M.V.I.-12 LYOPHILIZED
Clinical safety rating: caution
Comprehensive clinical and safety monograph for M.V.I.-12 LYOPHILIZED (M.V.I.-12 LYOPHILIZED).
Provides essential vitamins for normal metabolic function, acting as cofactors in enzymatic reactions, including energy production, red blood cell synthesis, and antioxidant defense.
| Metabolism | Vitamins are metabolized via various pathways in the liver and tissues, including phosphorylation, dephosphorylation, and oxidation-reduction reactions. |
| Excretion | Renal: water-soluble vitamins (B-complex, C) are excreted primarily via kidneys, with excess eliminated unchanged. Fat-soluble vitamins (A, D, E, K) are eliminated via bile and feces; renal excretion is minimal. Specific percentages: thiamine 80-90% renal, riboflavin 60-70% renal, pyridoxine 70-80% renal, cyanocobalamin 50-60% renal, ascorbic acid 60-70% renal; fat-soluble vitamins >90% biliary/fecal. |
| Half-life | Variable by vitamin: thiamine ~24h, riboflavin ~18h, pyridoxine ~30h, cyanocobalamin ~6 days, ascorbic acid ~8h, retinol ~20h, ergocalciferol ~19 days, alpha-tocopherol ~10h, phytonadione ~4h. Clinical context: short t1/2 of water-soluble vitamins requires daily dosing; long t1/2 of fat-soluble vitamins allows less frequent dosing but risk of accumulation. |
| Protein binding | Variable: thiamine ~10% bound to albumin; riboflavin ~30% bound to albumin; pyridoxine ~60% bound to albumin; cyanocobalamin bound to transcobalamins (~20%); ascorbic acid ~5% bound; retinol bound to retinol-binding protein (RBP) ~100%; ergocalciferol bound to vitamin D-binding protein (DBP) ~90%; alpha-tocopherol bound to lipoproteins ~90%; phytonadione bound to lipoproteins ~95%. |
| Volume of Distribution | Extensive for fat-soluble vitamins: retinol ~5 L/kg, ergocalciferol ~10 L/kg, alpha-tocopherol ~10 L/kg; water-soluble vitamins have Vd approximating total body water: thiamine ~0.6 L/kg, riboflavin ~0.5 L/kg, ascorbic acid ~0.4 L/kg. Clinical meaning: large Vd indicates extensive tissue distribution and storage. |
| Bioavailability | Intravenous: 100%. No oral formulation; M.V.I.-12 is for IV use only. |
| Onset of Action | Intravenous: immediate increase in plasma levels within minutes; clinical effects (e.g., resolution of deficiency symptoms) may take days to weeks depending on severity and specific vitamin. |
| Duration of Action | Effects last until vitamin stores are depleted; for water-soluble vitamins, duration is short (hours to days) due to rapid excretion; for fat-soluble vitamins, duration is longer (weeks to months) due to storage in tissues. |
10 mL (one vial) intravenously once daily, infused over at least 30 minutes.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment required for renal impairment. |
| Liver impairment | No specific dose adjustment required for hepatic impairment. |
| Pediatric use | For children weighing <40 kg: 0.25 mL/kg/day (max 10 mL) intravenously once daily. For children weighing ≥40 kg: same as adult dose (10 mL once daily). |
| Geriatric use | Standard adult dosing; no specific geriatric adjustment required. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for M.V.I.-12 LYOPHILIZED (M.V.I.-12 LYOPHILIZED).
| Breastfeeding | Most components are excreted into breast milk, but the product at recommended doses is compatible with breastfeeding. The milk-to-plasma ratio varies by component; for example, vitamin A M/P ratio is approximately 0.5-0.7, vitamin D is low. High doses of vitamin A or D may accumulate in infant and should be avoided. Caution with vitamin K if infant has deficiency or bleeding risk. |
| Teratogenic Risk | M.V.I.-12 Lyophilized contains vitamins A, D, E, K, C, B1, B2, B3, B5, B6, B9, B12. Vitamin A at high doses (>10,000 IU/day) is teratogenic in first trimester. Vitamin D excessive doses may cause fetal hypercalcemia. Vitamin K at high doses may increase neonatal jaundice risk. Folic acid supplementation is beneficial for neural tube defect prevention. Individual vitamin components should be reviewed; the combination product at recommended doses is generally considered low risk but requires monitoring of vitamin A and D levels. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to any component of the formulation.","Patients with preexisting hypervitaminosis."]
| Precautions | ["Hypersensitivity reactions may occur, especially in patients with allergies to thiamine or other components.","Monitor for signs of vitamin toxicity, particularly vitamins A and D.","Use with caution in patients with renal impairment due to potential accumulation of fat-soluble vitamins.","Administer only as an additive to intravenous fluids; do not give as a direct infusion."] |
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| Fetal Monitoring | Monitor serum levels of vitamins A and D if sustained high doses are administered. Assess for signs of hypervitaminosis (e.g., nausea, headache, liver function abnormalities). In pregnancy, monitor fetal growth and development via ultrasound if high-dose vitamin A is given. For vitamin K, assess neonatal coagulation status if large doses near term. |
| Fertility Effects | No known adverse effects on fertility or reproductive function at recommended doses. Vitamin deficiencies (e.g., folate, B12) may impair fertility; supplementation may improve outcomes. High-dose vitamin A can be teratogenic but not directly affect fertility. |