D-Panthenol + Methylcobalamin + Nicotinamide + Thiamine + Vitamin B6

Usage

This combination of B vitamins is prescribed for the treatment and prevention of deficiencies in these essential nutrients. It is commonly used to address conditions such as peripheral neuropathy (particularly diabetic neuropathy), to support nerve health and function, and to promote overall well-being. It may also be used as an adjunct therapy in other neurological disorders and in the management of certain types of anemia.

Pharmacological Classification: Nutritional supplement, vitamin combination.

Mechanism of Action: This combination provides the essential B vitamins necessary for various physiological processes:

• D-Panthenol: Converted to pantothenic acid (vitamin B5), a component of coenzyme A, crucial for energy metabolism, fatty acid synthesis, and maintaining healthy skin.
• Methylcobalamin: Active form of vitamin B12, vital for nerve function, DNA synthesis, red blood cell formation, and homocysteine regulation.
• Nicotinamide: A form of vitamin B3 and a precursor to NAD and NADP, coenzymes involved in energy metabolism, DNA repair, and cell signaling. It also possesses anti-inflammatory properties.
• Thiamine: Vitamin B1, essential for carbohydrate metabolism and nerve function.
• Vitamin B6 (Pyridoxine): Converted to pyridoxal phosphate, a coenzyme for various metabolic processes, including amino acid metabolism, neurotransmitter synthesis, and heme production.

Alternate Names

There is no specific alternate name for this combination. However, the individual components are also known as:

• D-Panthenol: Provitamin B5
• Methylcobalamin: Vitamin B12, Mecobalamin, Cyanocobalamin
• Nicotinamide: Niacinamide, Vitamin B3
• Thiamine: Vitamin B1
• Vitamin B6: Pyridoxine

Brand Names: Maxnerve, Neuromine Plus, Methylcrit-Plus, Cobitus-Plus+, Adee, Optineuron, Multi 8, Bethadoxin (Note: Brand availability may vary depending on the region.)

How It Works

Pharmacodynamics: The combined effects of the B vitamins contribute to maintaining neurological function, boosting energy production, and supporting skin health, as well as red blood cell formation and DNA synthesis. They act synergistically to optimize several metabolic pathways.

Pharmacokinetics:

• Absorption: Varies depending on the route of administration (oral or injection) and the specific vitamin. Oral absorption can be affected by factors like gastrointestinal function and the presence of food. Injections bypass the digestive system, resulting in faster absorption.
• Metabolism: B vitamins are generally readily metabolized in the liver.
• Elimination: Primarily through renal excretion.

Mode of Action: These vitamins act as coenzymes or precursors to coenzymes in crucial metabolic processes, including energy production, nerve function maintenance, DNA synthesis, and red blood cell formation. Methylcobalamin, in particular, plays a role in homocysteine metabolism, reducing its levels and thus promoting cardiovascular health. Nicotinamide’s role as a precursor to NAD and NADP involves it in cellular energy production and DNA repair.

Dosage

Dosage varies depending on the formulation, indication, and patient-specific factors. Always consult the specific product information.

Standard Dosage

Adults: Injectable forms often contain 1000mcg Methylcobalamin, 100mg Thiamine HCl, 100mg Pyridoxine HCl, 100mg Nicotinamide, and 50mg D-Panthenol. One injection per day is common for severe deficiencies. Oral forms vary widely.

Children: Pediatric dosing should be determined by a physician based on age, weight, and specific deficiency.

Special Cases:

• Elderly Patients: Dosage adjustments may be required due to age-related decline in renal function.
• Patients with Renal Impairment: Dose modifications may be necessary due to impaired vitamin excretion.
• Patients with Hepatic Dysfunction: Caution is advised, particularly with nicotinamide, due to potential hepatotoxicity.
• Patients with Comorbid Conditions: Adjustments may be necessary depending on the specific comorbidity and potential drug interactions.

Clinical Use Cases

Dosage in clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations should be individualized based on the patient’s condition and response. Intravenous administration is generally preferred in acute settings.

Dosage Adjustments

Dosage should be titrated based on the clinical response and monitored with regular check-ups.

Side Effects

Common Side Effects:

Nausea, vomiting, headache, rash, itching, injection site reactions (pain, redness, swelling), dizziness, gastrointestinal discomfort (diarrhea, flatulence).

