Folic Acid + Niacinamide + Thiamine + Vitamin C

Usage

This combination of vitamins is primarily used to treat or prevent deficiencies in folic acid, niacinamide, thiamine, and vitamin C. It is classified as a vitamin supplement. It’s commonly prescribed during pregnancy (due to the importance of folic acid in preventing neural tube defects), in cases of malnutrition or malabsorption syndromes, alcoholism, or for individuals on restrictive diets. It may also be prescribed for patients with chronic renal failure to maintain sufficient vitamin levels. This combination is also marketed as a treatment for nutritional deficiencies and is used to treat conditions related to such deficiencies like anemia, pellagra, acne, diabetes, osteoarthritis, and migraines.

Alternate Names

There is no specific alternate name for this combination. The individual components are known as:

• Folic Acid: Folate, Vitamin B9
• Niacinamide: Niacin, Vitamin B3, Nicotinamide
• Thiamine: Thiamin, Vitamin B1
• Vitamin C: Ascorbic Acid

Some brand names for products containing this combination (or similar vitamin formulations with additional ingredients) include Nephro-Vite® RX, Nephrocaps, Nephrocaps-QT, Hylavite, DEXIFOL, and Cobarise-CZS.

How It Works

Pharmacodynamics:

• Folic acid, after conversion to its active form tetrahydrofolate (THF), acts as a coenzyme for DNA and RNA synthesis, amino acid metabolism, and red blood cell production.
• Niacinamide converts to NAD and NADP, coenzymes essential for cellular metabolism and energy production. It also has anti-inflammatory properties.
• Thiamine is crucial for carbohydrate metabolism, nerve function, and energy production, especially in the brain and muscles. It acts as a coenzyme for several essential enzymes.
• Vitamin C is an antioxidant that protects cells from damage, supports collagen synthesis, and enhances iron absorption. It also plays a role in immune function.

Pharmacokinetics:

These vitamins are primarily absorbed in the gastrointestinal tract. Folic acid is absorbed in the small intestine. Thiamine requires active transport for absorption. Niacinamide and Vitamin C are absorbed via passive diffusion in the small intestine. They are metabolized in the liver and other tissues, and excess amounts are primarily excreted in the urine.

Dosage

Standard Dosage

Adults:

Oral administration is typical, with one tablet daily or as directed by a physician. Dosages may vary based on the specific formulation. In some instances, two tablets per day might be prescribed. Intravenous or intramuscular administration may be necessary in cases of severe deficiency or malabsorption.

Children:

Dosing is dependent on age and weight and should be determined by a physician. Close monitoring is recommended. For children ages 2-18, a daily dose of 2 mL through parenteral administration might be prescribed, typically for a duration of two weeks. However, this can vary.

Special Cases:

• Elderly Patients: Dosage adjustments are usually not required unless renal impairment exists.
• Patients with Renal Impairment: Dose reduction may be necessary.
• Patients with Hepatic Dysfunction: Dose adjustment is generally not required.
• Patients with Comorbid Conditions: Conditions like diabetes should be monitored, as niacinamide can affect blood glucose levels.

Clinical Use Cases

Dosage in clinical settings like those listed below should be determined based on individual patient needs by a healthcare professional. There aren’t standard dosage guidelines for these specific clinical situations, as vitamin supplementation is considered supportive care rather than primary treatment.

• Intubation: Not typically indicated.
• Surgical Procedures: May be given pre- or post-operatively to address potential deficiencies or increased needs.
• Mechanical Ventilation: Not specifically indicated.
• Intensive Care Unit (ICU) Use: Dose may be adjusted based on the patient’s nutritional needs and status.
• Emergency Situations: Not typically a first-line treatment. Vitamin supplementation can help address any underlying deficiencies in emergency situations such as cardiac arrest, but dosage will be decided on a case-by-case basis. In a study on out-of-hospital cardiac arrest patients, 3 g ascorbic acid and 200 mg thiamine every 12 hours for 4 days was used. Standard intravenous vitamin C supplementation is allowed for up to 200 mg/day in such a setting.

