Nutrifer

Uses

Iron-deficiency anemia.

Mecobalamin is used for-

• Peripheral Neuropathies
• Diabetic Neuropathy
• Verteberal Syndrome
• Nerve Compression Syndrome
• Multiple sclerosis
• Amyotrophic lateral sclerosis
• Parkinson’s disease
• Alzheimer’s disease
• Diabetic retinopathy
• Entrapment neuropathy
• Drug induced neuropathy
• Megaloblastic anemia due to Vitamin B12 deficiency

Nutrifer is also used to associated treatment for these conditions: Folate deficiency, Iron Deficiency (ID), Iron Deficiency Anemia (IDA), Zinc Deficiency, Mineral supplementationVitamin B12 Deficiency, Nutritional supplementation

How Nutrifer works

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

Dosage

Nutrifer dosage

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.

Tablet: The usual adult dosage is one 500 mcg tablet three times daily. The dosage should be adjusted according to the age of patient and the severity of symptoms.

Injection:

• Peripheral neuropathies: The usual adult dosage is one ampoule equivalent to 500 mcg of Mecobalamin, administered intramuscularly or intravenously three times a week.The dosage should be adjusted according to the age of patient and the severity of symptoms.
• Megaloblastic anemia: The usual adult dosage is one ampoule equivalent to 500 mcg of Mecobalamin, administered intramuscularly or intravenously three times a week. After about two months of administration, dosage should be changed to one ampoule equivalent to 500 mcg of Mecobalamin every one to three months as maintenance therapy

Side Effects

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

Generally Mecobalamin is well tolerated. However, a few side effects like GI discomfort (including anorexia, nausea or diarrhea) & rash may be seen after administration of Mecobalamin.

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

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.

The medicine should not be used for months if there is no response at all after its use for a certain period of time.

Interaction

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.

Decreased GI tract absorption with neomycin, aminosalicylic acid, H2-blockers and colchicine. Reduced serum concentrations with oral contraceptives. Reduced effects in anaemia with parenteral chloramphenicol.

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.

Pregnancy & Breastfeeding use

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).

Not recommended during pregnancy & lactation.

Contraindication

Haemochromatosis, haemolytic anemia.

Hypersensitivity to any component of this product.

Special Warning

Use in children: Not recommended.

Acute Overdose

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

Storage Condition

Oral: Store at room temperature. Protect from moisture and light.

Parenteral: Store at room temperature. Do not expose to direct light.

Innovators Monograph

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