Dextrose + Nicotinamide + Pyridoxine Hydrochloride + Thiamine + Vitamin B2 + Vitamin C

Usage

This combination, often referred to as a high-potency B vitamin with vitamin C and dextrose or a vitamin cocktail, is prescribed for treating and preventing vitamin deficiencies. These deficiencies primarily involve B vitamins (thiamine (B1), riboflavin (B2), pyridoxine (B6), and nicotinamide (B3)), vitamin C, and situations requiring supplemental glucose. It is beneficial for patients with impaired gastrointestinal absorption, severe deficiencies, receiving parenteral nutrition, pre- and post-operatively, during prolonged illness, burn patients, and those struggling with alcoholism.

Its pharmacological classifications include water-soluble vitamin supplement and nutrient replenisher.

The mechanism of action involves providing essential coenzymes and cofactors for metabolic processes like carbohydrate metabolism, energy production, neurotransmitter synthesis, and red blood cell formation. Vitamin C acts as an antioxidant, promotes collagen synthesis, enhances iron absorption, and supports immune function. Dextrose provides an immediate energy source.

Alternate Names

This combination may be referred to as high-potency B vitamins with vitamin C and dextrose, vitamin B-complex with vitamin C and glucose, or simply as a vitamin cocktail. Brand names may vary regionally.

How It Works

Pharmacodynamics: This combination replenishes essential vitamins and glucose. Thiamine, Riboflavin, Pyridoxine, and Nicotinamide are crucial for cellular function, energy production, and nerve function. Vitamin C acts as an antioxidant and is essential for collagen synthesis and immune function. Dextrose offers an immediate energy source.

Pharmacokinetics: When administered intravenously, the components are directly absorbed into the bloodstream. B vitamins are metabolized in the liver. Thiamine is converted to its active form, thiamine pyrophosphate (TPP). Riboflavin transforms into flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Pyridoxine becomes pyridoxal 5’-phosphate (PLP). Nicotinamide is a component of NAD and NADP. Vitamin C doesn’t require significant metabolism. Dextrose is rapidly utilized for energy. Elimination occurs primarily via renal excretion.

Dosage

Standard Dosage

Adults: A single dose vial containing specified amounts of each vitamin is diluted in a compatible intravenous solution (e.g., 5% dextrose or 0.9% sodium chloride) for infusion. The volume can vary (e.g., 500-1000 mL) and depends on the specific product formulation and the severity of the deficiency.

Children: Pediatric dosing should be individualized based on weight or age and the specific product formulation. Consult pediatric dosing guidelines and consider the potential for fluid overload.

Special Cases:

• Elderly Patients: Adjust based on renal function and overall clinical status.
• Patients with Renal Impairment: Dose modifications are essential considering the clearance rate.
• Patients with Hepatic Dysfunction: Adjustments are needed for impaired metabolism.
• Patients with Comorbid Conditions: Evaluate potential interactions and adjust accordingly.

Clinical Use Cases

Dosing is product-specific and should follow established guidelines for each clinical setting:

• Intubation: Use as per established protocols for vitamin supplementation during critical care.
• Surgical Procedures: Administer as per peri-operative protocols for nutritional support.
• Mechanical Ventilation: Dosage should align with critical care guidelines for multivitamin supplementation.
• Intensive Care Unit (ICU) Use: Refer to ICU protocols for multivitamin and dextrose administration.
• Emergency Situations: Follow established guidelines for specific situations.

Dosage Adjustments:

Dose modifications are necessary for patients with renal/hepatic dysfunction, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Monitor for efficacy and adverse effects to adjust the dosage.

Side Effects

Common Side Effects:

Infusion site reactions (pain, swelling), mild nausea, flushing.

Rare but Serious Side Effects:

Allergic reactions (anaphylaxis, rash), hypotension.

Long-Term Effects:

Long-term high doses of certain vitamins can potentially lead to hypervitaminosis. Regular monitoring of vitamin levels is recommended.

Adverse Drug Reactions (ADR):

Anaphylaxis, severe hypersensitivity reactions require immediate medical attention.

Contraindications:

Hypersensitivity to any component. Pre-existing hypervitaminosis of any of the vitamins in the formulation.

Drug Interactions:

• Pyridoxine can interfere with levodopa.
• Certain antibiotics (e.g., erythromycin, kanamycin) may have reduced effectiveness with some of the vitamins in this combination.
• Alcohol can exacerbate thiamine deficiency.

Pregnancy and Breastfeeding:

Consult the pregnancy safety guidelines for specific products. Generally, the combination can be used if clinically indicated, but the potential benefits must outweigh the potential risks. Monitor vitamin levels closely.

Drug Profile Summary

• Mechanism of Action: Provides essential vitamins for metabolic processes, antioxidant action (vitamin C), and immediate energy (dextrose).
• Side Effects: Infusion site reactions, mild nausea, flushing (rarely: allergic reactions, hypotension).
• Contraindications: Hypersensitivity, hypervitaminosis.
• Drug Interactions: Levodopa, certain antibiotics, alcohol.
• Pregnancy & Breastfeeding: Use cautiously if clinically indicated.
• Dosage: Product specific, adjusted based on patient needs and clinical context.
• Monitoring Parameters: Vitamin levels, renal function (especially for long-term use).

Popular Combinations:

Often used as part of parenteral nutrition regimens containing electrolytes, amino acids, and lipids.

Precautions

• General Precautions: Monitor patients for allergic reactions, especially with IV administration.
• Specific Populations: Consult specific guidelines for pregnant/breastfeeding women, children, and the elderly.
• Lifestyle Considerations: Advise patients about potential interactions with alcohol.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Dextrose + Nicotinamide + Pyridoxine Hydrochloride + Thiamine + Vitamin B2 + Vitamin C?

A: The dosage varies based on the specific product, patient’s age, weight, and clinical condition. It is crucial to consult the specific product’s prescribing information for detailed dosage recommendations.

Q2: How should this combination be administered?

A: It’s primarily administered intravenously, diluted in a compatible solution.

Q3: What are the common side effects?

A: Common side effects include infusion site reactions, mild nausea, and flushing.

Q4: Are there any specific contraindications?

A: Yes, contraindications include known hypersensitivity to any component and pre-existing hypervitaminosis.

Q5: What are the important drug interactions to consider?

A: Significant interactions may occur with levodopa and certain antibiotics.

Q6: Can this combination be used in pregnant or breastfeeding women?

A: It can be used if clinically indicated, but caution is advised. Consultation with a specialist is essential.

Q7: How should vitamin levels be monitored in patients receiving this combination?

A: Regular blood tests to assess vitamin levels are recommended, especially during long-term administration. The frequency of monitoring depends on the clinical context.

Q8: What precautions are necessary for elderly patients?

A: Assess renal function and consider any other comorbidities before and during treatment. Dosage adjustment may be needed.

Q9: What is the role of dextrose in this combination?

A: Dextrose provides a readily available source of energy, which can be particularly important in patients with malnutrition or those who are unable to take oral nutrition.