Usage
This combination of vitamins is prescribed for the prevention and treatment of vitamin deficiencies. These deficiencies can occur due to inadequate dietary intake, malabsorption syndromes, increased metabolic demands (e.g., during pregnancy, breastfeeding, or periods of rapid growth), certain medical conditions, or prolonged use of some medications. This combination is particularly important for patients receiving parenteral nutrition (intravenous feeding).
This formulation isn’t classified under a single pharmacological category. It’s considered a multivitamin supplement composed of essential nutrients with diverse functions.
The mechanism of action involves providing the body with essential vitamins that play crucial roles in various metabolic processes, including: energy production, cell growth and repair, immune function, bone health, and antioxidant defense.
Alternate Names
This combination is generally referred to by its component vitamins. Some alternate names include “Multivitamin Infusion,” “Multiple Vitamins for Infusion,” or simply a “Combination of vitamins A, D3, C, B1 (Thiamine), and B5 (D-Panthenol/dexpanthenol).” Brand names vary depending on the manufacturer and region. Some examples include (but are not limited to): L Vit MVI Injection, Multivitamin Injection, NL-Vit Injection, and Tilvit Injection.
How It Works
Pharmacodynamics:
- Vitamin A (Retinol, Palmitate): Essential for vision, cell growth and differentiation, immune function, and reproduction. It acts as a retinoid receptor agonist.
- Vitamin D3 (Cholecalciferol): Regulates calcium and phosphorus homeostasis, crucial for bone health, immune function, and cell growth. It acts by binding to the vitamin D receptor.
- Vitamin C (Ascorbic Acid): Antioxidant, cofactor in collagen synthesis, and supports immune function.
- Thiamine (Vitamin B1): Essential for carbohydrate metabolism, nerve function, and muscle function. It acts as a coenzyme in crucial metabolic pathways.
- D-Panthenol (Provitamin B5): Converted to pantothenic acid (Vitamin B5) in the body, essential for energy metabolism (coenzyme A synthesis) and hormone production.
Pharmacokinetics:
- Absorption: Varies depending on the vitamin and the route of administration (oral or intravenous). Intravenous administration bypasses absorption and delivers the vitamins directly into the bloodstream.
- Metabolism: Primarily in the liver, although some vitamins undergo minimal metabolism.
- Elimination: Through renal (urine) and hepatic (bile) pathways. Fat-soluble vitamins (A, D, E, and K) are stored in the liver and adipose tissue and eliminated more slowly than water-soluble vitamins (C and B vitamins).
Mode of Action (Cellular/Molecular Level):
These vitamins exert their effects through various mechanisms, including receptor binding (Vitamins A and D), acting as coenzymes in crucial metabolic pathways (Thiamine and Pantothenic Acid), and directly participating in biochemical reactions (Vitamin C).
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation:
- Vitamin A binds to retinoid receptors.
- Vitamin D binds to the vitamin D receptor.
- Other vitamins in this combination primarily function as coenzymes or antioxidants rather than directly interacting with receptors or modulating neurotransmitters.
Dosage
The dosage varies depending on the patient’s age, specific vitamin deficiencies, overall health status, and other medications. Always consult clinical guidelines and tailor the dosage to the individual patient.
Standard Dosage
Intravenous administration is standard for this combination, especially in patients receiving parenteral nutrition.
Adults:
The standard daily dosage is often 10 mL of the combined solution (after appropriate reconstitution and dilution as per product instructions), administered intravenously. For patients with increased requirements, multiples of the daily dosage may be administered for a short period, with careful monitoring.
Children:
Pediatric dosing is weight-based. Please consult specialized pediatric resources or the specific product’s package insert for precise weight-based dosing guidelines.
Special Cases:
- Elderly Patients: No specific dose adjustments are generally required based solely on age, but closely monitor for any underlying medical conditions influencing vitamin metabolism.
- Patients with Renal Impairment: Individualized dosing is required. Consider reducing the dosage or frequency based on the degree of impairment. Closely monitor vitamin levels.
- Patients with Hepatic Dysfunction: Individualized dosing is needed. Exercise caution, particularly with fat-soluble vitamins, due to the risk of accumulation and toxicity. Close monitoring is essential.
- Patients with Comorbid Conditions: Assess for potential drug interactions and modify the dosage as needed.
Clinical Use Cases
The dosage in specific clinical scenarios should be guided by the patient’s individual needs and clinical status. Consult clinical guidelines or specialized resources for precise recommendations regarding intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations.
Dosage Adjustments
Dose modifications are based on patient-specific factors like renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Therapeutic drug monitoring of vitamin levels is especially crucial for patients receiving long-term parenteral nutrition.
Side Effects
This combination is generally well-tolerated. However, potential side effects include:
Common Side Effects:
Injection site reactions (pain, redness, swelling) are possible with intravenous administration.
