggested for acute catabolic states. For the stable adult with fluid loss from the small bowel, an additional 12.2 mg zinc/liter of small bowel fluid lost (12.2 mL/liter of small bowel fluid lost), or an additional 17.1 mg zinc/kg of stool or ileostomy output (17.1 mL/kg of stool or ileostomy output) is recommended. Frequent monitoring of zinc blood levels is suggested for patients receiving more than the usual maintenance dosage level of zinc.

For full term infants and children up to 5 years of age, 100 mcg zinc/kg/day

(0.1 mL/kg/day) is recommended. For premature infants (birth weight less than 1500 g) up to 3 kg in body weight, 300 mcg zinc/kg/day (0.3 mL/kg/day) is suggested.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

How supplied

Zinc 1 mg/mL (Zinc Chloride Injection, USP) is supplied in 10 mL Plastic Vials (List No. 4090).

Store at 20 to 25°C (68 to 77°F).

HOSPIRA, INC., LAKE FOREST, IL 60045 USA. Revised: October, 2004

Zinc interactions

Pyridoxine reduces the effects of levodopa (but this does not occur if a dopa decarboxylase is also given); decreases serum concentrations of phenobarbitone. Concurrent administration of drugs eg, isoniazid, penicillamine and oral contraceptives increase the requirement for pyridoxine.

Absorption of cyanocobalamin from the GIT may be reduced by neomycin, aminosalicylic acid, histamine H₂-receptor antagonists and colchicine. Serum concentrations may be decreased by concurrent administration of oral contraceptives. Many of these interactions are unlikely to be of clinical significance but should be taken into account when performing assays for blood concentrations.

Parenteral chloramphenicol may attenuate the effect of Zinc in anaemia.

Folate deficiency states may be produced by a number of drugs including antiepileptics, oral contraceptives, antituberculous drugs, alcohol and Zinc antagonists eg, aminopterin, methotrexate, pyrimethamine, trimethoprim and sulphonamides; Zinc may decrease serum-phenytoin concentrations.

There may be an increased risk of myopathy or rhabdomyolysis when nicotinic acid is used concurrently with statins. Nicotinamide may increase the requirements for insulin or oral hypoglycaemics.

Ascorbic acid may increase the absorption of iron-deficiency states.

Ascorbic acid is often given in addition to desferrioxamine to patients with iron overload (thalassemia) to achieve better iron excretion. However, early on in treatment when there is excess tissue iron, there is some evidence that ascorbic acid may worsen the iron toxicity, particularly to the heart. Thus, ascorbic acid should not be given for the first month after starting desferrioxamine treatment.

The absorption of zinc may be reduced by iron supplements, penicillamine, Zinc-containing preparations and tetracyclines. Zinc supplements reduce the absorption of Zinc, ciprofloxacin, iron, norfloxacin, penicillamine and tetracyclines.

Zinc side effects

Applies to zinc sulfate: capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Nausea; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking zinc sulfate (the active ingredient contained in Zinc)

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe vomiting; unusual restlessness; very dry mouth, eyes, or skin.

Zinc contraindications

Hypersensitivity to any of the ingredients of Zinc.

Active ingredient matches for Biotin/boron/calcium/calcium d-pantothenate/chloride/chromium/copper/folic acid/iodine/iron/magnesium/manganese/niacinamide/nickel/phosphorus/potassium/selenium/silicon/tin/vanadium/vitamin A/vitamin B1/vitamin B12/vitamin B2/vitamin B6/vitamin C/vitamin D/vitamin E/zinc:

Biotin/boron/calcium/calcium d-pantothenate/chloride/chromium/copper/folic acid/iodine/iron/magnesium/manganese/niacinamide/nickel/phosphorus/potassium/selenium/silicon/tin/vanadium/vitamin A/vitamin B1/vitamin B12/vitamin B2/vitamin B6/vitamin C/vitamin D/vitamin E/zinc

References

1. DailyMed. "ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE; PHYTONADIONE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN 5'-PHOSPHATE SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. DailyMed. "COPPER: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
3. DailyMed. "CALCIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology