Multiple Micronutrient Supplements

Approved Indications:

• Pregnancy and Lactation:
• Prevention and treatment of micronutrient deficiencies, including iron, folic acid, vitamin A, zinc, and iodine.
• Reduction in risks of maternal anemia, low birth weight, and preterm birth.
• Pediatric and Adolescent Use:
• Support of growth, immunity, and neurocognitive development in children with dietary insufficiencies or high physiological demand.
• Adults with Nutritional Deficiency:
• Supplementation in malnourished individuals, those on restricted diets, elderly individuals, or patients with chronic illness.

Off-label or Clinically Accepted Uses:

• Post-bariatric surgery or gastrointestinal diseases:
  Prevention and correction of deficiencies due to malabsorption.
• Supportive care in chronic infections:
  Such as HIV/AIDS, tuberculosis, or inflammatory conditions to maintain adequate micronutrient status.
• Preventive use in populations with poor dietary diversity.

Adults (General and Pregnant/Lactating Women):

• 1 tablet or capsule orally once daily, preferably with food.
• UNIMMAP formulation contains 15 essential vitamins and minerals (e.g., Iron 30 mg, Folic Acid 400 mcg, Vitamin A 800 mcg, Zinc 15 mg).

Children (6 months to 12 years):

• Pediatric preparations (syrups, drops, powders) are dosed based on age and weight, typically once daily.

Elderly:

• Same adult dose; adjust for Vitamin D, B12, and calcium based on individual needs.

Renal/Hepatic Impairment:

• Use with caution if supplement includes potassium, magnesium, or fat-soluble vitamins. Monitor for accumulation.

Route of Administration:

• Oral only. Available as tablets, capsules, powders, syrups, or drops.

Multiple Micronutrient Supplements (MMS) restore and maintain essential nutrient levels required for numerous physiological functions. These include enzymatic reactions, red blood cell production, immune competence, cellular repair, fetal development, and bone health. Each component has a specific function: iron supports hemoglobin synthesis; folic acid and B12 promote DNA replication and neural tube closure; vitamin A ensures epithelial integrity and vision; vitamin D and calcium support bone formation; zinc aids in tissue healing and immune defense. The combination addresses concurrent micronutrient gaps for holistic physiological balance.

Absorption:

• Most vitamins and minerals are absorbed in the small intestine.
• Iron, calcium, and zinc absorption may be inhibited by phytates or other nutrients when co-administered.

Distribution:

• Fat-soluble vitamins (A, D, E, K) are stored in liver and adipose tissue.
• Water-soluble vitamins (B-complex, C) circulate freely; excess is excreted.

Metabolism:

• Some micronutrients (e.g., folate, vitamin D) undergo hepatic activation or hydroxylation.

Elimination:

• Water-soluble vitamins: excreted via urine.
• Fat-soluble vitamins: excreted in bile and feces.

Onset of Effect:

• Varies with nutrient. Hematologic improvement from iron or folate may take 2–4 weeks; neural development effects occur in early pregnancy.

Pregnancy:

• MMS are safe and recommended during pregnancy to reduce anemia and birth complications.
• Avoid excess Vitamin A (>10,000 IU daily) due to teratogenic risk.

Lactation:

• Safe during breastfeeding. Supports maternal recovery and improves micronutrient content in breast milk.

Caution:

• Use only formulations approved for pregnancy (e.g., UNIMMAP).
• Avoid megadoses unless clinically indicated.

• Primary Class: Nutritional Supplement
• Subclass: Multivitamin–Multimineral Preparation (UNIMMAP or similar)

• Known hypersensitivity to any component
• Hemochromatosis or iron overload (if iron-containing)
• Hypervitaminosis A or D
• Wilson’s disease (if copper-containing)
• Severe renal failure (if potassium- or magnesium-containing)

• Do not exceed recommended dosage to avoid vitamin toxicity.
• Iron-containing preparations may cause constipation, black stools, or GI irritation.
• High doses of Vitamin A or D can be harmful in pregnancy or liver disease.
• Use with caution in children — iron overdose can be fatal.
• Interactions with medications (e.g., antibiotics, levothyroxine) may reduce absorption of either agent.

Common:

• Gastrointestinal discomfort: nausea, bloating, constipation (especially due to iron)
• Metallic taste or discoloration of urine (e.g., from riboflavin)

Less Common:

• Rash or allergic reactions
• Diarrhea (due to magnesium or vitamin C)

Rare but Serious:

• Iron poisoning (especially in children)
• Hypervitaminosis A or D (if consumed in high doses for extended periods)

Timing:
Usually mild, dose-related, and resolve with food intake or dose adjustment.

• Iron, calcium, magnesium, zinc may reduce absorption of antibiotics (e.g., tetracyclines, quinolones); stagger administration.
• Levothyroxine: iron and calcium may reduce absorption; administer at least 4 hours apart.
• Antacids and PPIs: may impair absorption of iron and folate.
• No significant CYP450-mediated interactions reported.

• WHO/UNICEF/UNU (2021–2023): MMS (UNIMMAP formulation) recommended to replace iron–folic acid alone in antenatal care in low- and middle-income countries.
• Lancet (2021): Reported that MMS reduce risks of stillbirth, preterm birth, and low birth weight more effectively than IFA alone.
• Ongoing UNIMMAP revisions under review to enhance zinc and B12 content for regional needs.

• Temperature: Store at 15°C to 30°C (59°F–86°F)
• Humidity and Light: Keep in dry, airtight containers away from direct sunlight
• Handling Precautions:
• Keep out of reach of children due to iron toxicity risk
• Do not refrigerate unless specified
• Ensure cap is closed tightly after use
• Discard expired or degraded supplements