Multivitamins with Minerals.

Vitamins are essential for maintenance of normal metabolic functions including hematopoiesis. The water-soluble vitamins play vital roles in the conversion of carbohydrate, protein and fat into tissue and energy. Thiamine (B1) acts as a coenzyme in carbohydrate metabolism. Riboflavin (B2) functions as a coenzyme in the electron transport system associated with conversion of tissue oxidations into usable energy. Niacin serves as a coenzyme in oxidation-reduction reactions in tissue respiration. Pantothenic Acid functions as a coenzyme in various metabolic acetylation reactions. They are essential to nucleic acid synthesis and normal maturation of red blood cells. The water-soluble vitamins (B-complex) are not significantly stored by the body; excess quantities are excreted in the urine. They must be replenished regularly through diet or other means to maintain essential tissue levels. Thus these vitamins are rapidly depleted in conditions interfering with their intake or absorption.

It is indicated for supportive nutritional supplementation when a water-soluble vitamin formulation is required therapeutically in patients who are undergoing treatment.

It is used in the treatment and prevention of vitamins deficiency. It is usually given by mouth, the preferred route, but may if necessary be administered by the intramuscular. In the treatment of mild chronic thiamine deficiency usual doses of 10 to 25 mg daily by mouth, in single or divided doses have been recommended. In sever thiamine deficiency doses up to 300 mg daily are given and even higher daily doses may be employed.

Folic acid is used in the treatment and prevention of the folate deficiency state. It does not correct folate deficiency due to dihydrofolate reductase inhibitors; calcium folinate is used for this purpose. Folic acid is also used in women of child-bearing potential and pregnant women to protect against neural tube defects in their offspring.

In simple deficiency states magnesium salts may be given by mouth in doses of up to 50 mmol of magnesium daily adjusted according to individual requirements. In acute or severe hypomagnesaemia, magnesium may be given parenterally most usually as the chloride or sulphate. Careful monitoring of plasma-magnesium and other electrolyte concentrations is essential. Doses should be reduced in renal impairment.

Zinc is an essential element of nutrition and traces are present in a wide range of foods. It is a constituent of many enzyme systems and is present in all tissues. Features of zinc deficiency include growth retardation and defects of rapidly-dividing tissues such as the skin, the immune system and the intestinal mucosa. Water soluble zinc salts are used as supplements to correct zinc deficiency.

Zinc sulphate is used topically in a variety of skin conditions mainly for its astringent properties. The insoluble zinc salts, commonly the oxide are used similarly. Zinc sulphate is also used as an astringent in eye drops.

Individual calcium salts have specific uses. Calcium carbonate or acetate are effective phsopahte binders and are given by mouth to reduce phosphate absorption from the gut in patients with hyperphosphataemia; this is particularly relevant to patients with chronic renal failure in order to prevent the development of renal osteodystrophy. The initial dose of calcium carbonate is 2.5 g daily titrated to a maximum of 17 g daily. The initial dose of calcium acetate is 3 or 4 g daily; most patients require 6 to 12 g daily.

Large doses of vitamins have been proposed for a variety of disorders, but adequate evidence of their value is lackin. Excessive intakes of most water-soluble vitamins have little effect due to their rapid excretion in urine, but excessive intakes of fat-soluble vitamins accumulate in the body and are potentially dangerous.

Adverse reactions have been reported with specific vitamins, but generally at levels substantially higher than those in relvit forte capsules.

However, allergic and idiosyncratic reactions are possible at lower levels.

Enteral nutrition. Reviewing the complications of enteral nutrition Bastow has noted that many of the problems encountered can be avoided by using a fine bore tube, administering the feed by continuous infusion and by careful monitoring of the patient for metabolic abnormalities.

Although diarrhea has been widely believed to be a common occurrence in patients receiving enteral nutrition it may not necessarily be caused by the tube feeding itself, concomitant drug therapy can often be implicated. However, enteral feding has been shown to be associated with increased colonic secretion, which can be reversed by infusion of short chain fatty acids.

General: Certain patients may require additional nutritional supplementation with fat-soluble vitamins and minerals according to the dietary habits of the individual. It is not intended for treatment of severe specific vitamin deficiencies.

Information for the Patient: Because toxic reactions have been reported with injudicious use of certain vitamins, urge patients to follow your specific instructions regarding dosage regimen.

It is contraindicated in patients known to be hypersensitive to any of its components.

Keep in cool, dry place and protect from moisture and light. Store at a temperature of 25°C.