M.V.C. 9+3
Clinical safety rating: caution
Comprehensive clinical and safety monograph for M.V.C. 9+3 (M.V.C. 9+3).
M.V.C. 9+3 is a multivitamin supplement providing essential vitamins and minerals that serve as cofactors in various metabolic reactions, including energy production, DNA synthesis, and cellular function. The specific components include B-vitamins (thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folic acid, cyanocobalamin, ascorbic acid) and vitamins A, D, E, and K, which act as antioxidants, support immune function, and are required for normal growth and development.
| Metabolism | Individual vitamins are metabolized via various pathways: B-vitamins undergo phosphorylation, methylation, and other reactions; ascorbic acid is metabolized primarily in the liver; vitamin A is metabolized to retinoic acid; vitamin D undergoes hepatic and renal hydroxylation; vitamin E is metabolized via glucuronidation and side-chain oxidation; vitamin K is metabolized mainly in the liver. |
| Excretion | Renal: 10-70% (B vitamins, ascorbic acid, electrolytes); fecal: minimal (trace unabsorbed components). Biliary: negligible. |
| Half-life | Variable per component: thiamine 1-2 h, pyridoxine 15-20 h, cyanocobalamin 6 days (plasma); clinical depletion: weeks to months for stores. |
| Protein binding | Variable: ascorbic acid 25%, thiamine 90% (to albumin), pyridoxine 60% (to albumin), cyanocobalamin 90% (transcobalamin), retinol 95% (retinol-binding protein), cholecalciferol 90% (vitamin D-binding protein), alpha-tocopherol 90% (lipoproteins), phytonadione 99% (lipoproteins). |
| Volume of Distribution | 0.6-1.2 L/kg (total body water for water-soluble; lipid stores for fat-soluble). Broad distribution to tissues. |
| Bioavailability | IM: 70-100%; IV: 100%; oral: not applicable (no oral formulation; if compounded, 50-90% for water-soluble, 30-50% for fat-soluble). |
| Onset of Action | IV: immediate (minutes) for repletion; IM: 15-30 min for water-soluble vitamins; delayed for fat-soluble (A, D, E, K): 12-24 h. |
| Duration of Action | Water-soluble: 6-24 h (excess excreted); fat-soluble: days to weeks (tissue depot). Clinical effect: sustained with daily dosing. |
1 vial (10 mL) intravenously over at least 30 minutes daily, or as directed by vitamin and mineral requirements.
| Dosage form | INJECTABLE |
| Renal impairment | Contraindicated in severe renal impairment (eGFR <30 mL/min/1.73 m²) due to risk of aluminum toxicity and accumulation of fat-soluble vitamins. For eGFR 30-59 mL/min/1.73 m², use with caution and monitor serum vitamin levels. |
| Liver impairment | Child-Pugh Class A: No adjustment. Child-Pugh Class B: Use with caution; reduce dose to 1 vial every other day and monitor for signs of vitamin toxicity. Child-Pugh Class C: Avoid use due to risk of hepatic encephalopathy from fat-soluble vitamins. |
| Pediatric use | Children ≥11 years: Same as adult dose (1 vial daily IV). Children 2-10 years: 0.5 mL/kg/day IV, not to exceed adult dose; maximum infusion rate 0.2 mL/min. Infants and neonates: 0.3 mL/kg/day IV, with close monitoring of renal function. |
| Geriatric use | No specific dose adjustment recommended; use with caution in elderly patients with impaired renal function. Monitor renal function and serum vitamin levels closely, as elderly patients are at increased risk for toxicity due to age-related decline in renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for M.V.C. 9+3 (M.V.C. 9+3).
| Breastfeeding | Generally safe during breastfeeding. Components are endogenous and excreted in breast milk in low amounts. M/P ratio not established; no adverse effects reported with recommended doses. |
| Teratogenic Risk | M.V.C. 9+3 is a multivitamin supplement with minerals. At recommended doses, individual vitamins and minerals are not associated with major teratogenic risk. However, caution with vitamin A: excess (>10,000 IU/day) is teratogenic. Low risk in first trimester. No known risks in second and third trimesters at standard doses. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to any component of the formulation","Hypervitaminosis of any vitamin contained in the product"]
| Precautions | ["Allergic reactions have been reported with multivitamin preparations, especially those containing thiamine or folic acid.","Use caution in patients with pre-existing hypervitaminosis or known hypersensitivity to any component.","Vitamin K may antagonize warfarin therapy.","Excessive vitamin A may cause hypervitaminosis A, especially in patients with renal impairment."] |
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| Fetal Monitoring |
| No specific monitoring required beyond routine prenatal care. Monitor for signs of vitamin or mineral toxicity (e.g., vitamin A) if high doses are used. |
| Fertility Effects | No adverse effects on fertility with recommended doses. Adequate micronutrient status supports fertility; supplementation may improve outcomes in deficiency states. |