Medivitan

Medivitan®

The drug contains a complex of B vitamins, which take part in the process of hematopoiesis and are necessary for the normal functioning of the nervous and other tissues, organs and systems of the body.

The vitamins included in the composition: pyridoxine (B6), cyanocobalamin (B12) and folic acid (B9) regulate protein, carbohydrate and fat metabolism, contribute to their normalization, improve the function of motor, sensory and autonomic nerves.

Pyridoxine (vitamin B6) entering the body is phosphorylated, converted into pyridoxal-5-phosphate and is part of enzymes that carry out decarboxylation, transamination and racemization of amino acids, as well as the enzymatic conversion of sulfur-containing and hydroxylated amino acids. Participates in tryptophan metabolism (participation in the reaction of serotonin biosynthesis). Isolated pyridoxine deficiency is very rare, mainly in children on special artificial nutrition.

Cyanocobalamin (vitamin B12) in the body (mainly in the liver) is converted into methylcobalamin and 5-deoxyadenosylcobalamin. Methylcobalamin is involved in the conversion of homocysteine to methionine and S-adenosylmethionine - key reactions in the metabolism of pyrimidine and purine bases, and therefore deoxyribonucleic (DNA) and ribonucleic (RNA) acids. If there is insufficiency of the vitamin in this reaction, it can be replaced by methyltetrahydrofolic acid, and folate-requiring metabolic reactions are disrupted. 5-deoxyadenosylcobalamin serves as a cofactor in the isomerization of L-methylmalonyl-CoA to succinyl-CoA, an important reaction in carbohydrate and lipid metabolism. Vitamin B12 deficiency leads to impaired proliferation of rapidly dividing cells of hematopoietic tissue and epithelium, as well as impaired formation of the myelin sheath of neurons.

Folic acid (vitamin B9) is not synthesized in the human body; comes with food and is produced by normal intestinal microflora. It is a precursor of tetrahydrofolic acid, which participates as a cofactor in enzyme systems that transfer one-carbon fragments (in the form of methyl, methylene, formyl or methenyl groups) in a number of nucleotide and amino acid exchange reactions. Plays an important role in regulating the processes of proliferation, differentiation and maturation of cells, including erythropoiesis and embryogenesis.

Medivitan 4ml 1ml amp. 8pcs/pack - Instructions

Compound

Active ingredients: pyridoxine hydrochloride, cyanocobalamin and folic acid.
Other ingredients: sodium chloride, sodium hydroxide, water for injection.

Release form

Solution for injections I: clear red liquid in a 5 ml ampoule.

Solution for injection II: transparent yellow liquid in a 2 ml ampoule.

1 package contains 8 burst ampoules with 4 ml of solution for injection I and 1 ml of solution for injection II.

pharmachologic effect

Vitamin B6 in its phosphorylated form (pyridoxal 5-phosphate, PALP) is a coenzyme for a large number of enzymes that are involved in all non-oxidative amino acid metabolism. Vitamin B6 interferes with tryptophan metabolism at various stages. As part of the synthesis of red blood pigment, vitamin B6 catalyzes the formation of a-amino-ß-ketoadipic acid.

Folic acid is effective in its reduced form as tetrahydrofolic acid and as a carrier of Q-groups. Thus, folic acid is central to the intermediary metabolism of all living cells.

Cyanocobalamin, a derivative of vitamin B12 that comes as a prodrug, must first be converted into its coenzymes methylcobalamin and 5-deoxyadenosylcobalamin, which are effective in humans. Methylcobalamin is necessary for the formation of methionine from homocysteine. During the methylation of homocysteine to methionine, free tetrahydrofolic acid is formed from 5-methyltetrahydrofolic acid, from which “activated Q-units” arise after Q-transfer of serine. They are important for the biosynthesis of purine bases and deoxyribonucleic acid, for example in the context of hematopoiesis. 5-Deoxyadenosylcobalamin is required for the conversion of methylmalonyl coenzyme A to succinyl coenzyme A. The absence leads to increased levels of propionic acid and methylmalonic acid, which are the causes of the formation of abnormal fatty acid chains.

Tetrahydrofolic acid from 5-methyl-tetrahydrofolic acid becomes available for the synthesis of the stored folate polyglutamate compound. Another consequence is limited transfer of the forminino group of forminoglutamic acid from tetrahydrofolic acid, so that more forminoglutamic acid (FIGLU) is excreted in the urine.

Pharmacokinetics

Vitamin B12 is absorbed in two ways:

1. Vitamin B12 is actively absorbed in the small intestine in a form associated with intrinsic factor. Transport of vitamin B12 into tissue occurs due to the accumulation of transcobalamins, substances from a number of plasma beta globulins.

2. Regardless of the intrinsic factor, the vitamin can also enter the bloodstream by passive diffusion through the gastrointestinal tract or mucous membranes.

50 to 90% of a 0.1 to 1 mg intramuscular or intravenous dose of cyanocobalamin is excreted in the urine within 48 hours, and is excreted in the urine even more quickly after intravenous administration.

When taking 1.5 mg of monosodium folic acid, maximum serum concentrations are achieved within the first hour. The subsequent drop in concentration occurs quickly, so that the baseline values are again reached after 12 hours. After parenteral administration, approximately 80% is excreted through the kidneys during the first 6 hours and another 17% over the next 4 hours.

