MULTRYS
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MULTRYS (MULTRYS).
MULTRYS is a multivitamin preparation for intravenous infusion; its components serve as coenzymes or cofactors in various metabolic pathways, including energy production, red blood cell formation, and antioxidant defense.
| Metabolism | Metabolism varies by component; e.g., vitamins are metabolized in the liver via conjugation, oxidation, or reduction, with some eliminated unchanged in urine. |
| Excretion | Renal elimination of individual vitamins and trace elements varies; no intact drug is excreted, as MULTRYS is a mixture. Approximate ranges: thiamine 50% unchanged in urine, riboflavin 60-70% as metabolites in urine, vitamin B6 70-80% as 4-pyridoxic acid in urine, vitamin C 50% unchanged in urine, biotin 50% unchanged in urine, folic acid mainly as metabolites in urine, vitamin B12 via bile (50-60%) and urine (10-30%). Trace elements: zinc primarily fecal (90%), copper primarily fecal (80-90%), selenium primarily urine (50-60%), chromium primarily urine (80%), manganese primarily fecal (95-97%). |
| Half-life | Not applicable as a single entity; values vary by component. For example: thiamine 10-20 minutes (plasma), riboflavin 1-2 hours, vitamin B6 2-3 weeks (tissue stores), vitamin C 16 days (10-20 days for depletion), biotin 1-2 days, folic acid 3-4 hours (plasma), vitamin B12 4-5 days (plasma), zinc 2-3 days (plasma), copper 12-24 hours, selenium 11-20 days, chromium 0.5-1 day, manganese 5-10 days. |
| Protein binding | Variable: thiamine <10%, riboflavin 30-40%, vitamin B6 60-70%, vitamin C 20-25%, biotin 40-50%, folic acid 50-60%, vitamin B12 90% (transcobalamins), zinc 90-95% (albumin and alpha-2-macroglobulin), copper 85-95% (ceruloplasmin), selenium 50-60% (selenoprotein P and albumin), chromium ~90% (transferrin), manganese 80-90% (transmanganin and albumin). |
| Volume of Distribution | Not applicable as a single entity; values vary by component. Example: thiamine 0.3-0.5 L/kg, riboflavin 0.5-1.0 L/kg, vitamin B6 1.5-2.0 L/kg, vitamin C 0.3-0.5 L/kg, biotin 0.5-1.0 L/kg, folic acid 0.5-1.5 L/kg, vitamin B12 0.3-0.5 L/kg, zinc 0.5-1.0 L/kg, copper 0.3-0.5 L/kg, selenium 0.3-0.5 L/kg, chromium 0.5-1.0 L/kg, manganese 0.5-1.0 L/kg. |
| Bioavailability | Intravenous administration only; bioavailability is 100% by definition for IV route. Not administered orally. |
| Onset of Action | Not applicable; MULTRYS is a multivitamin and trace element combination for parenteral nutrition, not for acute clinical effects. Clinical effect on deficiency states typically occurs within days to weeks of continuous supplementation. |
| Duration of Action | Not applicable; continuous supplementation is required to maintain levels. Duration depends on component half-life and tissue stores; e.g., water-soluble vitamins have short duration (hours to days), fat-soluble vitamins and trace elements have longer duration (days to weeks). |
10 mL (one vial) intravenously three times per week, not to exceed 10 mL per dose.
| Dosage form | SOLUTION |
| Renal impairment | No dose adjustment required for renal impairment, but monitor for aluminum toxicity in chronic use. |
| Liver impairment | No specific adjustment guidelines; use with caution in severe hepatic impairment due to risk of vitamin A toxicity. |
| Pediatric use | Weight-based dosing: 0.2 mL/kg intravenously three times per week, not to exceed 10 mL per dose. |
| Geriatric use | No specific dose adjustment; monitor for vitamin accumulation and aluminum toxicity due to potentially reduced renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for MULTRYS (MULTRYS).
| Breastfeeding | MulTRYs components are normal dietary constituents and are excreted into breast milk but are not expected to cause harm. M/P ratio not available. Use only recommended daily allowances; avoid mega-doses of fat-soluble vitamins. |
| Teratogenic Risk | MulTRYs (multivitamin with minerals) is generally considered safe in pregnancy. However, caution is advised with high doses of vitamin A (retinol) which can be teratogenic. Avoid exceeding 5000 IU vitamin A per day. No increased risk of major malformations at recommended doses. Trimester all: use only recommended daily allowances. |
■ FDA Black Box Warning
None.
| Serious Effects |
["Hypersensitivity to any ingredient.","Patients with pre-existing hypervitaminosis.","Severe renal impairment (due to aluminum content)."]
| Precautions | ["May cause allergic reactions, including anaphylaxis, especially in patients with sensitivities to any component.","Contains aluminum, which may accumulate in patients with renal impairment.","Monitor for signs of vitamin toxicity (e.g., hypervitaminosis A or D) with prolonged use.","Use with caution in patients with liver disease or blood coagulation disorders due to vitamin K content.","Not for direct infusion; must be diluted in appropriate intravenous fluids."] |
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| Fetal Monitoring |
| Monitor maternal hemoglobin and ferritin if iron deficiency anemia is present. Check vitamin B12 and D levels if clinically indicated. No specific fetal monitoring required beyond routine prenatal care. |
| Fertility Effects | No known negative effects on fertility. Adequate vitamin and mineral levels may support normal fertility. Excessive vitamin A (retinol) may impair fertility; avoid high doses. |