MULTIPLE VITAMINS

General

multiple vitamins

• Adavite

• Certagen

• Dayalets

• Hexavitamin

• LKV Drops

• Multi-75

• Multi-Day

• Nutrox

• One-A-Day

• Optilets

• Poly-Vi-Sol

• Quintabs

• Ru-lets

• Sesame Street Vitamins

• Sigtab

• Syrvite

• Tab-A-Vite

• Therabid

• Theragran

• Thera Multi-Vitamin

• Theravee

• Theravim

• Theravite

• Therems

• Unicaps

• Vita-Bob

• Vita-Kid

• Zymacap

multivitamin infusion

• B complex with C and B

• Cernevit-12

• Multi Vitamin Concentrate

• M.V.I.-12

• M.V.I. Pediatric

Pregnancy Category
Category Unknown

Ther. class.
vitamins

Indications

• PO: Treatment and prevention of vitamin deficiencies. Special formulations are available for patients with particular needs, including:

» Prenatal multiple vitamins (with larger doses of folic acid),

» Preconceptional multiple vitamins,

» Multiple vitamins with iron,

» Multiple vitamins with fluoride,

» Multiple vitamins with other minerals or trace elements.

• IV: Treatment and prevention of vitamin deficiencies in patients who are unable to ingest oral feedings or vitamins.

Action

• Contain fat-soluble vitamins (A, D, and E) and most water-soluble vitamins (B-complex vitamins B₁, B₂, B₃, B₅, B₆, B₁₂, vitamin C, biotin, and folic acid). These vitamins are a diverse group of compounds necessary for normal growth and development. Many act as coenzymes or catalysts in numerous metabolic processes.

• Liquid products do not contain folic acid.

Therapeutic Effect(s):

• PO: Prevention of deficiency or replacement in patients whose nutritional status is questionable.

• IV: Replacement in patients who are unable to ingest oral feedings or vitamins.

Pharmacokinetics

Absorption: Well absorbed from the GI tract after oral administration; some processes are active, some are passive. Absorption of water-soluble vitamins generally increases in deficiency states. Absorption of some lipid-soluble vitamins may require bile acids.

Distribution: Widely distributed; cross the placenta and enter breast milk. Fat-soluble vitamins (A, D, E, and K) are stored in fatty tissues and the liver.

Metabolism and Excretion: Utilized in various biologic processes. Excess amounts of water-soluble vitamins (B vitamins, vitamin C, and folic acid) are excreted unchanged by the kidneys.

Half-life: Unknown.

TIME/ACTION PROFILE

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown
IV	unknown	unknown	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity to preservatives, colorants, or additives, including tartrazine, saccharin, and aspartame (oral forms);

• Some products contain alcohol and should be avoided in patients with known intolerance.

Use Cautiously in:
Patients with anemia of undetermined cause.

Adverse Reactions/Side Effects

In recommended doses, adverse reactions are extremely rare

GU: urine discoloration (preparations with B vitamins).

Misc: allergic reactions to preservatives, additives, or colorants.

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug
Large amounts of vitamin B may interfere with the beneficial effect of levodopa .

Route/Dosage

• PO (Adults and Children): 1 dose unit (tablet/capsule/dropperful)/day or amount recommended by individual manufacturer..

• IV (Adults and Children): Amount sufficient to meet RDA for age group. Usually added to large-volume parenteral or total parenteral nutrition (hyperalimentation) solution..

Availability

• Tablets:_OTC

• Chewable tablets:_OTC

• Chewable wafers:_OTC

• Capsules:_OTC

• Liquids:_OTC

• Drops:_OTC

• Injection

• In combination with: fluoride, minerals, and trace elements_{Rx, OTC}.

Assessment

• Assess patient for signs of nutritional deficiency before and throughout therapy. Patients at risk include geriatric patients and those who are debilitated, burned, or unable to take oral nutrition and those with malabsorption syndromes or chronic alcoholism.

Toxicity and Overdose

• Toxicity rarely occurs with multivitamin preparations because of the small amounts per unit of fat-soluble vitamins. For symptoms, see individual vitamin entries.

» If overdose occurs, treatment includes induction of emesis or gastric lavage, calcium gluconate IV if hypocalcemic, and maintenance of high urine output.

Potential Nursing Diagnoses

• Imbalanced nutrition: less than body requirements (Indications)

Implementation

• Vitamins are usually given orally but may be given parenterally to patients in whom oral administration is not feasible.

» Combinations with >1 mg folic acid require a prescription.

• PO: Forms are not standardized.

» Chewable tablets should be crushed or chewed before swallowing.

» Liquid preparations may be dropped directly into the mouth or mixed with juice or cereal.

IV Adminstration:

• IV:
Administer multivitamin infusion by infusion only; do not use direct IV injection.
Solution is bright yellow and will color IV solutions and stain clothing.

• Continuous Infusion:

Diluent: Dilute each 5- or 10-mL ampule in 500–1000 mL of D5/LR, D5/0.9% NaCl, D5W, D10W, D20W, lactated Ringer's injection, 0.9% NaCl, 3% NaCl, or 1/6 M sodium lactate. Do not administer solution that has crystallized.

• Y-Site Compatibility:

» acyclovir

» alfentanil

» amikacin

» aminophylline

» ascorbic acid

» atracurium

» atropine

» aztreonam

» benztropine

» bumetanide

» buprenorphine

» butorphanol

» calcium choride

» calcium gluconate

» cefazolin

» cefoperazone

» cefotaxime

» cefotetan

» cefoxitin

» ceftazidime

» ceftriaxone

» cefuroxime

» chloramphenicol

» chlorpromazine

» cimetidine

» clindamycin

» cyanocobalamin

» cyclosporine

» dexamethasone sodium phosphate

» digoxin

» diltiazem

» diphenhydramine

» dobutamine

» dopamine

» enalapril

» ephedrine

» epinephrine

» epoetin alfa

» erythromycin lactobionate

» esmolol

» famotidine

» fentanyl

» fluconazole

» fludarabine

» folic acid

» furosemide

» gentamicin

» glycopyrrolate

» heparin

» hydrocortisone

» imipenem cilastatin

» indomethacin

» isoproterenol

» ketorolac

» labetalol

» lidocaine

» magnesium sulfate

» mannitol

» meperidine

» metaraminol

» methicillin

» methoxamine

» methyldopate

» methylprednisolone

» metoclopramide

» metoprolol

» miconazole

» midazolam

» minocycline

» morphine

» nafcillin

» nalbuphine

» naloxone

» nitroprusside

» norepinephrine

» ondansetron

» oxacillin

» oxytocin

» papaverine

» penicillin G

» pentamidine

» pentazocine

» pentobarbital

» phenobarbital

» phentolamine

» phenylephrine

» phytonadione

» potassium chloride

» procainamide

» prochlorperazine

» propranolol

» protamine

» pyridoxime

» ranitidine

» sodium bicarbonate

» streptokinase

» succinylcholine

» sufentanil

» tacrolimus

» theophylline

» thiamine

» ticarcillin/clavulanate

» tobramycin

» tolazoline

» vasopressin

» verapamil

• Y-Site Incompatibility:

» azathioprine

» dantrolene

» diazepam

» diazoxide

» ganciclovir

» hydralazine

» phenytoin

» trimethoprim/sulfamethoxazole

• Additive Incompatibility:
Incompatible in solution with many antibiotics.

Patient/Family Teaching

• Encourage patient to comply with recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the 4 basic food groups.

• Advise parents not to refer to chewable multivitamins for children as candy.

Evaluation/Desired Outcomes

Prevention or decrease in the symptoms of vitamin deficiency.