Vitamin A

Synonym/Generic name: Retinol, Anti-infective - Gastrointestinal disorders associated with

vitamin, Anti-cancerous vitamin disturbances in lipid absorption
Precursor: Provitamine-A (Carotenes) Precautions:
- β-carotene: Contains 2 mol of Vitamin A - Hypervitaminosis-A can occur in infants and
- α-carotene: Contains 1 mol of Vitamin A young children given excessive doses for long
periods.
- γ-carotene: Contains 1 mol of Vitamin A
- Avoid use in early pregnancy
Functions:
Side effects:
- Rhodopsin helps in color vision
- Rough skin
- Forms retinal pigments of the eye
- Dry hair
- Maintains integrity and normal growth of
glandular and epithelial tissue e.g., intestinal, - Enlarged liver
respiratory, urinary, eye, skin - Raised ESR
- Helps in normal cellular differentiation - Raised serum calcium and phosphatase
RDA: concentrations
- Adult male: 600 µg RE (5000 IU) Dosage & administration:
- Adult female: 600 µg RE (4000 IU) Oral
- Pregnant woman: 600 µg RE - Adult: Prophylaxis: 4000 I.U.
- Lactating mother: 950 µg RE - Child: Up to 50000 I.U./day
Indications: - In deficiency state: 50000-300000 I.U.
- Night blindness Injection
- Impaired dark adaptation - Adult: By deep IM injection: 150000-300000 I.U.
monthly, increased to weekly in acute deficiency
- Lichen planus
states
- Acne
- Child: Same as adult
- Dry skin and other hyperkeratoses

AVAILABLE VITAMIN A PREPARATIONS IN BANGLADESH

Trade Name Company Dosage form Each unit contains

A-FORTE Incepta Soft Gelatin Capsule 50000 I.U./capsule
OVIT-A Opsonin Soft Gelatin Capsule 50000 I.U./capsule
RATINOL Forte Drug International Soft Gelatin Capsule 50000 I.U./capsule
VIS-A Pacific Soft Gelatin Capsule 50000 I.U./capsule

Vitamin D
Synonym/Generic name:
- Vitamin D
- Vitamin D2 (Ergocalciferol)
- Vitamin D3 (Cholecalciferol)
Functions:
- Intestine: Promotes intestinal absorption of Ca2+ and Phosphorus
- Bone: Stimulates normal mineralization, affects collagen maturation
- Kidney: increases tubular reabsorption of PO42-
- Others: Permits normal growth
RDA:
- Infants & Children: 5.0 µg
- Adult: 2.5 µg
- Pregnant and lactating mother: 10 µg
Pharmaceutical Vitamin D preparations include:
- Ergocalciferol (Calciferol or Vitamin D2)
- Cholecalciferol (Vitamin D3 derivative)
- Alfacalcidiol (1-α-hydroxycholecalciferol)
- Calcitriol (1, 25-dihydroxycholecalciferol)
- Dihydrotachysterol

ERGOCALCIFEROL (D2) / CHOLECALCIFEROL (D3)

Preparations available: Tablet, Capsule, Solution, - Nausea and vomiting

Drop, Injection) - Diarrhoea
Indication : - Weight loss
- Prophylaxis of rickets in mature infants - Polyurea
- Therapy of rickets and osteomalacia induced by - Sweating
Vitamin-D deficiency
- Headache
- Supportive treatment in osteoporosis
- Thirst
- Prophylaxis and recognizable risk of a Vitamin
- Vertigo
deficiency disease
- Raised concentration of Ca2+ and phosphate in
- Deficiency caused by intestinal malabsorption or
plasma and urine
chronic liver disease
Dosage and administration:
- Abnormal calcium or phosphate metabolism
Indication for both adult and child:
- Renal osteodystrophy
- Simple Vitamin-D deficiency: 400 i.u. (10
- Hypocalcaemia or hypothyroidism
mcg)/day
- As adjunct in treatment of lupus vulgaris and TB
- Deficiency caused by intestinal malabsorption or
adenopathies
chronic liver disease: 40,000 i.u. (1 mg)/day
Contraindication:
- Renal osteodystrophy: Upto 200,000 i.u. (5
- Renal dysfunction mg)/day
- Hypercalcaemia - Rickets and osteomalacia: 1000-500 i.u./day
- Metastatic calcification Drug interactions:
Side-effects: - Uncontrolled intake of Ca2+ should be avoided
Symptoms of overdose include: - Mg containing antacids may cause
- Anorexia hypermagnesamia during therapy with
- Lassitiude cholecalciferol in chronic renal dialysis

