I Care

Approved and Clinically Accepted Uses:

• Age-related macular degeneration (AMD):
• As part of formulations (e.g., AREDS/AREDS2) shown to reduce progression of intermediate to advanced AMD.
• Nutritional Supplementation:
• To prevent or correct deficiencies in Vitamin C, Vitamin E, copper, and zinc caused by inadequate diet, malabsorption, or increased physiological needs.
• Ocular and Retinal Health:
• Lutein and zinc support macular pigment density, visual acuity, and protect against oxidative damage in retina.
• General Antioxidant and Immune Support:
• Combined use provides broad antioxidant defenses and supports immune cell function.

Off‑Label, Clinically Accepted Uses:

• Healthy aging support and skin photoprotection (Vitamin C + E synergy).
• Cardiovascular risk modulation by oxidative stress reduction.
• Supportive adjunct in chronic diseases where oxidative stress is implicated (e.g. diabetes, neurodegeneration).

Adults (Typical Daily Supplement):

• Vitamin C: 250–500 mg
• Vitamin E (α‑tocopherol): 200–400 IU
• Lutein: 10–20 mg
• Zinc: 25–80 mg (commonly 40 mg)
• Copper: 1–2 mg (to balance zinc supplementation and prevent copper deficiency)

These levels align with AREDS2 formulation.

Elderly:

• Same as adult dosing; well tolerated. Monitoring recommended if intake exceeds RDA over long term.

Pediatrics:

• Not typically administered as combination formulation unless under medical guidance for deficiencies.

Renal/Hepatic Impairment:

• Vitamin C: Use lower dose (≤250 mg/day) if renal insufficiency (reduce oxalate risk).
• Copper & Zinc: Supplement cautiously in severe hepatic disease due to copper retention risk. No formal dosage adjustment, but monitor levels.

Administration:

• Orally with food to enhance absorption and reduce GI irritation.
• Preferably once daily, preferably with meals (fat improves vitamin E and lutein absorption).
• Duration: Indicated for long-term, often months to years, especially for AMD support.

• Vitamin C acts as a water-soluble antioxidant, regenerating other antioxidants (including vitamin E), enhancing collagen synthesis, and supporting immune function.
• Vitamin E, a lipid-soluble antioxidant, protects cell membranes and lipoproteins from oxidative peroxidation.
• Lutein is a carotenoid concentrated in the macula; it filters blue light and neutralizes oxidative stress in retinal tissues.
• Zinc serves as a cofactor in antioxidant enzymes like superoxide dismutase; it also stabilizes retinal cell membranes and supports immune function.
• Copper is required for essential enzymes (such as ceruloplasmin) involved in iron metabolism and antioxidant defense; it prevents zinc-induced copper deficiency.

Together, this combination provides synergistic protection against oxidative damage, supports ocular health, and maintains antioxidant enzyme systems.

• Vitamin C: Rapid GI absorption (active transport), peak 1–2 h post-dose; bioavailability declines at higher doses; half-life ~2 h; excreted renally as ascorbate or oxalate.
• Vitamin E: Fat-soluble; absorbed via lymphatics; stored in adipose tissue and liver; half-life ~44 h; eliminated mainly via bile/feces.
• Lutein: Lipid-soluble; absorbed with dietary fat; distributed to retina and adipose tissue; hepatic metabolism; excreted in bile.
• Zinc: Absorbed in small intestine; binds albumin and metallothionein; excreted in feces primarily; half-life variable depending on body pool.
• Copper: Absorbed in small intestine; bound to ceruloplasmin for systemic distribution; excreted in bile.

• Vitamin C & E: Considered safe at recommended supplementation doses during pregnancy and lactation. High-dose vitamin E (>400 IU/day) should be avoided due to possible bleeding risk.
• Lutein: Generally considered safe; limited formal data in pregnancy but included in prenatal formulations.
• Zinc & Copper: Essential trace elements; recommended at dietary levels during pregnancy. High doses should be avoided.
• Recommendation: Avoid excessive intake beyond pregnancy RDA unless supervised by a healthcare provider.

• Nutritional Supplement – Multivitamin/Mineral with Antioxidants and Ocular Support

• Hypersensitivity to any component.
• Wilson’s disease or copper overload disorders.
• Severe renal impairment with risk of oxalate nephropathy (high-dose Vitamin C).
• History of kidney stones related to oxalate (Vitamin C) or excessive zinc (nephrotoxic risk).

• Renal stone risk: Vitamin C at high doses may increase oxalate.
• Copper overload: Monitor in hepatic dysfunction—copper accumulation possible.
• Bleeding risk: Vitamin E at high doses may enhance anticoagulation; caution with warfarin or antiplatelets.
• Zinc–copper balance: Excessive zinc without copper can lead to copper deficiency anemia or neutropenia.
• Monitoring: Periodic assessment of renal function, serum zinc and copper levels if long-term high-dose usage.

Common (usually mild):

• GI upset or mild nausea (Vitamin C)
• Diarrhea at high Vitamin C doses
• Soft stool/fatty stools (high-dose vitamin E)

Less Common:

• Skin flushing (Vitamin E)
• Metallic taste sensation (zinc)
• Minor visual disturbances (rare lutein-associated)

Rare and Serious:

• Oxalate nephrolithiasis (high-dose Vitamin C)
• Hemorrhagic events with supra‑physiologic vitamin E
• Copper deficiency anemia or neutropenia if zinc excess
• Allergic reactions (rare e.g., rash, angioedema)

Onset typically correlates with dose and duration—GI effects in days; metabolic imbalances over weeks/months.

• Vitamin C: Enhances iron absorption; may increase aluminum absorption from antacids.
• Vitamin E: May potentiate anticoagulants (warfarin, clopidogrel); reduce platelet aggregation.
• Zinc: High doses reduce absorption of copper, iron, and certain antibiotics (e.g., quinolones, tetracyclines)—administer separate by ≥2 hours.
• Copper: Enhances absorption of iron; monitor chelating agents or penicillamine interactions.
• Food/Alcohol: Fat enhances Vitamin E and lutein absorption; chronic alcohol may impair zinc absorption and metabolism of antioxidants.

No significant CYP450-mediated interactions.

• AREDS2 study (recent guidelines): Combination of Vitamin C (500 mg), Vitamin E (400 IU), zinc (80 mg), copper (2 mg), lutein (10 mg), and zeaxanthin shown to reduce progression of intermediate-to-advanced AMD.
• WHO/National guidance: Emphasizes antioxidant supplementation only in deficiency or specific AMD risk populations; no broad recommendation for general population.
• Regulatory: No new restrictions or contraindications added; ongoing interest in lutein and antioxidant roles in aging.

• Tablets/Capsules: Store at 15–25 °C (59–77 °F); excursions allowed 15–30 °C (59–86 °F); protect from humidity and light; keep in tightly closed container.
• Effervescent Forms: Use immediately after opening; store in dry place.
• Handling: Do not freeze. Keep out of reach of children.
• Reconstitution/Refrigeration: Not required. Stable at room temperature when unexposed to moisture.