Interacting drugs- summary

 Pyridoxine +

 Levodopa

decrease  pyridoxine reduces levodopas efficacy by increasing peripheral metabolism. Avoid vitamin supplementaion that contains > 5mg pyridoxine per daily dose

 Phenobarbital

 phenobarbital serum level decreased.

Phenytoin

phenytoin serum levels decreased.

Pyridoxine deficiency, inborn errors of metabolism.

Sensory neuropathy syndromes, unstable gait, numb feet, akwardness of hands,

perioral numbness, decreased sensationto touch,

temperature and vibration, parasthesia, somnolence, low serum folic acid levels.

Sensitivity to pyridoxine.

Special precautions:

Pyridoxine deficiency alone is rare.

Multi-vitamin deficencies can be expected in any inadequate diet.

Some drugs may result in increased pyridoxine requirements-cyclosporine, hydralysine, oralcontrceptives and penicillamine.

Abuse and dependence have been noted in adults given 200mg/day followed by withdrawal

. Drug abuse and dependence- noted in adults withdrawn from 200mg/day

Warnings-

Pregnancy- Pyridoxine requirements are increased during pregnancy and lactation. Pyridoxine may inhibit lactation by prolactin suppression

Children- Safety and efficacy have not been established for use in children

Indications:

Pyridoxine deficiency, inborn errors of metabolism.

Dosage:

Preferably taken with meals

10 to 20mg daily for 3 weeks.

Overdosage- Symptoms

Ataxia and severe sensory neuropathy occured in patients who had consumed (50mg to 2g) over a long period of time

Treatment

1. When pyridoxine is discontinued symptoms will lessen.

2. It may take 6 months for sensation to normalise

Missed dose

1. If you miss taking a vitamin for 1 or more days there is no cause for concern, since it takes some time for your body to become seriously low in vitamins

2. However, if your health care professional has recommended that you take this vitamin, try to remember to take it as directed every day.  to your regular dosing schedule

 3. Do not double doses.

ANTIOXIDANTS AND METHYLATING AGENTS

Folic acid, pyridoxine, cyanocobalamin Folic acid is esstential for cell replication and growth. It is required for the synthesis for DNA proteins, RBCs and for energy production

Pyridoxine (Vitamin B6) functions as a co-enzyme in synthesis of haeme, neurotransmitters and nucleic acid.

Cynanocobalamin (vitamin B-12) acts as a co-factor in the conversion of methylmalonyl-co A to succinyl-coA in homocysteine metabolism, the B-vitamin folate, B-12 and B-6 function as essential cofactors and coenzymes in regulating the remethylation and trans-sulfuration pathways.

Studies show that a good number of the adult population are deficient in these three vitamins.

Choline Choline is required for the synthesis of phospholipids, phosphatidyl choline and spingomycetin -the structural components for all human cell membranes. Choline is a precursor for acetylcholine, an important neurotransmitter involved in muscle control, memory and many other functions.

Betaine, a derivative of choline is a source of methyl groups required for methylation reactions. Methyl groups from betaine may be used to convert homocysteine to methionine. The role of choline in methylation probably explains the finding that choline-deficient diets are associated with an increased rate of cancer in animal studies.

Choline have a beneficial role in neurodegenerative disorders. Methionine It is an essential amino acid and a principal supplier of sulfur, which prevents disorders of the hair, skin and nails. It also helps in lowering the cholesterol levels by increasing the hepatic production of lecithin.

It also reduces hepatic fat, protects the kidneys, regulates the formation of ammonia, influences hair follicles and promotes hair growth. It is a natural chelating agent for heavy metals.

Lycopene It is a potent antioxidant carotenoid present in tomatoes. It s supplementation has been shown to be associated with a decreased risk of cardiac disease, cancer of the prostrate, breast, lung, colon, endometrium and cervix Vitamin C It is a water soluble antioxidant that scavenges superoxide, hydroxyl radicals and single oxygen.

It protects against cancer cell growth by destroying free radicals, increasing collagen synthesis, altering DNA and protein metabolism preventing transformation of precancerous cells to cancerous cells and producing cytotoxicity in cancer cells In epidemological studies,

Vitamin C has been shown to have a protective effect in preventing and treating oesophageal , oral pharyngeal, stomach, lung, cervical, rectal, colon, and pancreatic cancer.

In addition, supplementation with the combination of Vitamin C and Vitamin E has shown to slow down artherosclerotic progression in hypercholesterolemic persons. Vitamin E It helps to prevent oxidation of ployunsaturatted fatty acids and fat soluble vitamins in the body and stimulates the immune system to destroy tumor cells as they are transformed to cancerous state.

It has been shown to prevent cancer and cardiovascular disease. It also aids in normal blood clotting and healing. Vitamin E intake from food or supplements is also associated with less congnitive decline with age and may have an important role in neurodegenerative disorders.

Selenium Se;enium acts as an antioxidant by activating the enzyme glutathione peroxidase. People living in areas with selenium -poor soils are found to have higher cancer rates than those living in selenium-rich soils areas. Red bush tea extract Also known as Rooibos tea extract, it is caffeine free and has a low tannin content. It is highly defensive natural antioxidant including falvanoids.

Because of its contents, it may be antiaging, particularly in preventing age-related byproduts of oxidaton of the brain. It was shown to inhibit the cancer causing- causing effect of X_Rays in test animals. It has also been successfully used in the management of various dermatolgical conditions.

Containdications:

Hypersensitivity to any ingredients

Precautions:

Urine may give a false positive result by Benedicts test because of the presence of absorbic acid (Vitamin C) Summary Oxidative damage and antioxidant deficiency impacts on wide range of human diseases. Several studies show that antioxidants like Vitamin C,

Vitamin E, Selenium, carotenoids and methylating agents like the B-group Vitamins and choline have a beneficial effect in the prevention of chronic diseases Thus the combination of these nutrients may help prevent a host of diseases including cancer, cardiovascular disease and other chronic diseases.

Pharmacology:

Vitamin B6 activity in natural substances, pyridoxine in plants, and pyridoxal or pyridoxamine in animals are converted to physiologically active forms of Vitamin B6, pyridoxal phosphate (codecarboxylase) and pyridoxamine phosphate. Vitamin B6 acts as a coenzyme in the metabolism of proteins, carbohydrates and fats.

Pharmcokinetics:

Pyridoxine is readily absorbed from GI tract. Its biological half-life appears to be 15 to 20 days. Vitamin B6 is degraded to 4-hydroxic acid in the liver. The metabolite is excreted in the urine.

Preferably taken with meals

Pregnancy-

Pyridoxine requirements are increased during pregnancy and lactation. Pyridoxine may inhibit lactation by prolactin suppression

Children-

Safety and efficacy have not been established for use in children