Cyanocobalamin + Elemental Iron + Folic Acid

Usage

This combination medication is primarily prescribed for the prevention and treatment of nutritional deficiencies, particularly iron-deficiency anemia, and megaloblastic anemia caused by vitamin B12 (cyanocobalamin) or folic acid deficiency. It is also used prophylactically during pregnancy to prevent neural tube defects in the developing fetus and address increased nutritional demands.

• Pharmacological Classification: Hematinic, Antianemic, Vitamin Supplement

• Mechanism of Action: This combination works by providing the essential components for red blood cell formation and overall health. Iron is crucial for hemoglobin synthesis, the protein responsible for oxygen transport within red blood cells. Vitamin B12 and folic acid are vital for DNA synthesis and cell division, especially in rapidly proliferating cells like red blood cell precursors. The combination ensures optimal red blood cell production, preventing and treating anemia associated with deficiencies of these nutrients.

Alternate Names

No widely recognized alternate names exist for this specific combination. However, individual components have alternate names: Cyanocobalamin (Vitamin B12), Elemental Iron (Fe), and Folic Acid (Vitamin B9).

• Brand Names: Numerous brand names exist depending on the manufacturer and specific formulation. Some examples include (but are not limited to): Hemovit, Folvite-Fe, Irofol.

How It Works

• Pharmacodynamics: Iron, as a component of hemoglobin, is essential for oxygen transport. Vitamin B12 and folic acid, as cofactors in DNA synthesis, enable proper cell division and maturation of red blood cells, preventing macrocytic anemia.

• Pharmacokinetics:

  • Absorption: Iron absorption occurs primarily in the duodenum and upper jejunum. Factors such as dietary components, gastric acidity, and the form of iron administered can influence its absorption. Vitamin B12 absorption requires intrinsic factor, a protein secreted by the stomach. Folic acid is readily absorbed from the small intestine.
  • Metabolism: Iron is stored as ferritin and hemosiderin, primarily in the liver, spleen, and bone marrow. Vitamin B12 and folic acid are converted to their active forms within the body.
  • Elimination: Iron is primarily lost through shedding of epithelial cells and blood loss. Excess vitamin B12 and folic acid are excreted in urine.

• Mode of Action: Iron is incorporated into the heme molecule of hemoglobin, enabling oxygen binding and transport. Vitamin B12 and folate are essential cofactors in DNA synthesis, participating in the conversion of deoxyuridine monophosphate (dUMP) to deoxythymidine monophosphate (dTMP), a crucial step in DNA replication. This ensures proper cell division and maturation, particularly for rapidly dividing cells like red blood cell precursors.

• Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: Not directly applicable for this combination’s primary mechanism of action related to red blood cell production.

• Elimination Pathways: Iron primarily through shedding of epithelial cells, vitamin B12 and folic acid mainly through renal excretion.

Dosage

Dosage is dependent on the specific formulation and the individual patient’s needs. Always consult with a healthcare professional for appropriate dosage recommendations.

Standard Dosage

Adults: A typical dosage might include 100-200mg of elemental iron, 1mg of folic acid, and 5-25mcg of cyanocobalamin once daily.

Children: Dosage should be adjusted based on age, weight, and specific deficiency. Consult pediatric dosing guidelines or a pediatrician.

Special Cases:

• Elderly Patients: Dosage adjustments may be needed based on renal function and other health conditions.
• Patients with Renal Impairment: Dose reduction or alternative treatment may be necessary.
• Patients with Hepatic Dysfunction: Cautious use and monitoring are advisable.
• Patients with Comorbid Conditions: Individualized dosing considerations are necessary for patients with conditions like diabetes, cardiovascular disease, or gastrointestinal disorders.

Clinical Use Cases

Dosages provided below are general examples and may not be appropriate for all patients. Consult with a healthcare professional for specific recommendations based on the clinical situation.

• Intubation: Not specifically indicated.
• Surgical Procedures: Pre-operative supplementation may be considered in anemic patients.
• Mechanical Ventilation: Not specifically indicated.
• Intensive Care Unit (ICU) Use: Supplementation might be needed depending on nutritional status and underlying conditions.
• Emergency Situations: Not typically used in acute emergency situations.

Dosage Adjustments

Dose modification based on renal/hepatic function, concurrent medications, and individual response is crucial. Regular monitoring of hemoglobin, hematocrit, and other relevant laboratory parameters is essential.

Side Effects

Common Side Effects:

Nausea, constipation, diarrhea, dark stools, and stomach upset.

Rare but Serious Side Effects:

Allergic reactions (rash, itching, swelling), iron overload (in patients with hemochromatosis or thalassemia).

Long-Term Effects:

Iron overload with chronic excessive intake.

Adverse Drug Reactions (ADR):

Severe allergic reactions (anaphylaxis), iron toxicity.

Contraindications

Hypersensitivity to any of the components, hemochromatosis, hemosiderosis, iron overload disorders, anemias not caused by iron, B12, or folate deficiency (e.g., pernicious anemia, aplastic anemia, sideroblastic anemia), Leber’s hereditary optic neuropathy.

Drug Interactions

Antacids, proton pump inhibitors (PPIs), H2 receptor antagonists, antibiotics (tetracyclines, quinolones), levodopa, bisphosphonates, levothyroxine, anticonvulsants. Alcohol, dairy products, and eggs can interfere with iron absorption.

Pregnancy and Breastfeeding

Generally considered safe during pregnancy and breastfeeding when prescribed by a physician. Adequate folic acid intake is crucial during pregnancy to prevent neural tube defects.

Drug Profile Summary

Please refer to the previous sections for details.

Popular Combinations

Often combined with other vitamins and minerals in multivitamin formulations.

Precautions

Assess for pre-existing allergies, metabolic disorders, and organ dysfunction. Caution in patients with gastrointestinal disorders. Monitor iron levels to avoid overload. Adjust dose based on age, weight, and comorbidities.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Cyanocobalamin + Elemental Iron + Folic Acid?

A: Dosage varies depending on the individual’s needs and the specific formulation. A common dosage might involve 100-200 mg of elemental iron, 1mg of folic acid, and 5-25 mcg of cyanocobalamin daily. Consult with a healthcare professional for appropriate recommendations.

Q2: Can this combination be used in patients with kidney disease?

A: Caution is advised in patients with renal impairment. Dose adjustments may be necessary, and close monitoring of renal function is essential.

Q3: Are there any specific dietary restrictions while taking this medication?

A: Avoid consuming dairy products, eggs, or antacids concurrently with this medication, as they can impair iron absorption. Take the medication on an empty stomach, unless gastrointestinal upset occurs, in which case it may be taken with food.

Q4: Can this combination cause constipation?

A: Constipation is a common side effect. Increasing fluid intake, dietary fiber, and physical activity can help alleviate this.

Q5: Is this medication safe during pregnancy?

A: This combination is generally considered safe during pregnancy under the guidance of a healthcare professional. Folic acid is especially important for preventing neural tube defects in the developing fetus.

Q6: What are the signs of iron overload?

A: Signs of iron overload can include fatigue, joint pain, abdominal pain, and skin discoloration. Regular monitoring of iron levels is important, especially in patients at risk of iron overload.

Q7: Can this medication interact with other medications I’m taking?

A: Yes, this combination can interact with various medications, such as antacids, antibiotics, and thyroid medications. Inform your doctor about all other medications and supplements you are taking.

Q8: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.

Q9: Can this combination be used in children?

A: Yes, but the dosage needs to be adjusted based on the child’s age, weight, and specific deficiency. Consult a pediatrician for appropriate pediatric dosing recommendations.