Rare but Serious Side Effects:

Allergic reactions (difficulty breathing, hives, swelling), neuropathy (with high doses), liver damage (with high doses of nicotinamide).

Long-Term Effects:

Chronic complications from prolonged use are rare but potential long-term effects of high doses should be monitored.

Contraindications

• Hypersensitivity to any of the components.
• Leber’s hereditary optic neuropathy (with cyanocobalamin/methylcobalamin).

Drug Interactions

• Levodopa: Vitamin B6 may decrease its efficacy.
• Anticonvulsants: May reduce the absorption of some B vitamins.
• Certain antibiotics and chemotherapy drugs.
• Alcohol.
• Proton pump inhibitors.

Pregnancy and Breastfeeding

This combination is generally considered safe during pregnancy and breastfeeding at recommended dosages. However, consultation with a physician is essential.

Drug Profile Summary

• Mechanism of Action: Replenishes essential B vitamins, supporting nerve function, energy metabolism, and cellular health.
• Side Effects: Generally well-tolerated; may include injection site reactions, gastrointestinal discomfort, headache, dizziness, and allergic reactions.
• Contraindications: Hypersensitivity to any of the components, Leber’s hereditary optic neuropathy.
• Drug Interactions: Levodopa, anticonvulsants, certain antibiotics and chemotherapy drugs, alcohol, proton pump inhibitors.
• Pregnancy & Breastfeeding: Generally safe; consult a physician before use.
• Dosage: Varies significantly based on formulation, condition, and patient factors. See “Dosage” section for further details.
• Monitoring Parameters: Vitamin B levels, renal and hepatic function (especially for elderly patients or those with existing kidney/liver disease), blood counts.

Popular Combinations

This combination itself is a popular formulation of B vitamins. Sometimes it is combined with other vitamins and minerals.

Precautions

• Monitor for allergic reactions.
• Assess renal and hepatic function, especially in elderly patients or those with pre-existing conditions.
• Caution with high doses of nicotinamide in patients with liver disease.
• Avoid excessive alcohol intake, as it can interfere with B vitamin absorption and metabolism.
• In patients with kidney disorders, monitor for potential methylcobalamin accumulation.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for D-Panthenol + Methylcobalamin + Nicotinamide + Thiamine + Vitamin B6?

A: Dosage varies widely based on the specific formulation, indication, and patient-specific factors (age, weight, renal/hepatic function, etc.). Consult the specific product information and follow the prescribing physician’s instructions. Injectable preparations often contain 1000mcg Methylcobalamin, 100mg Thiamine HCl, 100mg Pyridoxine HCl, 100mg Nicotinamide, and 50mg D-Panthenol, given as one injection per day for severe deficiencies. Oral dosages vary.

Q2: Can this combination be used during pregnancy and breastfeeding?

A: It is generally considered safe at recommended doses, but always consult a physician before use during pregnancy or breastfeeding.

Q3: What are the common side effects?

A: Common side effects include nausea, vomiting, headache, rash, itching, injection site reactions, dizziness, and gastrointestinal discomfort.

Q4: Are there any serious side effects I should be aware of?

A: While rare, serious side effects include allergic reactions, neuropathy (with high doses), and liver damage (with excessive nicotinamide).

Q5: What are the contraindications for this combination?

A: Contraindications include hypersensitivity to any of the components and Leber’s hereditary optic neuropathy (with cyanocobalamin/methylcobalamin).

Q6: Does this combination interact with other medications?

A: Yes, potential interactions exist with levodopa, anticonvulsants, certain antibiotics and chemotherapy drugs, alcohol, and proton pump inhibitors. Provide a complete medication history to the prescribing physician.

Q7: How should I administer this combination?

A: The route of administration depends on the specific formulation. Injectable forms are administered intramuscularly or intravenously by a healthcare professional. Oral formulations are available as tablets, capsules, or liquids.

Q8: What should I monitor in patients receiving this combination?

A: Monitor vitamin B levels, renal and hepatic function, and watch for any signs of adverse effects. Regular blood count monitoring might be necessary.

Q9: Can this combination be used in children?

A: Yes, but pediatric dosing should be determined by a physician based on the child’s age, weight, and the specific deficiency being treated.

Q10: Are there any specific precautions for elderly patients?

A: Yes, elderly patients may require dosage adjustments due to decreased renal function. Close monitoring of renal function and potential drug interactions is essential.