AVAILABLE CHOLECALCIFEROL PRODUCTS IN BANGLADESH:

a. VIGANTOL OIL
ƒ Company: Merck/Techno Drugs:
ƒ Presentation: Contains 0.5 mg cholecalciferol, equivalent to 20,000 IU
ƒ Packaging: Available in 10 ml dropping bottle
ƒ Dosage and administration:
- Prophylaxis of rickets in mature infants: Daily 1 drop (approx. 500 IU)
- Premature infants: Daily 2 drops (1000 IU). These drops are given on a spoonful of milk or spoon-fed.
- Therapy of rickets and osteomalacia induced by Vitamin-D deficiency: Daily 2-8 drops (approx. 1000-5000
IU)
- Supportive treatment in osteoporosis: Daily 2-4 drops (approx. 1000-2500 IU)
- Prophylaxis and recognizable risk of a Vitamin deficiency disease: Daily 1-2 drops (approx. 500-1000 IU)
- Prophylaxis in malabsorption: Daily 4-8 drops (equivalent to 2500-5000 IU)
- Therapy of hypoparathyroidism and pseudoparathyroidsm: The recommended dose is 10000-20000 IU/day
b. OSTEO-D
ƒ Company: Incepta Pharmaceuticals Ltd.
ƒ Presentation: It is available as cholecalciferol injectable and oral solution.
- Each injectable solution (1 ampoule) contains: 200000 I.U. of Cholecalciferol BP
- Each 1 mL oral solution contains: 5 µg (200 I.U.) of Cholecalciferol BP
ƒ Dosage and administration:
Injectable solution
Disease (Only for Curative treatment) Dosage
Rickets 1 ampoule every 2 weeks for 1 month; then 1 ampoule for
every 4 months
Osteoporosis 1 ampoule every 2 weeks for 3 months
Osteomalacia 1 ampoule every 2 weeks for 3 months
Tetatny caused by hypocalcaemia 1 ampoule every 4 months which may be increased to 2
ampoules
Renal osteodystrophy 1 ampoule daily
Menopause 1 ampoule every 6 months
Oral solution
Period (Preventive measures) Dosage
Pregnancy 1 ampoule at 6th or 7th month
During breast feeding 1 ampoule every 6 months
Children up to 5 years of age 1 ampoule every 6 months
Adolescent & elderly 1 ampoule every 6 months
Packaging:
- Injectable solution: Each commercial box contains 1 ampoule of 1 mL solution
- Oral solution: Each bottle contains 15 mL of oral solution
c. DEBOLIN
ƒ Company: Chemist Laboratories Ltd.
ƒ Presentation: It is available as cholecalciferol injectable solution.
- Each injectable solution (1 ampoule) contains: 200000 I.U. of Cholecalciferol BP
ƒ Dosage and administration:
- Infants receiving vitamin D enriched milk: ½-ampoule i.e. 100000 I.U. every 6 months
- Nursed infants or infants not receiving vitamin D enriched milk: 1 ampoule every 6 months
- Adolescent & elderly: 1 ampoule every 6 months

ALFACALCIDOL

Vitamin D3 derivative ƒ Indications and dosage:

Action Oral:
Alfacalcidol is a precursor of the active calcitriol. It Treatment of Hypocalcaemia
does not require renal hydroxylation but requires 25- Adult:
hydroxylation in liver for conversion into calcitriol.
- Initially: 1 µg/day
- Maintenance: 0.25-1 µg/day - Monitor serum levels in patients with renal
Child: failure. Caution in hypercalciuria especially in
those with history of renal calculi.
- For <20 kg: 0.05µg/kg body wt. daily
Drug Interaction:
- For neonates and premature infants: 0.05-0.1
µg/kg body wt. daily - Thiazide diuretics cause hypercalcaemia by
increasing renal tubular reabsorption of
Geriatric or Elderly:
calcium and thus increase the hypercalcaemic
- 0.5 µg/day response to alfacalcidol.
ƒ Safety alert: - Antiepileptics increase vitamin D requirements
Contraindication: Adverse effects:
- Hypercalcaemia - Anorexia
- Hyperphosphataemia (except when occurring with - Nausea
hyperthyroidism)
- Vomiting
- Hypermagnesaemia
- Diarrhoea
Special cases:
- Lassitude
- Pregnancy and lactation
- Polyuria
- Renal impairment
- Sweating
- Infants & elderly
- Headache
- Thirst and vertigo

