Vit A (MHRA)

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SUMMARY OF PRODUCT CHARACTERISTICS

1. NAME OF THE MEDICINAL PRODUCT

Abidec Multivitamin Drops

2. QUALITATIVE AND QUANTITATIVE COMPOSITION

Abidec Multivitamin Drops contains 1333IU retinol (as vitamin A palmitate),


400IU ergocalciferol solution, 0.4mg thiamine hydrochloride, 0.8mg
riboflavine, 0.8mg pyridoxine hydrochloride, 8mg nicotinamide, and 40mg
ascorbic acid in each 0.6ml dose.

For excipients, see 6.1.

3. PHARMACEUTICAL FORM

A yellow to orange brown oral drops, solution which darkens upon storage,
with some cloudiness.

4. CLINICAL PARTICULARS

4.1. Therapeutic indications

Abidec Multivitamin Drops is indicated for the prevention of vitamin


deficiencies and for the maintenance of normal growth and health during the
early years of infancy and childhood; multivitamin supplement.

4.2. Posology and method of administration

Adults and children over 12 years:


Not appropriate.

Children aged 1 to 12 years:


Oral. One 0.6ml dose taken daily.
Maximum daily dose : 0.6ml

Children under 1 year:


Oral. One 0.3ml dose taken daily.
Maximum daily dose : 0.3ml

The Elderly:
Not appropriate.

Hepatic/renal dysfunction
Normal dosage is appropriate.

4.3 Contraindications

Abidec Multivitamin Drops is contraindicated in individuals with known


hypersensitivity to the product or any of its components including peanut oil.

Abidec Multivitamin Drops contains Arachis oil (peanut oil) and should not be
taken by patients known to be allergic to peanut. As there is a possible
relationship between allergy to peanut and allergy to Soya, patients with Soya
allergy should also avoid Abidec Multivitamin Drops.

4.4 Special warnings and precautions for use

When prescribing Abidec Multivitamin Drops, as with all multi-vitamin preparations,


allowance should be made for vitamins obtained from other sources.

While children are taking Abidec Multivitamin Drops no other vitamin supplement
containing vitamins A and D should be taken unless under medical supervision.

This multivitamin supplement should not be given to babies who are receiving more
than 500mls of formula milk per day to avoid exceeding the safe upper limit of
Vitamin A.

Excessive dosage of vitamin A and D may lead to hypervitaminoses. Due allowance


should always be made for intake of these vitamins from other sources.

Patients with rare hereditary problems of fructose intolerance, glucose-galactose


malabsorption or sucrase-isomaltase insufficiency should not take this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per unit volume, that is to
say essentially ‘sodium-free’.

May be harmful to the teeth.


4.5. Interaction with other medicinal products and other forms of interaction

None.
4.6. Pregnancy and lactation

Not indicated.

4.7. Effects on ability to drive and use machines

None known.

4.8. Undesirable effects

Vitamin A palmitate
Adverse effects are extremely rare at daily doses of less than 9mg (16363.6iu).

Ergocalciferol (Vitamin D2)


The only known adverse effects of vitamin D occur when excessive doses are
taken. Adverse effects are not anticipated at the quantity present in Abidec
Multivitamin Drops.

Ascorbic Acid (C), Nicotinamide, Pyridoxine (B6), Riboflavin (B2) &


Thiamine (B1)
These water soluble vitamins are generally non toxic compounds with a wide
margin of safety, the excess amounts being rapidly excreted in the urine.
Adverse effects are not anticipated at the quantities present in Abidec
Multivitamin Drops.

4.9. Overdose

Symptoms and sign


Abidec Multivitamin Drops contains levels of vitamins which present little
risk in overdose.

Vitamin A palmitate
Acute administration of high doses of vitamin A can cause headache, nausea,
vomiting and irritability. In infants acute toxicity can lead to transient
hydrocephalus. All these effects disappear within 24 hours of taking retinol.

Ergocalciferol (Vitamin D2)


Excessive doses of vitamin D, 60 000 units per day, can result in
hypercalcaemia and hypercalciuria. Adverse effects of hypercalcaemia may
include muscle weakness, apathy, headache, anorexia, nausea and vomiting,
hypertension and cardiac arrhythmias.

