Becosules

• Prevention and Treatment of Micronutrient Deficiencies
  Indicated for combined deficiencies of B‑complex vitamins (B₁, B₂, B₃, B₅, B₆, B₇, B₉, B₁₂) and vitamin C caused by malnutrition, malabsorption, chronic disease, alcoholism, or physiological stress.
• Peripheral Neuropathy and Neuralgia
  Used to support nerve health in diabetic neuropathy, alcoholic neuropathy, trigeminal neuralgia, and post-herpetic neuralgia.
• Anemia Management
  Effective in megaloblastic or macrocytic anemia due to folate or B₁₂ deficiency.
• Elevated Homocysteine
  Employed to reduce homocysteine levels with B₆, B₉, and B₁₂, potentially lowering cardiovascular risk.
• Immune Function and Wound Healing
  Vitamin C enhances collagen production and immunity; B‑vitamins support tissue repair post-surgery, trauma, burns, or infection.
• Support in Pregnancy and Lactation
  Helps meet increased nutritional needs and prevent neural tube defects (folate).

Route: Oral (tablets, capsules, liquids). Injectable forms available for clinical use.

Adults:

• B₁ (thiamine): 1.1–1.5 mg
• B₂ (riboflavin): 1.1–1.7 mg
• B₃ (niacinamide): 14–20 mg
• B₅ (pantothenic acid): 5–10 mg
• B₆ (pyridoxine): 2–10 mg (up to 100 mg/day therapeutically)
• B₇ (biotin): 30–100 µg
• B₉ (folic acid): 400 µg (higher during pregnancy or deficiency)
• B₁₂ (cyanocobalamin): 2.4–6 µg (higher doses for deficiency)
• Vitamin C (ascorbic acid): 60–500 mg based on need

Pediatrics:
Adjusted per age and weight; pediatric formulas are available.

Elderly:
Typically same dosing; monitor for malabsorption or deficiency.

Renal/Hepatic Impairment:
Use cautiously. Reduce pyridoxine or niacin in severe dysfunction; monitor levels.

Administration Tips:
Take with meals. Injectable forms used for malabsorption or severe deficiency.

This combination provides water-soluble vitamins essential as enzymatic cofactors in energy metabolism (carbohydrates, fats, proteins), DNA synthesis, and neural function (B‑complex), along with antioxidant and collagen-synthesis support (vitamin C). B₉ and B₁₂ enable red blood cell production and lower homocysteine; B₁, B₆, and B₁₂ support nerve health and neurotransmitter synthesis. Together, they restore nutrient balance, support immune and neural repair, and enhance wound healing.

• Absorption: Rapidly absorbed in the small intestine; absorption increases with food.
• Distribution: B₁₂ stored in liver; other B‑vitamins and vitamin C circulate primarily in plasma and tissues with limited storage.
• Metabolism: Converted intracellularly to active forms (e.g., thiamine pyrophosphate, pyridoxal phosphate). Vitamin C is metabolized to dehydroascorbic acid.
• Excretion: Excess water-soluble vitamins excreted via urine; B₁₂ is minimally excreted and stored.
• Half-life: B₁₂: days–weeks; B₆, B₉, vitamin C: hours–days.

• Pregnancy: Generally considered safe at recommended doses. Folic acid (400–800 µg/day) is essential for preventing neural tube defects. No known teratogenicity at standard intake.
• Lactation: Vitamins pass into breast milk, supporting infant development. Supplementation is beneficial.
• Caution: High-dose pyridoxine (>100 mg/day) should be used only under medical supervision.

• Primary Class: Water-soluble vitamin combination.
• Subclass: B‑complex vitamins + vitamin C (ascorbic acid).
• Pharmacologic Category: Micronutrient supplement.

• Hypersensitivity to any component.
• High-dose pyridoxine contraindicated in patients with pre-existing sensory neuropathy.
• Renal failure requiring pyridoxine or niacin reduction.
• Measles-related immunization without medical supervision (due to folic acid’s potential interactions).

• Pyridoxine >100 mg/day: Risk of peripheral neuropathy.
• Niacin high dose: May cause flushing, hepatotoxicity, hyperuricemia, hyperglycemia.
• Renal/hepatic disease: Monitor for vitamin accumulation.
• Allergic reactions: Rare; discontinue if occur.
• Injectable use: Ensure aseptic technique to prevent contamination.

Common:

• Mild gastrointestinal discomfort, nausea
• Headache
• Niacin-induced flushing

Serious/Rare:

• Neuropathy (high-dose B₆)
• Hepatotoxicity (excess niacin)
• Hypersensitivity reactions
• Urinary stones (excess vitamin C in predisposed individuals)

Dose-dependent: Flushing and hepatotoxicity linked to niacin dosage; neuropathy related to B₆ dose and duration.

• Levodopa: High-dose B₆ decreases efficacy by enhancing peripheral metabolism.
• Phenytoin/Phenobarbital: May lead to B-vitamin depletion; supplementation recommended.
• Isoniazid: Depletes B₆; prophylactic pyridoxine needed.
• Methotrexate: Folate antagonist; folic acid supplementation reduces toxicity.
• Oral contraceptives: May reduce B-vitamin levels.
• Alcohol: Inhibits absorption and increases excretion of B-vitamins.

• WHO/CDC: Continued recommendation of folate for women of reproductive age.
• FDA advisory: Caution against high-dose pyridoxine and niacin due to adverse risk profiles.
• Clinical practice trends: Shift toward monitoring micronutrient status in elderly and chronic disease patients; widespread use of low-dose B‑complex + C for symptom management.

• Store at 20°C–25°C (68°F–77°F).
• Protect from moisture, heat, and direct sunlight.
• Keep container tightly closed and away from children.
• No refrigeration required for oral formulations.