Precare

A. Approved Indications

• Prenatal Nutritional Support
  Indicated for nutritional supplementation before conception, during pregnancy, and postpartum (including lactation) to prevent or treat vitamin and mineral deficiencies that may affect maternal and fetal health.

B. Clinically Accepted Off-label Uses

• Hyperemesis Gravidarum: As supportive therapy alongside antiemetics
• Prevention of Neural Tube Defects (e.g., Spina Bifida) in high-risk pregnancies (especially folic acid component)
• Post-bariatric Surgery Pregnancy Support
• Micronutrient Replenishment in Adolescents during Pregnancy

Route of Administration: Oral
Dosage Form Available in Bangladesh (per Medex.com.bd):

• A–Z tablets and capsules containing a full range of essential vitamins and minerals, including folic acid, iron, calcium, DHA, iodine, zinc, etc.

Adults (Pregnant and Lactating Women):

• Typical dose: 1 tablet or capsule once daily, taken with food to improve absorption and reduce GI upset
• May be started at least 1 month prior to conception and continued throughout pregnancy and breastfeeding

Pediatric / Adolescent Pregnancies (Age 13–18):

• Same adult dose; ensure iron and folic acid content meets recommended dietary allowance (RDA)

Elderly Women of Childbearing Age:

• Use with caution; no special adjustments required if pregnancy is established

Renal/Hepatic Impairment:

• Use with caution; avoid preparations with high doses of fat-soluble vitamins (A, D, E, K) in patients with impaired hepatic or renal function

Administration Tips:

• Take with meals to minimize nausea and promote better absorption
• Avoid concurrent administration with high-calcium foods if the formulation contains iron
• Do not exceed the prescribed dose to prevent hypervitaminosis or mineral toxicity

A–Z prenatal multivitamins and multiminerals function by supplementing essential micronutrients that support maternal metabolic demands and fetal development. Each component contributes uniquely:

• Folic acid reduces neural tube defect risk by supporting DNA/RNA synthesis and methylation
• Iron prevents maternal anemia and supports fetal oxygenation
• Calcium and Vitamin D aid fetal skeletal development
• Iodine supports fetal neurodevelopment and thyroid function
• DHA (if included) aids brain and retinal development
• Zinc, B-complex vitamins, Vitamin C, and E play roles in immunity, cellular function, and antioxidant protection
  This combined supplementation improves pregnancy outcomes, supports maternal health, and promotes fetal growth and development.

Given that this is a multi-ingredient supplement, pharmacokinetics vary by nutrient:

• Absorption:
• Water-soluble vitamins (B-complex, C) are readily absorbed in the small intestine
• Fat-soluble vitamins (A, D, E, K) require bile for absorption
• Minerals like iron and calcium are absorbed variably based on gastric pH and presence of food
• Distribution:
• Nutrients are distributed via plasma proteins and stored in tissues (e.g., Vitamin A in liver, calcium in bone)
• Metabolism:
• Most vitamins undergo hepatic metabolism; folic acid is converted to active tetrahydrofolate forms
• Excretion:
• Water-soluble vitamins are excreted renally
• Excess iron is stored in ferritin; calcium and vitamin D metabolites excreted via bile and urine

• Pregnancy:
  Most ingredients are considered Category A or B, meaning no demonstrated fetal risk at recommended doses. Excessive intake of Vitamin A (>10,000 IU/day) is teratogenic and must be avoided.
• Lactation:
  Safe and recommended during breastfeeding to support maternal and infant nutrient requirements.
  Vitamins and minerals pass into breast milk in small amounts; typically beneficial unless consumed in excessive doses.
• Recommendation:
  Use prenatal vitamins with safe vitamin A levels (<5,000 IU/day as preformed retinol) to avoid teratogenic risk

• Primary Therapeutic Class: Nutritional Supplement
• Subclass: Prenatal Multivitamin–Multimineral Combination

• Hypersensitivity to any component of the formulation
• Vitamin A toxicity (especially in liver disease or prior high-dose use)
• Hemochromatosis or hemosiderosis (iron overload)
• Severe renal impairment (may accumulate minerals like magnesium, potassium, or vitamin D)
• Concomitant use of other high-dose supplements without medical supervision

• Hypervitaminosis Risk:
  Avoid excessive intake of fat-soluble vitamins (A, D, E, K)
• Iron Overload:
  Monitor for signs of iron toxicity, especially in patients with hereditary hemochromatosis
• Gastrointestinal Irritation:
  Iron and magnesium may cause constipation, diarrhea, or stomach discomfort
• Allergic Reactions:
  Rare; may occur due to coloring agents, excipients, or specific nutrients
• Drug-Nutrient Interactions:
  Caution when co-administered with certain medications (see section 10)
• Monitoring Needs:
  Long-term use may warrant lab monitoring of serum ferritin, hemoglobin, calcium, or vitamin D if clinically indicated

Common:

• Gastrointestinal:
  Nausea, constipation, vomiting, diarrhea, metallic taste (especially from iron)
• Neurologic:
  Headache, dizziness (rare)
• Dermatologic:
  Rash or itching (infrequent, usually due to preservatives or excipients)

Rare or Serious:

• Iron toxicity (with overdose or accidental ingestion by children)
• Hypercalcemia or hypervitaminosis D in patients with kidney impairment
• Anaphylaxis (extremely rare, but reported with hypersensitivity)

Timing:

• Side effects often occur shortly after ingestion; GI side effects may improve with food or time

• Iron + Antacids or Calcium:
  Reduced absorption; administer 2 hours apart
• Folic Acid + Methotrexate/Phenytoin:
  May reduce effectiveness of these medications
• Vitamin K + Warfarin:
  Antagonizes warfarin effect; monitor INR if co-administered
• Calcium + Tetracyclines/Levothyroxine:
  Reduced absorption of both; separate administration by at least 4 hours
• Enzyme Systems:
  Most components do not affect CYP450 pathways
  No induction or inhibition expected at nutritional doses

• WHO & CDC Recommendations (2023):
  Prenatal supplementation with iron and folic acid continues to be a global standard to reduce maternal anemia and neural tube defects.
• USPSTF Guidelines (2023):
  Recommends 400–800 mcg folic acid daily in all women of reproductive age, ideally through prenatal supplementation.
• ACOG (2024):
  Recommends comprehensive prenatal multivitamin–multimineral use throughout pregnancy and postpartum, emphasizing iron, folate, calcium, and iodine.
• Emerging Practice:
  DHA inclusion in prenatal formulations is encouraged due to benefits in neurodevelopment.

• Temperature: Store at 20°C to 25°C (68°F to 77°F)
• Humidity: Protect from moisture and store in tightly closed containers
• Light Protection: Store in original packaging away from direct sunlight
• Handling Instructions:
• Keep out of reach of children to avoid accidental overdose, especially iron-containing formulations
• Do not use after expiration date
• No refrigeration or reconstitution required