Thiamine hydrochloride (Vitamin B1)


When taken orally, thiamine is non-toxic. If large doses are ingested they are
not stored by the body but excreted unchanged by the kidneys.

Riboflavin (Vitamin B2)


Riboflavin has been found to be practically non-toxic.

Pyridoxine hydrochloride (Vitamin B6)


Acute doses less than 500mg per day appear to be safe. Excessive doses may
lower serum folate concentrations. Sensory neuropathy has been described
with chronic dosing of 200 mg daily.

Nicotinamide
A single large overdose of nicotinamide is unlikely to have serious ill effects,
though transient abnormalities of liver function might occur.

Ascorbic acid (Vitamin C)


Ascorbic acid is not stored to a great extent by the body, any excess amounts
are eliminated in the urine. Ascorbic acid is thought to become toxic at chronic
doses in excess of 6 g.

Treatment
Treatment should be supportive and symptomatic.

5. PHARMACOLOGICAL PROPERTIES

5.1. Pharmacodynamic properties

Vitamin A palmitate
Vitamin A plays an essential role in the function of the retina, the growth and
function of epithelial tissue, bone growth, reproduction and embryonic
development.

Ergocalciferol (Vitamin D2)


Vitamin D is a regulator of both calcium and phosphate homeostasis.

Thiamine hydrochloride (Vitamin B1)


Vitamin B1 is essential for proper carbohydrate metabolism and plays an
essential role in the decarboxylation of alpha keto acids.

Riboflavin (Vitamin B2)


Riboflavin is essential for the utilisation of energy from food. It is a
component of co-enzymes which play an essential role in oxidative/ reductive
metabolic reactions. Riboflavin is also necessary for the functioning of
pyridoxine and nicotinic acid.
Pyridoxine hydrochloride (Vitamin B6)
Vitamin B6 is a constituent of the co-enzymes, pyridoxal pyrophosphate and
pyridoxamine phosphate, both of which play an important role in protein
metabolism.

Nicotinamide
Nicotinamide is an essential component of co-enzymes responsible for proper
tissue respiration.

Ascorbic acid (Vitamin C)


Ascorbic acid is a water soluble vitamin and a powerful antioxidant. It is a
cofactor in numerous biological processes, such as the metabolism of folic
acid, amino acid oxidation and the absorption and transport of iron. It is also
required for the formation, maintenance and repair of intercellular cement
material. Ascorbic acid is important in the defence against infection, the
normal functioning of T-lymphocytes and for the effective phagocytic activity
of leucocytes. It also protects cells against oxidation damage to essential
molecules.

5.2. Pharmacokinetic properties

Absorption
Vitamins A, B1, B2, B6, C, D2 and nicotinamide are well absorbed from the
gastro-intestinal tract.

Distribution
The vitamins present in Abidec Multivitamin Drops are widely distributed to
all tissues in the body.

Metabolism and elimination

Vitamin A palmitate
Vitamin A palmitate is hydrolysed in the intestinal lumen to retinol which is
then absorbed. Retinol circulates in the blood bound to retinol binding protein
which protects it from glomerular filtration. The complex circulates to target
tissues where the vitamin is released, permeates the cell and binds
intracellularly to cellular retinol binding protein. Of the absorbed retinol 20 -
50 % is either conjugated or oxidised to various products and excreted over a
matter of days in the urine and faeces, while the remainder is stored. This
stored retinol is gradually metabolised by the liver and peripheral tissues.

Ergocalciferol (Vitamin D2)


Vitamin D circulates in the blood associated with vitamin D binding protein. It
is stored in fat deposits. Ergocalciferol is hydroxylated in the liver and gut to
25-hydroxy colecalciferol which is then further metabolised in the kidney to
the active form 1,25-dihydroxycolecalciferol and other hydroxylated
metabolites. Ergocalciferol and it’s metabolites are excreted largely in bile
with eventual elimination in the faeces, with only small amounts of some of
the metabolites appearing in the urine.