AVAILABLE ALFACALCIDOL PREPARATIONS IN BANGLADESH:

Trade Name: ONE-ALPHA (Leo Pharmaceuticals)

Dosage form Unit Packaging
Capsule 0.25 µg 100’s
Capsule 1 µg 100’s
Drops 2 µg/mL 20 mL
Injection 2 µg/mL 0.5 mL x 10’s
Injection 2 µg/mL 1 mL x 10’s

CALCITRIOL

Vitamin D group - May be increased to 0.5-1 mg daily at 4-8 week

Action intervals
Calcitriol promotes calcium absorption in the intestines Child:
and retention at the kidneys thus increasing serum - 0.25-2 µg/day with haemodialysis
calcium levels. It also increases renal tubule phosphate - 0.014-0.041 µg/kg/day without haemodyalysis
resorption consequently decreasing excessive serum
- May be increased to 4-8 weeks intervals
phosphatase levels, parathyroid hormone levels and
bone resorption. Hyperparathyroidism/Pseudo-
hyperparathyroidism
Indications and dosage
Adult:
Oral
- 0.5-2 µg once daily
Management of Hyperparathyroidism is Renal Failure
Child:
Adult:
- >6 years: Same as adult dose
- 0.25 µg/day or every other day
- 1-5 years: 0.25-0.75 µg once daily
Vitamin D Resistant Rickets (Familial Special cases:
Hypophosphataemia) - Idiopathic hypercalcaemia; pediatric doses
Adult: must be individualized and monitored under
- Initially: 0.015-0.02 µg/kg once daily close medical supervision.
- Maintenance: 0.03-0.06 mcg/kg once daily - Coronary disease, renal impairment and
arteriosclerosis especially in the elderly
Child:
- Hypoparathyroidism
- Same as adult dose but maximum dose: 2 µg once
daily Drug Intaraction:
Hypocalcaemia in Premature Infants - Hypermagnesaemia may develop in patients on
chronic renal dialysis
Child:
- Hypercalcaemia in patients on digitalis may
- 1 mg once daily for 5 days
precipitate cardiac arrhythmia
Intravenous
- Intestinal absorption of calcitriol may be
Management of Hyperparathyroidism is Renal Failure reduced by cholestyramine and cholestipol
Adult: - Phenytoin, barbiturates may decrease the half
- 0.5 µg daily, 3 times a week if undergoing life of calcitriol.
haemodyalysis
- Hypoparathyroid patients on calcitriol may
- May be increased to 0.5-3 µg daily 3 times a week
develop hepercalcaemia with thiazide diuretics
- Child:
0.01-0.05 µg/kg, 3 times a week if undergoing Adverse effects:
haemodyalsis - Weakness
Hypocalcaemic Tetany in Premature Infants - Headache
Child: - Somnolence
- 0.05 µg/kg once daily for 5-12 days - Nausea
Safety Alerts - Vomiting
Contraindication: - Dry mouth
- Hypercalcaemia - Constipation
- Hypervitaminosis D - Muscle pain
- Evidence of vitamin D toxicity - Nephrocalcinosis
- Malabsorption syndrome - Conjunctivitis
- Abnormal sensitivity to the effects of vitamin D - Pruritus
- Pregnancy - Albuminuria
- Cardiac arrhythmia

AVAILABLE CALCITRIOL PRODUCTS IN BANGLADESH

Trade Name (& Dosage form) Company Unit (package available)

