Supplement, multivitamin

The primary uses of pyridoxine hydrochloride are in multivitamin supplement tablets and for fortification of human food and animal feed, especially for poultry and pigs. Most breakfast cereals and infant formulas in the United States are supplemented. Lesser amounts are used therapeutically to correct deficiencies or to treat specific disorders. Pyridoxine hydrochloride has been used experimentally to treat a variety of conditions with varying degrees of effectiveness (4,23). Pyridoxine hydrochloride is readily incorporated into premixes and foods. 

If your patient with parkinsonism is taking levodopa, he must be careful to avoid vitamin B6 (pyridoxine) because it may interfere with the therapeutic effects of the drug. Most multivitamin supplements contain vitamin B6. Therefore, be sure to instruct your patient to check with his health care provider before taking any vitamin supplements. 

One other study deserves a mention. The Cancer Prevention Study 11 was a prospective investigation using a very large cohort of over one million adult Americans, in which the effects of commercial multivitamin supplements and vitamins A, C or E on mortality were studied, during a follow-up period of seven years. The results were complex in that the use of multivitamins plus vitamins A, C and/or E significantly reduced the risk of lung cancer in both former smokers and life-long non-smokers, but vitamins A, C and E apparently increased the risk in current smokers. 

When the alcoholic first presents for treatment, his/her nutritional status should be fully assessed. Vitamin supplementation should always be a component of this treatment. In the emergency room setting, the alcoholic patient usually receives intravenous fluids containing magnesium, thiamine, and multivitamin supplements. The yellow-colored fluid is commonly called a banana bag or rally pack. A daily... 

Vitamin supplement Counsel patients to take a multivitamin supplement that contains fat-soluble vitamins to ensure adequate nutrition because orlistat reduces the absorption of some fat-soluble vitamins and beta-carotene. Instruct patients to take the supplement once a day at least 2 hours before or after the administration of orlistat, such as at bedtime. 

A daily multivitamin supplement may prevent reduction in serum levels of vitamins D, E, K, and folic acid... 

Replenish other vitamin stores with folate, B-complex, and multivitamin supplements. 

Vitamins and minerals (micronutrients) help to regulate your metabolism. They are the building blocks of blood and bone, and they maintain muscles and nerves. In Canada, a standard called Recommended Nutrient Intake [RNI] outlines the amounts of micronutrients that people should ingest each day. Eating a balanced diet is the best way to achieve your RNI. Sometimes, however, you may need to take multivitamin supplements when you are unable to attain your RNI through diet alone. 

Patients should be advised to rest and to avoid extreme heat. They should be warned that symptoms may be aggravated by illness, stress, malnutrition, pain, or surgery. Various drugs have been shown to worsen symptoms of myasthenia gravis. These include the aminoglycoside antibiotics such as tobramycin, gentamicin, and neomycin tetracyclines such as doxycycline and minocycline class 1 antiarrhythmics such as lidocaine, quinidine, and procainamide magnesium in calcium and multivitamin supplements beta-blockers such as timolol and propranolol calcium channel blockers such as verapamil and penicillamine. 

Werler MM, Cragan JD, Wasserman CR, Shaw GM, Erickson JD, Mitchell AA. Multivitamin supplementation and multiple births. Am J Med Genet 1997 71(l) 93-6. 

It is estimated that the minimum daily requirement of folate is 5 micrograms/kg. Liver stores are about 160 micrograms in premature children, and 220 micrograms in full-term infants. Infants who require parenteral nutrition will rapidly become folate deficient unless fohc acid is included in the regimen. Since many multivitamin supplements do not contain folic acid, its inclusion should be ensured by the addition of folic or folinic acid. 

Prolintane, an amfetamine-related substance, is a central nervous system stimulant with similar structure and properties to dexamfetamine. Prolintane hydrochloride is available mainly in many formulations with multivitamin supplements in many European countries, Australia, and South Africa. 

An early review of newer case reports and placebo-controlled trials involving several hundred patients did not show an increase in fetal abnormalities (176). However, the relative risks of cardiovascular defects and oral clefts in infants whose mothers were exposed to dihydrofolate reductase inhibitors, such as trimethoprim, during the second or third month after the last menstrual period, compared with infants whose mothers had no such exposure, are 3.4 (95% Cl = 1.8, 6.4) and 2.6 (1.1, 6.1) respectively (177). Multivitamin supplements containing folic acid reduced the adverse effects of dihydrofolate reductase inhibitors. There have been two reports of severe spinal malformations in the fetuses of HIV-positive women treated with combination antiretroviral therapy and co-trimoxazole (178). 

Frank T, et al. Assessment of thiamin status in chronic renal failure patients, transplant recipients and hemodialysis patients receiving a multivitamin supplementation. Int J Vitam Nutr Res 2000 70 159-166. 

This includes multivitamin supplements as well which are injected intramuscularly, intravenously, or given orally. The latter is quite inefficient, however. 

Kumpusalo E, Karinpaa A, Jauhiainen M, et al. 1990. Multivitamin supplementation of adult omnivores and lactovegetarians Circulating levels of vitamin A, D and E, lipids, apolipoproteins and selenium. Int J Vitam Nutr Res 60(l) 58-66. 

Vitamin 65 interferes with the therapeutic effects of levodopa. Multivitamin supplements should not be taken together with levodopa and foods high in vitamin Be (for example liver, walnuts and bananas) should be limited during use of levodopa. 

Otto Shape, an overweight medical student (see Chapter 1), discovered that he could not exercise enough during his summer clerkship rotations to lose 2 to 3 lb per week. He decided to lose weight by eating only 300 kcal/day of a dietary supplement that provided half the calories as carbohydrate and half as protein. In addition, he consumed a multivitamin supplement. During the first 3 days on this diet,... 

Immediate treatment with large doses (50-KX) mg) of intravenous thiamine may produce a measurable decrease in cardiac output and increase in peripheral vascular resistance as early as 30 minutes after the initial injection. Dietary supplementation of thiamine is not as effective because ethanol consumption interferes with thiamine absorption. Because ethanol also affects the absorption of most water-soluble vitamins, or their conversion to the coenzyme form, Al Martini was also given a bolus containing a multivitamin supplement. 

Note Patients must not take multivitamin supplements containing pyridoxine during the course of levodopa therapy. L... 

Maternal hypothyroxinemia also occurred in women who had started iodine supplementation at least 2 years prior to becoming pregnant and who were also given iodine-containing multivitamin supplements, though to a lesser degree (16%). 

Als et al., 2003 Pearce et aL, 2004), it can also be due to increased iodine content in milk (Dahl et al., 2003 Phillips, 1997) and, concerning children, due to increased usage of multivitamin supplements, which typically contain 100—150 pg iodine per tablet. 

E.E., and Thun, M.J., Vitamin C, vitamin E, and multivitamin supplement use and stomach cancer mortality in the Cancer Prevention Study II cohort. Cancer Epidemiol Biomarkers Prev., 11,35,2002. 

In patients with normal vitamin K status, multivitamin supplements containing 10 to 50 micrograms of vitamin K] (phytomenadione) will generally have no clinically important effect on the INR or anticoagulant requirements. Vitamin K doses of 150 micrograms daily are likely to require a dose adjustment in a proportion of patients. However, in patients with poor vitamin K status, even low vitamin K doses of 25 micrograms daily may have an important effect. 

KumikD, Lubetsky A, Almog S, HaUdn H. Multivitamin supplements may affect war iin anticoagulation in susce ble patients. Am Pharmaco er (2003) 37,1603-. ... 

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