Grotal

Uses

Calcium Pantothenate is used as a calcium supplement, dietary supplements, burning feet syndrome, greying hair, peripheral neuritis, muscular cramps.

Iron-deficiency anemia.

Lysine is an amino acid commonly found as a component of total parenteral nutrition.

Supplemental lysine has putative anti-herpes simplex virus activity. There is preliminary research suggesting that it may have some anti-osteoporotic activity.

Grotal is also used to associated treatment for these conditions: Folate deficiency, Iron Deficiency (ID), Iron Deficiency Anemia (IDA), Zinc Deficiency, Mineral supplementationWeight Loss, Weight Gain, Amino acid supplementation

How Grotal works

Iron is necessary for the production of hemoglobin. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia.

Proteins of the herpes simplex virus are rich in L-arginine, and tissue culture studies indicate an enhancing effect on viral replication when the amino acid ratio of L-arginine to lysine is high in the tissue culture media. When the ratio of L-lysine to L-arginine is high, viral replication and the cytopathogenicity of herpes simplex virus have been found to be inhibited. L-lysine may facilitate the absorption of calcium from the small intestine.

Dosage

Grotal dosage

Slow intravenous or deep intramuscularas required or as directed by physician.

Iron-deficiency anaemia:

• Adult:60 mg bid up to 60 mg 4 times daily. Prevention: 60 mg daily.
• Child:Severe: 4-6 mg/kg/day in 3 divided doses; Mild to moderate: 3 mg/kg/day in 1-2 divided doses. Prevention: 1-2 mg/ kg/ day.

Should be taken on an empty stomach. Best taken on an empty stomach. May be taken with meals to reduce GI discomfort.

Side Effects

Mild gastrointestinal disturbances, bradicardia, arrythmia and irritation after IV injection

GI symptoms e.g. stomach cramping, constipation, nausea, vomiting, dark stools, heartburn, diarrhea, teeth staining, urine discoloration.

Toxicity

Acute iron overdosage can be divided into four stages. In the first stage, which occurs up to six hours after ingestion, the principal symptoms are vomiting and diarrhea. Other symptoms include hypotension, tachycardia and CNS depression ranging from lethargy to coma. The second phase may occur at 6-24 hours after ingestion and is characterized by a temporary remission. In the third phase, gastrointestinal symptoms recur accompanied by shock, metabolic acidosis, coma, hepatic necrosis and jaundice, hypoglycemia, renal failure and pulmonary edema. The fourth phase may occur several weeks after ingestion and is characterized by gastrointestinal obstruction and liver damage. In a young child, 75 milligrams per kilogram is considered extremely dangerous. A dose of 30 milligrams per kilogram can lead to symptoms of toxicity. Estimates of a lethal dosage range from 180 milligrams per kilogram and upwards. A peak serum iron concentration of five micrograms or more per ml is associated with moderate to severe poisoning in many.

Precaution

Renal impairment, sarcoidosis, concurrent administration of thiazide diuretics may increase the risk of hypercalcaemia.

Avoid in patients with peptic ulcer, enteritis, or ulcerative colitis and those who receive frequent blood transfusions. Not to be used in premature infants until the vitamin E stores (deficient at birth) are replenished. Avoid prolonged treatment (>6 mth) except in patients with continuous menorrhagia or bleeding.

Interaction

There are no known drug interactions and none well documented.

Concurrent admin with antacids/ H2 antagonists may reduce absorption of iron. Chloramphenicol may delay response to iron. Iron may reduce the absorption of levodopa, methyldopa and penicillamine when given together. Absorption may be reduced when used with quinolones or tetracyclines. Concurrent admin with vitamin C may increase iron absorption.

Elimination Route

The efficiency of absorption depends on the salt form, the amount administered, the dosing regimen and the size of iron stores. Subjects with normal iron stores absorb 10% to 35% of an iron dose. Those who are iron deficient may absorb up to 95% of an iron dose.

Absorbed from the lumen of the small intestine into the enterocytes by an active transport process

Pregnancy & Breastfeeding use

Pregnancy Category-C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Pregnancy Category- A. Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Contraindication

Contraindicated in patients with hypercalcaemia, hypercalciuria.

Haemochromatosis, haemolytic anemia.

Acute Overdose

Overdose may lead to severe iron toxicity, espcially in children.

Innovators Monograph

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