Pyridoxine, pyridoxal and pyridoxamine are rapidly absorbed, mainly in the upper gastrointestinal tract, and are eliminated from the body within 2–5 hours. The main excretion product is 4-pyridoxic acid.

Indications for use

The medication is used in cases of deficiency of vitamin B6, vitamin B12 and folic acid (B9, B11), which cannot be replenished only with an appropriate diet.

Contraindications

allergy to the composition;
inflammatory tissue change in the injection area;
megaloblastic anemia as a result of isolated vitamin B12 deficiency, isolated folic acid deficiency.

Side effects

Drug reactions associated with acne, eczema and urticaria, as well as anaphylactic and anaphylactoid reactions, have been very rarely reported with parenteral administration of cyanocobalamin.

In addition, in rare cases, allergic hypersensitivity reactions (skin reaction, urticaria, shock) to folic acid may occur.

Sometimes local intolerance may occur. In high doses, folic acid can cause gastrointestinal problems.

Drug interactions

Therapeutic doses of pyridoxine hydrochloride may reduce the effects of L-dopa. There are interactions with INH, D-penicillamine, cycloserine.

The effect of folic acid antagonists can be reduced or even reversed by using a Medivitan iV pre-filled syringe.

Application and dosage

Unless otherwise indicated, a prefilled syringe dose of Medivitan IV should be administered intramuscularly or intravenously twice weekly and this therapy should be continued for 4 weeks (total of 8 injections).

In case of impaired intestinal absorption, a pre-filled syringe of Medivitan iV should be administered intramuscularly or intravenously at intervals of 4 weeks.

Folic acid should be given orally daily between injections.

Overdose

To date, no cases of intoxication have been reported.

special instructions

The Medivitan iV prefilled syringe contains sodium, but each 5 mL of prepared injection solution contains less than 1 mmol (23 mg) of sodium.

Use during pregnancy and breastfeeding

Use is allowed only if there are strict indications.

Impact on the ability to drive vehicles and operate machinery

No special precautions are required.

Terms of sale

As prescribed by a doctor.

Storage conditions

The medication must be stored in a dark place out of reach of children.

The preparation contains a complex of B vitamins (pyridoxine (B6), cyanocobalamin (B12) and folic acid (B9)), which take part in the process of hematopoiesis and are necessary for the normal functioning of the nervous and other tissues, organs and systems of the body. They regulate protein, carbohydrate and fat metabolism, contribute to their normalization, improve the function of motor, sensory and autonomic nerves.

Pyridoxine (vitamin B6), entering the body, is phosphorylated, converted into pyridoxal-5-phosphate and is part of enzymes that carry out decarboxylation, transamination and racemization of amino acids, as well as the enzymatic conversion of sulfur-containing and hydroxylated amino acids. Participates in tryptophan metabolism (participation in the reaction of serotonin biosynthesis). Isolated pyridoxine deficiency is very rare, mainly in children on special artificial nutrition.

Cyanocobalamin (vitamin B12) in the body (mainly in the liver) is converted into methylcobalamin and 5-deoxyadenosylcobalamin. Methylcobalamin is involved in the conversion of homocysteine to methionine and S-adenosylmethionine - key reactions in the metabolism of pyrimidine and purine bases, and therefore deoxyribonucleic (DNA) and ribonucleic (RNA) acids. If there is insufficiency of the vitamin in this reaction, it can be replaced by methyltetrahydrofolic acid, which disrupts metabolic reactions in which the participation of folic acid is required. 5-deoxyadenosylcobalamin serves as a cofactor in the isomerization of L-methylmalonyl-CoA to succinyl-CoA, an important reaction in carbohydrate and lipid metabolism. Vitamin B12 deficiency leads to impaired proliferation of rapidly dividing cells of hematopoietic tissue and epithelium, as well as impaired formation of the myelin sheath of neurons.

Medivitan instructions for use of the drug

Pyridoxine (vitamin B6) entering the body, it is phosphorylated, converted into pyridoxal-5-phosphate and is part of enzymes that carry out decarboxylation, transamination and racemization of amino acids, as well as the enzymatic conversion of sulfur-containing and hydroxylated amino acids. Participates in tryptophan metabolism (participation in the reaction of serotonin biosynthesis). Isolated pyridoxine deficiency is very rare, mainly in children on special artificial nutrition.

Cyanocobalamin (vitamin B12) in the body (mainly in the liver) is converted into methylchobalamin and 5-deoxyadenosylcobalamin. Methylcobalamin is involved in the conversion of homocysteine to methionine and S-adenosylmethionine - key reactions in the metabolism of pyrimidine and purine bases, and therefore deoxyribonucleic (DNA) and ribonucleic (RNA) acids. If there is insufficiency of the vitamin in this reaction, it can be replaced by methyltetrahydrofolic acid, and folate-requiring metabolic reactions are disrupted. 5-deoxyadenosylcobalamin serves as a cofactor in the isomerization of L-methylmalonyl-CoA to succinyl-CoA, an important reaction in carbohydrate and lipid metabolism. Vitamin B12 deficiency leads to impaired proliferation of rapidly dividing cells of hematopoietic tissue and epithelium, as well as impaired formation of the myelin sheath of neurons.