Thiamine hydrochloride (Vitamin B1)


Thiamine has a plasma half life of 24 hours and is not stored to any great
extent in the body. Excess ingested thiamine is excreted in the urine as either
the free vitamin or as the metabolite, pyrimidine.

Riboflavin (Vitamin B2)


Following absorption riboflavin is converted into the co-enzymes: flavin
mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Riboflavin is
not stored in body tissues to any great extent and amounts in excess of the
body’s requirements are excreted in the urine largely unchanged.

Pyridoxine hydrochloride (Vitamin B6)


The half life of pyridoxine ranges from 15 - 20 days. Once absorbed vitamin
B6 is converted to it’s active co-enzyme form pyridoxal 5-phosphate. Muscle
is the major storage site for pyridoxal 5-phosphate. It is degraded in the liver
to 4-pyridoxic acid which is eliminated by the kidneys.

Nicotinamide
Nicotinamide is readily taken up into tissues and utilised for the synthesis of
the co-enzyme forms nicotinamide adenine dinucleotide (NAD) and
nicotinamide adenine dinucleotide phosphate (NADP). Nicotinamide is
degraded in the liver and other organs to a number of products that are
excreted in the urine, the major metabolites being
n-methyl-2-pyridone-5-carboxamide and n-methylnicotinamide.

Ascorbic acid (Vitamin C)


Ascorbic acid reaches a maximum plasma concentration 4 hours following
oral administration after which there is rapid urinary excretion. Following oral
administration 60 % of the dose is excreted in 24 hours either as ascorbic acid
or its metabolite dihydroascorbic acid.

Pharmacokinetics in Renal Impairment


There have been no specific studies of Abidec Multivitamin Drops in renal
impairment.

Pharmacokinetics in the Elderly


Not appropriate.

5.3. Preclinical safety data


Mutagenicity
There is insufficient information to determine the mutagenic potential of the
active ingredients. However very large doses of vitamin C are claimed to be
mutagenic.

Carcinogenicity
There is insufficient information to determine the carcinogenic potential of the
active ingredients.

Teratogenicity
High doses of vitamin D are known to be teratogenic in experimental animals,
but direct evidence for this is lacking in humans. The teratogenicity of vitamin
A in animals is well known, both high and low levels of the vitamin result in
defects. But the significance of this for humans is in dispute. Synthetic
versions of vitamin A (Isotretinoin and Etretinate) have been shown to be
powerful teratogens. There is insufficient information to determine the
teratogenic potential of the other active ingredients.

Fertility
Not appropriate.

6. PHARMACEUTICAL PARTICULARS

6.1. List of excipients

Sodium hydroxide
Sugar (mineral water grade)
Refined peanut oil (a carrier for Vitamin A palmitate)
Polysorbate 60
Purified water
Nitrogen, Oxygen free

6.2. Incompatibilities

None known.

6.3. Shelf life

18 months after manufacture.


Once opened use within 4 weeks.
6.4. Special precautions for storage

Do not store above 25°C. Keep bottle in outer carton.

6.5 Nature and contents of container

Abidec Multivitamin Drops are presented in an amber Type III glass bottle,
with Tamper-evident Polypropylene cap or ROPP aluminium cap containing a
PET/ Aluminium/ Polyethylene/ Expanded Polyethylene laminated wad.

One or two 25 ml bottles are enclosed in a printed cardboard carton with one
polyethylene / polystyrene syringe graduated at 0.3 ml and 0.6 ml.
Alternatively, two cartons containing a 25 ml bottle and polyethylene /
polystyrene syringe may be shrink wrapped to provide a pack size of 50 ml.

6.6. Instruction for use, handling and disposal

None applicable.

7. MARKETING AUTHORISATION HOLDER

Omega Pharma Ltd.


1st Floor
32 Vauxhall Bridge Road
LONDON, SW1V 2SA
United Kingdom

8. MARKETING AUTHORISATION NUMBER

PL 02855/0015

9 Date of the first authorisation or renewal

11/10/2005
10 DATE OF REVISION OF THE TEXT

14/04/2021

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