Side Effects

Common Side Effects:

While generally well-tolerated, potential side effects can include abdominal cramps, nausea, diarrhea, irritability and yellow discoloration of urine.

Rare but Serious Side Effects:

Allergic reactions (e.g., skin rash, itching, swelling, severe dizziness, trouble breathing). High doses of niacinamide can cause liver problems.

Long-Term Effects:

Long-term use of high doses of certain B vitamins can lead to nerve damage. Chronic use of high doses of vitamin C can potentially increase the risk of kidney stones due to oxalate formation.

Contraindications

Contraindications include hypersensitivity to any component of the combination. Use cautiously in patients with severe liver or kidney disease.

Drug Interactions

• Niacinamide can interfere with anti-diabetic medications, potentially increasing blood sugar.
• Folic acid can interact with certain anticonvulsants.
• Some medications can affect the absorption or metabolism of B vitamins.

Pregnancy and Breastfeeding

This combination is generally considered safe during pregnancy and breastfeeding, especially at recommended dosages. Folic acid is essential for preventing neural tube defects. However, very high doses of any vitamin should be avoided unless specifically recommended by a physician.

Drug Profile Summary

• Mechanism of Action: Provides essential vitamins for metabolic processes, cellular function, and overall health.
• Side Effects: Generally well-tolerated; high doses may cause gastrointestinal upset, allergic reactions, or other specific vitamin-related side effects.
• Contraindications: Hypersensitivity.
• Drug Interactions: Certain anti-diabetic medications, anticonvulsants, and other drugs may interact.
• Pregnancy & Breastfeeding: Generally safe at recommended dosages.
• Dosage: Varies depending on age, condition, and formulation; usually once daily orally, or as directed by a physician.
• Monitoring Parameters: Monitor for signs of deficiency resolution or potential side effects. Monitor diabetic patients’ blood sugar levels, especially when starting or adjusting niacinamide dosage.

Popular Combinations

This combination is frequently found in multivitamin formulations with other B vitamins and sometimes other minerals.

Precautions

Pre-screening for allergies and monitoring for side effects are recommended. Adjust doses for renal impairment. Monitor diabetic patients’ blood glucose levels. Exercise caution in patients with existing liver or kidney conditions.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Folic Acid + Niacinamide + Thiamine + Vitamin C?

A: The dosage varies. Adults typically take one tablet daily, but this can change based on individual needs. A physician should determine pediatric dosages. Specific clinical cases and underlying medical conditions should be considered when determining dosages.

Q2: Can I take this combination if I am pregnant?

A: This combination is generally considered safe during pregnancy, especially at recommended dosages. Folic acid is crucial for preventing neural tube defects. Consult with your physician for appropriate dosage recommendations.

Q3: What are the common side effects?

A: Common side effects are generally mild and include abdominal cramps, nausea, diarrhea, and irritability. Yellowing of urine may occur, which is harmless and due to riboflavin.

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

A: While rare, serious side effects can include allergic reactions. High doses of niacinamide may cause liver problems. Consult a physician immediately if you experience any unusual or severe symptoms.

Q5: How does this combination interact with other medications?

A: Niacinamide can interact with anti-diabetic medications. Folic acid can interact with certain anticonvulsants. Inform your physician about all medications you are taking, including over-the-counter drugs and supplements, to avoid potential interactions.

Q6: Can I take this supplement if I have diabetes?

A: You can, but caution is advised. Niacinamide can affect blood glucose levels. Careful monitoring of blood sugar is essential, and adjustments to diabetes medications might be necessary. Consult with your physician before taking this combination if you have diabetes.

Q7: 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.

Q8: Can this combination treat anemia?

A: This combination can help prevent or treat certain types of anemia, particularly megaloblastic anemia caused by folic acid or vitamin B12 deficiency. However, anemia can have various underlying causes. A proper diagnosis is essential to determine the appropriate treatment approach.

Q9: What is the role of this combination in kidney disease?

A: Individuals with chronic kidney disease, especially those on dialysis, have increased needs for certain water-soluble vitamins and also experience losses of these vitamins during dialysis. This combination can help supplement those losses and prevent or treat deficiencies. The dosage may need adjustments depending on the stage of kidney disease.