AtoZin

Approved and Clinically Accepted Uses:

• Prevention and treatment of nutritional deficiencies in individuals with inadequate dietary intake, chronic illness, or during recovery.
• Pregnancy and lactation: To supplement increased nutritional needs, especially folic acid, iron, calcium, iodine, and vitamin D.
• Geriatric patients: To maintain micronutrient balance, especially B12, vitamin D, and calcium, due to age-related absorption decline.
• Pediatric populations: For children with selective eating habits, growth concerns, or chronic conditions impairing nutrient absorption.
• Convalescence and post-surgical recovery: To support wound healing and tissue repair.
• Individuals with restrictive diets: Including vegans, vegetarians, and those with food allergies.
• Patients with chronic diseases: Such as malabsorption syndromes, liver disease, renal disease (low-mineral formulation), or alcohol dependence.

General Adult Dose:

• Oral: 1 tablet or capsule once daily, preferably with food.
• Formulation: Film-coated tablet or soft gelatin capsule containing 100% or more of the RDA for essential vitamins and minerals.

Pediatric Dose:

• 4–12 years: ½ to 1 chewable tablet daily, or as directed.
• <4 years: Pediatric liquid or drops, dose based on weight and formulation.

Pregnant & Lactating Women:

• 1 tablet or capsule daily, ensuring it contains:
• Folic acid: 400–800 mcg
• Iron: 27 mg
• Calcium: 1000 mg
• Vitamin D: 600–800 IU
• Iodine: 150 mcg

Geriatric Dose:

• 1 tablet daily with enhanced B12 (at least 25–100 mcg) and vitamin D (800–1000 IU).

Special Populations:

• Renal impairment: Use low-mineral formulations; monitor electrolytes.
• Hepatic impairment: No specific adjustment, but avoid high-dose fat-soluble vitamins.

Administration Route:

• Oral; swallow whole with water. Liquid and injectable forms available for patients with swallowing difficulties or malabsorption.

Multivitamin and multimineral preparations act by replenishing essential micronutrients that serve as coenzymes, cofactors, and antioxidants in metabolic reactions. Fat-soluble vitamins (A, D, E, K) regulate vision, calcium metabolism, antioxidant defense, and coagulation. Water-soluble vitamins (B-complex, C) are vital for energy metabolism, hematopoiesis, and immune function. Minerals such as iron, zinc, selenium, and magnesium contribute to enzymatic activity, oxygen transport, antioxidant defense, and cellular signaling. The combined effect supports normal physiological functioning, tissue repair, and disease prevention.

• Absorption: Water-soluble vitamins are absorbed in the small intestine by active transport or diffusion. Fat-soluble vitamins require bile salts for emulsification. Mineral absorption varies by type (e.g., calcium and iron are tightly regulated).
• Distribution: Water-soluble vitamins distribute in body fluids and are not stored significantly. Fat-soluble vitamins and some minerals (e.g., iron) accumulate in tissues.
• Metabolism: Most vitamins are metabolized in the liver to active or storage forms. Vitamin D undergoes hydroxylation in the liver and kidney.
• Excretion: Water-soluble vitamins are excreted primarily via urine. Fat-soluble vitamins and minerals are excreted via bile and feces.
• Half-life: Varies widely — hours for vitamin C; weeks to months for vitamin D and B12.

• Pregnancy: Multivitamin & multimineral preparations used in pregnancy are considered safe and beneficial when dosed appropriately. Excess preformed vitamin A (>10,000 IU/day) should be avoided due to teratogenicity.
• Lactation: Most components are excreted in breast milk in small amounts and are generally safe. Nutrients such as iodine, vitamin D, and B12 are beneficial to infants when transferred via milk.
• Caution: High-dose formulations should be avoided unless prescribed. Use pregnancy-specific formulations for safety.

• Primary Class: Vitamin and Mineral Supplement
• Subclass: Multivitamin-Multimineral Combination (Comprehensive A–Z Formulation)

• Hypersensitivity to any component of the formulation
• Hypervitaminosis A, D, or E
• Hemochromatosis or other iron overload disorders (in iron-containing formulations)
• Hypercalcemia or hypercalciuria
• Children under 4 years using adult-dose preparations
• Severe renal failure (especially if containing high-dose electrolytes or minerals)

• Pediatric Risk: Iron overdose is a leading cause of pediatric poisoning — keep out of children's reach.
• Fat-Soluble Vitamin Toxicity: Long-term excessive use may cause toxicity (e.g., vitamin A hepatotoxicity or hypercalcemia from excess vitamin D).
• Mineral Overload: Monitor in patients with renal impairment or those on other mineral supplements.
• Drug Excipients: Some preparations contain colorants, preservatives, or allergens (e.g., soy, gelatin).
• Chronic Use: Not a substitute for a balanced diet; excessive or unmonitored long-term use should be avoided.
• Monitoring: Recommended for iron, vitamin D, and B12 levels in long-term users or special populations.

Common:

• Gastrointestinal: Nausea, constipation, diarrhea, stomach upset
• Metallic taste or unpleasant aftertaste

Less Common:

• Skin rash, itching, or flushing (e.g., from niacin)
• Headache or dizziness
• Dark-colored stools (especially with iron)

Serious (Rare):

• Hypersensitivity reactions
• Iron overdose (especially in children)
• Hypervitaminosis A or D with chronic high doses
• Electrolyte imbalance with mineral overuse

Onset & Severity:

• Mild effects often occur early in therapy and may resolve with continued use or food co-administration.
• Severe reactions are dose-related and usually arise from misuse or accidental overdose.

• Iron and calcium: Decrease absorption of tetracyclines, fluoroquinolones, and levothyroxine.
• Folic acid: May reduce serum levels of anticonvulsants like phenytoin.
• Vitamin K: May reduce effectiveness of warfarin.
• Magnesium and zinc: May impair antibiotic absorption if taken concurrently.
• Cholestyramine and orlistat: May reduce fat-soluble vitamin absorption.
• Alcohol: Chronic use may interfere with absorption/metabolism of several vitamins, especially B1, B6, and folate.

• Recent evaluations confirm multivitamins may reduce risk of specific deficiencies in targeted populations (e.g., pregnancy, elderly), but routine use in healthy adults offers limited long-term benefit.
• Updated recommendations emphasize individualized supplementation, especially for vitamin D, folate, and B12.
• Newer A–Z formulations now include lutein, lycopene, omega-3s, and probiotics for added value in eye health and immune support.

• Store in a cool, dry place at 20–25°C (68–77°F).
• Protect from moisture, light, and heat.
• Do not refrigerate unless specified by manufacturer (especially for liquid or reconstituted forms).
• Keep the container tightly closed.
• Keep out of reach of children — especially important for iron-containing formulations.
• Shake liquid preparations before use and use within labeled expiration period.