CALCIJEX Unimed & Unihealth 1 µg/mL (5’s)
Ampoule
DIACALTROL Drug Intrernational 0.25 µg (50’s)
Soft Gelatin Capsule
ENCATROL Globe 0.25 µg (3 x 10’s)
Soft Gelatin Capsule
ROCATROL Roche 0.5 µg and 0.25 µg (30’s)
Capsule
ROICAL Shin Poong 0.25 µg (30’s, 60’s, 120’s, 500’s)
Capsule
 Vitamin E
Synonym/Generic name: α-tocopherol / Antisterility - Vitamin E deficiency resulting from impaired
vitamin absorption
Functions: - Premature ageing and lack of vitality
- Acts as natural antioxidants (defend cells against - Heart conditions and circulatory disorders
peroxides and superoxides) - Increased requirements due to diet rich in
- Protects cell membrane particularly lipoprotein polyunsaturated fats
(Unsaturated fatty acid) thus stabilizing them and - Sickle cell anemia
preventing their destruction
- Chronic cold
RDA:
- Infertility
- Infants: 3-4 mg
- Hemolytic anemia due to vitamin E deficiency
- Girls (upto 11 yrs): >8 mg
Therapeutic uses:
- Boys (11-14 yrs): 8 mg
- Heavy metal poisoning
- Children (1-10yrs): 5-7 mg
- Hepatotoxin poisoning
- Adult male: 10 mg
- Oxygen therapy and replacement therapy in
- Pregnant & lactating mother: 2-3 mg nutritional deficiency states (particularly skin and
Pharmacology: hair)
Vitamin E acts as antioxidant in the body. Vitamin E Contraindication:
protects polyunsaturated fatty acids and other No known contraindication found
oxygen sensitive substances such as vitamin A and
Side effects:
Vitamin C from oxidation. Vitamin E reacts with free
radicals, which is the cause of oxidative damage to Overdoses (>1 g) have been associated with minor
cell membranes, without the formation of another side effects including hypertension, fatigue, diarrhea
free radical in the process. The main pharmacological and myopathy, abdominal pain.
action of vitamin E in humans is its antioxidant effect. Drug interactions:
In premature infants’ irritability edema, thrombosis Vitamin E may impair the absorption of vitamin A.
and hemolytic anemia may be caused due to vitamin Vitamin K functions impairment happens at the level
E deficiency. Creatinuria, ceroid deposition, muscle of prothrombin formation and potentates the effects
weakness, decreased erythrocyte survival or of warfarin.
increased in vitro hemolysis by oxidizing agents have
Use in Pregnancy & Lactation:
been identified in adults and children with low serum
tocopherol concentrations. Vitamin is safe in pregnancy and lactation when used
in recommended doses. Effects of higher doses are
Indication:
not established.
- As a dietary supplement
Use in Children:
Vitamin E is safe for children
AVAILABLE VITAMIN E PRODUCTS IN BANGLADESH

a. E-GEL
Company: Renata Limited
Dosage and administration:
- Betterment of cardiovascular function: 400 I.U.-800 I.U. /day
- Deficiency syndrome in adults: 200 I.U.-400 I.U./day
- Deficiency syndrome in children: 200 I.U./day
- Thalassemia: 800 I.U./day
- Betterment of skin and hair: 200 I.U./day (Topical use is also established for beautification)
- Chronic cold in adults: 200 I.U./day
Packaging:
- Each pack contains 10 x 10 capsules in blister pack
- Each pack contains 5 x 10 capsules in blister pack
b. E-TAB
Company: The Acme Laboratories Ltd.
Dosage and administration:
- To cover vitamin E requirement: 1 tab/day
- Prophylactic use in malabsorption: 1 tab/day
- In intermittent claudication: 2-3 tab/day
- In cystic fibrosis: 1 tab/day
- For geriatric patients: 1 tab/day
Packaging:
- 10 x 10 film-coated tablets in strip

Vitamin K
Synonym/Generic name: Phylloquinone i.e. Contraindication:
Phytomenadione; available in two forms K1 (Plants) - Hypersensitivity to vitamin-K
and K2 (Intestinal microflora).
Side effects/Adverse effects:
Functions:
- Anaphylactic reactions upon parenteral
- Stimulates the production and release of certain administration
coagulation factors, e.g. prothrombin
Dosage and administration:
- Decreases prothrombin time and increases the
Oral
clotting time during deficiency
- Adult: 10-20 mg with maximum of 40 mg per day
RDA:
- Child (Neonates): 1 mg
- Adult male: 70-80 µg
- Child (Over 3 months): 5-10 mg
- Adult female: 60-70 µg
Injection
Indication:
- Adult: 10-20 mg IM or IV with maximum of 40 mg
- Hypoprothrombinaemia
per day
- Prophylactic treatment of hemorrhagic diseases
- Child (Neonates): 1 mg IM
of the newborn
- Child (Over 3 months): 5-10 mg

AVAILABLE VITAMIN E PRODUCTS IN BANGLADESH

Trade Name Company Dosage form Composition Per unit

BABYKION Chemist Laboratories Ltd. Oral/IM/IV Ampoule contains: 2 mg/2mL
KONAKION MM Roche Injection Ampoule contains: 2 mg/2mL