MULTIPLE VITAMINS INJECTION PEDIATRIC (PHARMACY BULK PACKAGE)
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MULTIPLE VITAMINS INJECTION PEDIATRIC (PHARMACY BULK PACKAGE) (MULTIPLE VITAMINS INJECTION PEDIATRIC (PHARMACY BULK PACKAGE)).
Multiple vitamins provide essential micronutrients required for various metabolic processes, including cofactors for enzymatic reactions, antioxidant activity, and maintenance of cellular function.
| Metabolism | Individual vitamins are metabolized via specific pathways: water-soluble vitamins (B-complex, C) are generally not stored and excess is excreted renally; fat-soluble vitamins (A, D, E, K) are stored in liver and adipose tissue and metabolized via hepatic enzymes. |
| Excretion | Renal excretion of water-soluble vitamins (e.g., B-complex, vitamin C) as unchanged drug or metabolites; fat-soluble vitamins (A, D, E, K) excreted primarily in feces via bile. Specific percentages are formulation-dependent. |
| Half-life | Variable by component: e.g., thiamine 10-20 min, pyridoxine 15-20 days, cyanocobalamin ~6 days (for hydroxyl form; longer for tissue storage). Context: Half-lives reflect rapid clearance of water-soluble vitamins versus prolonged hepatic storage of fat-soluble vitamins. |
| Protein binding | Variable: thiamine ~0%, pyridoxine ~60% bound to albumin, cyanocobalamin ~90% bound to transcobalamins; fat-soluble vitamins highly bound (vitamin A bound to retinol-binding protein, vitamin D to vitamin D-binding protein). |
| Volume of Distribution | Water-soluble: approximates extracellular fluid (~0.2 L/kg) or total body water for some; fat-soluble: large, >1 L/kg due to adipose tissue storage. |
| Bioavailability | IV administration yields 100% bioavailability; IM or SQ absorption is variable but high (70-90%) for aqueous solutions; oral bioavailability widely variable (e.g., thiamine ~5%, riboflavin ~50%, vitamin C ~70%) but pediatric injection is IV only. |
| Onset of Action | Intravenous: water-soluble vitamins act within minutes for coenzyme functions; fat-soluble vitamins require hours to days for physiological effects. |
| Duration of Action | Water-soluble: hours to days, depending on tissue saturation; fat-soluble: weeks to months, with risk of accumulation. |
No standard adult dose; this product is a pharmacy bulk package intended for preparation of pediatric parenteral nutrition solutions only. Not for direct administration.
| Dosage form | INJECTABLE |
| Renal impairment | No specific renal dose adjustment available; use with caution in renal impairment due to potential accumulation of fat-soluble vitamins and folic acid. |
| Liver impairment | No specific hepatic dose adjustment; contraindicated in severe hepatic disease due to risk of toxicity from vitamin A and E. |
| Pediatric use | Weight-based dosing: For infants and children up to 11 years, typical daily supplementation in parenteral nutrition: 5 mL per day for infants ≤1 kg, 5 mL for 1-3 kg, and 5-10 mL for >3 kg; for children >11 years, use adult formulation. |
| Geriatric use | No specific elderly dose adjustment; use standard pediatric dosing if indicated, but generally not recommended for elderly patients as this formulation is intended for pediatric use. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for MULTIPLE VITAMINS INJECTION PEDIATRIC (PHARMACY BULK PACKAGE) (MULTIPLE VITAMINS INJECTION PEDIATRIC (PHARMACY BULK PACKAGE)).
| Breastfeeding | Excreted in breast milk in small amounts; considered compatible with breastfeeding at recommended doses. M/P ratio not established for the combination product. |
| Teratogenic Risk | First trimester: No known teratogenic risk at recommended doses. Second and third trimesters: Safe at recommended doses; high doses of fat-soluble vitamins (A, D, E, K) may cause fetal toxicity. No significant teratogenic risk identified. |
■ FDA Black Box Warning
Not applicable.
| Serious Effects |
["Known hypersensitivity to any component.","Pre-existing hypervitaminosis.","Use in patients with significant renal or hepatic impairment (caution advised)."]
| Precautions | ["Hypersensitivity reactions may occur.","Aluminum content may be toxic with prolonged use in renal impairment.","Monitor for hypervitaminosis, especially with fat-soluble vitamins.","Do not administer unless solution is clear and container is undamaged."] |
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| Fetal Monitoring |
| Monitor maternal serum levels of vitamins A, D, B12, and folate if prolonged high-dose therapy. Assess fetal growth and development with routine ultrasound. No specific fetal monitoring required. |
| Fertility Effects | No known adverse effects on fertility at recommended doses. High doses of vitamin A may impair fertility. |