Rare but Serious Side Effects:
Allergic reactions, although rare, can occur following intravenous administration. Hypervitaminosis (vitamin toxicity), especially with fat-soluble vitamins A and D, is a concern with prolonged use or high dosages.
Long-Term Effects:
Long-term use can potentially lead to hypervitaminosis if not closely monitored, especially in patients with impaired excretion.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis) are rare but require immediate intervention.
Contraindications
- Known hypersensitivity to any component of the multivitamin formulation.
- Pre-existing hypervitaminosis of any of the vitamins in the combination.
- It’s contraindicated prior to blood sampling for the diagnosis of megaloblastic anemia, as some vitamins (like B12 and folate) in the combination may mask serum deficits.
Drug Interactions
- Vitamin K: Can interact with warfarin, reducing its anticoagulant effect. Monitor INR closely.
- Certain antibiotics: Can interact with individual vitamins, affecting their absorption or effectiveness. Consult drug interaction resources.
- Other medications: Each vitamin component has its own potential drug interactions. Consult comprehensive drug interaction resources.
- Alcohol, smoking, and certain foods: Can affect vitamin absorption and metabolism.
Pregnancy and Breastfeeding
Pregnant and breastfeeding women have increased vitamin requirements. Consult clinical guidelines for appropriate vitamin supplementation during these periods. While generally considered safe at recommended doses, excessive intake of fat-soluble vitamins (especially vitamin A) should be avoided.
Drug Profile Summary
- Mechanism of Action: See “How It Works” section.
- Side Effects: Generally well-tolerated; see “Side Effects” section.
- Contraindications: Hypersensitivity, hypervitaminosis.
- Drug Interactions: Consult drug interaction resources for specifics.
- Pregnancy & Breastfeeding: Consult clinical guidelines for appropriate supplementation.
- Dosage: Variable depending on individual needs and product formulation; see “Dosage” section.
- Monitoring Parameters: Monitor vitamin levels (especially fat-soluble vitamins) during long-term use and in patients with impaired renal or hepatic function.
Popular Combinations
This combination of vitamins A, D3, C, B1, and B5 is frequently found in multivitamin formulations.
Precautions
- Screen for allergies, metabolic disorders, and organ dysfunction before initiating therapy.
- Pregnant Women: Avoid excessive vitamin A intake.
- Breastfeeding Mothers: Ensure appropriate supplementation without exceeding recommended doses.
- Children & Elderly: Use weight-based dosing for children and monitor elderly patients for underlying conditions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for D-Panthenol + Thiamine + Vitamin A + Vitamin C + Vitamin D3?
A: The dosage is patient-specific. The standard adult dose is often 10 mL of the combined solution (after reconstitution and dilution as directed), administered intravenously. Pediatric doses are weight-based. Consult clinical guidelines and the specific product information.
Q2: How should this multivitamin be administered?
A: Intravenous infusion is the standard route of administration, particularly in patients receiving parenteral nutrition. Follow the reconstitution and dilution instructions provided with the specific product.
Q3: What are the primary indications for this multivitamin combination?
A: Prevention and treatment of vitamin deficiencies due to various factors like inadequate dietary intake, malabsorption, increased metabolic demands, or certain medical conditions.
Q4: Are there any contraindications to using this multivitamin?
A: Yes. Contraindications include hypersensitivity to any component, pre-existing hypervitaminosis, and prior to blood sampling for megaloblastic anemia diagnosis.
Q5: What are the key drug interactions to be aware of?
A: Vitamin K can interact with warfarin. Certain antibiotics can also interact with individual vitamins. Consult a comprehensive drug interaction resource for details.
Q6: Can this combination be used during pregnancy and breastfeeding?
A: Yes, but consult clinical guidelines for appropriate dosing. Avoid excessive vitamin A intake.
Q7: What are the most important monitoring parameters?
A: Monitor plasma vitamin levels, especially fat-soluble vitamins (A, D, E), during long-term use and in patients with renal or hepatic impairment.
Q8: What are potential long-term adverse effects?
A: Hypervitaminosis, particularly of fat-soluble vitamins, can occur with prolonged or excessive use. Regular monitoring is essential.
Q9: What are the symptoms of hypervitaminosis A and D?
A: Hypervitaminosis A can manifest as nausea, vomiting, headache, blurred vision, and liver damage. Hypervitaminosis D can cause hypercalcemia, leading to nausea, vomiting, constipation, and kidney stones.
Q10: Can this combination be used in patients with renal or hepatic impairment?
A: Yes, but dosage adjustments are usually necessary. Closely monitor vitamin levels and exercise caution with fat-soluble vitamins. Individualized dosing based on the degree of impairment is required.
