M.V.I. ADULT (PHARMACY BULK PACKAGE)
Clinical safety rating: caution
Comprehensive clinical and safety monograph for M.V.I. ADULT (PHARMACY BULK PACKAGE) (M.V.I. ADULT (PHARMACY BULK PACKAGE)).
M.V.I. Adult is a multivitamin formulation providing essential vitamins that serve as cofactors in various enzymatic reactions and metabolic pathways. Vitamin A is essential for vision and cell differentiation; B vitamins (B1, B2, B3, B5, B6, B7, B9, B12) act as coenzymes in energy metabolism, red blood cell production, and nerve function; Vitamin C is an antioxidant and cofactor for collagen synthesis; Vitamin D regulates calcium homeostasis; Vitamin E is an antioxidant; and Vitamin K is required for hepatic synthesis of clotting factors.
| Metabolism | Vitamins are metabolized mainly in the liver via conjugation or transformation; water-soluble vitamins are excreted renally; fat-soluble vitamins (A, D, E, K) are stored in tissues and undergo enterohepatic circulation. |
| Excretion | Renal excretion of water-soluble vitamins (B-complex, C); bile/fecal elimination of fat-soluble vitamins (A, D, E, K). Approximate percentages: Vitamins B1, B2, B6, C: >90% renal; Vitamin A: 70% fecal, 30% renal metabolites; Vitamin D: 75% fecal, 25% renal; Vitamin E: >60% fecal; Vitamin K: 50% fecal, 50% renal. |
| Half-life | Variable; thiamine (B1) ~9-18 min; riboflavin (B2) ~66-84 min; pyridoxine (B6) ~15-20 days; ascorbic acid (C) ~16-20 days (in deficiency states) or ~10-14 days (normal); retinol (A) ~2-3 days; ergocalciferol (D2) ~19-48 hours; alpha-tocopherol (E) ~40-60 hours; phytonadione (K1) ~1-2 hours. |
| Protein binding | Thiamine: 90% bound to albumin; Riboflavin: 60% bound; Pyridoxine: 70-80% bound; Ascorbic acid: 25% bound; Retinol: 95% bound to retinol-binding protein; Calciferol: 85-90% bound to vitamin D-binding protein; Tocopherol: >90% bound to lipoproteins; Phylloquinone: 99% bound to lipoproteins. |
| Volume of Distribution | Water-soluble vitamins: 0.5-1.0 L/kg (total body water); fat-soluble vitamins: 5-10 L/kg (extensive tissue storage). Clinical meaning: High Vd for fat-soluble vitamins indicates large tissue reservoirs. |
| Bioavailability | IV: 100% bioavailability. Not administered orally via this product. |
| Onset of Action | IV: Immediate for water-soluble vitamins (minutes); fat-soluble vitamins: hours to days (tissue distribution). |
| Duration of Action | Water-soluble vitamins: 8-12 hours; fat-soluble vitamins: 2-4 weeks (due to storage). Clinical note: Daily infusion required for sustained effect. |
10 mL intravenously once daily, added to 500 mL of compatible infusion fluid and administered over 8-24 hours.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required; M.V.I. Adult is a multivitamin formulation with no excipients requiring renal adjustment. |
| Liver impairment | Caution in severe hepatic impairment (Child-Pugh Class C); monitor for vitamin accumulation, particularly fat-soluble vitamins. No specific dose adjustment established. |
| Pediatric use | Not recommended for use in children; alternative pediatric formulations are available. |
| Geriatric use | No specific dose adjustment required; use standard adult dosing with monitoring for vitamin levels and renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for M.V.I. ADULT (PHARMACY BULK PACKAGE) (M.V.I. ADULT (PHARMACY BULK PACKAGE)).
| Breastfeeding | Vitamins in M.V.I. Adult are excreted into breast milk; at recommended doses, they are considered compatible with breastfeeding. No adverse effects reported in nursing infants. The milk-to-plasma (M/P) ratio is not established for the combination product. Fat-soluble vitamins (A, D, E, K) achieve higher milk concentrations with maternal supplementation, but at RDA levels, infant exposure is within safe limits. Monitor infant for signs of toxicity only if maternal intake exceeds RDA. |
| Teratogenic Risk | M.V.I. Adult is a multivitamin formulation containing vitamins A, D, E, K, C, B1, B2, B3, B6, B9, B12, and B5. Therapeutic doses of individual vitamins generally have low teratogenic risk; however, excessive vitamin A (retinol) >10,000 IU/day is teratogenic (first trimester: CNS, cardiac, facial defects; second/third trimester: no increased risk with supplementation within RDA). Vitamin D excess may cause hypercalcemia and fetal anomalies. Folic acid (vitamin B9) is protective against neural tube defects. Overall, at recommended doses, the teratogenic risk profile is low, with specific risks only at supratherapeutic levels. |
■ FDA Black Box Warning
None.
| Common Effects | No common side effects seen |
| Serious Effects |
["Hypersensitivity to any component.","Pre-existing hypervitaminosis (e.g., vitamin A or D toxicity).","Patients with severe hepatic impairment or cholestasis (for vitamin K-containing product).","Concurrent use with certain drugs (e.g., methotrexate high dose due to folic acid antagonism)."]
| Precautions | ["Allergic reactions have been reported, especially with vitamin B1 (thiamine) and B12.","Aluminum toxicity: Contains aluminum, which may be toxic with prolonged use in renal impairment.","Reduce dosage in patients with liver disease or cholestasis.","Folic acid may mask vitamin B12 deficiency.","Ensure adequate hydration to avoid crystallization of vitamins in urine."] |
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| Fetal Monitoring | No specific monitoring required beyond routine prenatal care. In cases of high-dose or prolonged use, monitor serum levels of fat-soluble vitamins (A, D, E, K) and calcium. Fetal ultrasound for anomalies only if maternal vitamin A intake exceeds 10,000 IU/day. For patients with renal impairment, monitor for hypervitaminosis. |
| Fertility Effects | No known adverse effects on fertility at recommended doses. Adequate folate status is essential for ovulation and early pregnancy; deficiency may impair fertility. Vitamin D deficiency has been associated with infertility; supplementation may improve outcomes. No data suggesting negative impact on male or female fertility. |