Zovia D

Approved Medical Uses:

• Prevention and treatment of vitamin deficiencies in patients unable to maintain adequate oral intake due to illness, surgery, trauma, or malabsorption.
• Parenteral nutrition support in patients receiving total parenteral nutrition (TPN), to fulfill daily vitamin requirements.
• Adjunctive therapy in conditions such as alcoholism, chronic liver disease, or gastrointestinal disorders where absorption is impaired.
• Post-operative nutritional support, including patients recovering from major surgery or burns.
• Prolonged fasting, starvation, or cachexia in critically ill patients.

Clinically Accepted Off-label Uses:

• Supportive therapy in cancer patients receiving chemotherapy or radiotherapy.
• Vitamin supplementation in elderly, frail, or immobilized patients with poor nutritional status.
• Repletion of vitamin levels in ICU or emergency settings, especially in multi-organ failure or septic shock.

Route of Administration: Intravenous (IV) infusion only

Adults:

• Recommended dose: One IV infusion containing multivitamins + 5% dextrose daily
• Usual volume: 500 mL to 1000 mL infused over 6–8 hours
• Adjust based on clinical condition, fluid status, and vitamin requirements

Pediatric Patients:

• Neonates and Infants: Dose individualized based on weight and clinical need. Typical volume: 100–250 mL/day
• Children: 250–500 mL/day infused over 6–12 hours
• Always use pediatric-specific multivitamin preparations

Elderly:

• Same as adult dosing. Monitor for comorbidities (e.g., renal or cardiac impairment) requiring slower infusion or dose adjustments

Renal Impairment:

• Adjust dose to avoid accumulation of fat-soluble vitamins (particularly vitamins A and D)
• Monitor fluid status and electrolytes carefully

Hepatic Impairment:

• Use with caution; reduce doses of hepatically metabolized vitamins (e.g., Vitamin A)
• Monitor liver function tests during prolonged use

Administration Instructions:

• Administer slowly via controlled infusion pump
• Do not mix with other medications unless compatibility is confirmed
• Use immediately after preparation; discard unused portion

Multivitamin [Water & Fat Soluble] + 5% Dextrose provides essential vitamins and carbohydrates required for normal metabolic function and cellular repair. The water-soluble vitamins (e.g., B-complex and C) act as cofactors in enzymatic reactions related to energy metabolism, hematopoiesis, and neurotransmitter synthesis. The fat-soluble vitamins (A, D, E, and K) play critical roles in vision, bone mineralization, antioxidant defense, and blood coagulation. The addition of 5% dextrose supplies a readily available source of glucose, preventing catabolism, supporting cellular energy needs, and promoting vitamin utilization in malnourished or acutely ill patients.

Absorption: Not applicable (IV administration bypasses GI absorption)

Distribution:

• Water-soluble vitamins distribute freely in plasma and tissues, with minimal storage
• Fat-soluble vitamins accumulate in liver and adipose tissue
• Dextrose distributes throughout total body water

Metabolism:

• B vitamins and Vitamin C are metabolized in the liver and tissues
• Vitamins A, D, E, and K undergo hepatic metabolism
• Dextrose is metabolized via glycolysis and enters the Krebs cycle

Elimination:

• Water-soluble vitamins: Renally excreted; excess eliminated rapidly
• Fat-soluble vitamins: Slow elimination; can accumulate with prolonged use
• Dextrose: Metabolized to CO₂ and water

Half-life:

• Water-soluble vitamins: Hours to a day
• Fat-soluble vitamins: Days to weeks
• Dextrose: Very short, rapidly utilized

Bioavailability: 100% via IV route

Pregnancy:

• No specific FDA pregnancy category for this combination.
• Generally considered safe when used at therapeutic doses.
• Caution with Vitamin A, as high doses may be teratogenic.

Lactation:

• Most vitamins are excreted into breast milk.
• Safe when used within normal therapeutic ranges.
• Monitor infant for signs of vitamin excess if high-dose therapy is given to mother.

• Primary Class: Parenteral Multivitamin Supplement
• Subclass: Water- and Fat-soluble Vitamin Combination with Dextrose Carrier

• Known hypersensitivity to any vitamin component or formulation excipients
• Hypervitaminosis A or D
• Severe hepatic impairment or active liver disease (risk of vitamin toxicity)
• Fluid overload or pulmonary edema (due to dextrose infusion)
• Glucose intolerance or uncontrolled hyperglycemia

• Monitor closely in renal or hepatic impairment; adjust doses of fat-soluble vitamins
• Vitamin A toxicity risk with prolonged or high-dose therapy
• Hyperglycemia risk in diabetic patients due to 5% dextrose content
• Risk of anaphylaxis or hypersensitivity, especially from thiamine or preservatives
• Monitor liver enzymes, renal function, glucose levels, and vitamin levels during long-term use
• Avoid rapid infusion to reduce risk of metabolic disturbances

Common Adverse Effects:

• Infusion site pain or thrombophlebitis
• Nausea, metallic taste
• Mild rash or flushing

Uncommon to Rare:

• Headache, dizziness
• Diarrhea or abdominal discomfort
• Elevated liver enzymes

Serious or Rare Effects:

• Anaphylactic reactions
• Hypervitaminosis A or D with prolonged use
• Hepatic dysfunction
• Electrolyte imbalance or fluid overload

• Levodopa: High doses of Vitamin B6 may reduce its efficacy
• Warfarin: Vitamin K can antagonize anticoagulant effect
• Orlistat, Cholestyramine: Reduce absorption of fat-soluble vitamins
• Antibiotics (e.g., tetracycline): May bind with vitamins and reduce their absorption
• Enzyme interaction: Some fat-soluble vitamins are metabolized via CYP450 enzymes (especially CYP3A4); caution with inducers/inhibitors

• WHO (2024) and ASPEN recommend routine parenteral multivitamin use in all patients receiving TPN to prevent deficiencies
• EMA advises regular monitoring of vitamin A levels in long-term parenteral nutrition
• New preservative-free formulations have been developed to reduce risk of hypersensitivity reactions
• Clinical guidelines updated to prioritize early micronutrient support in ICU and surgical patients

• Store below 25°C
• Protect from light (especially for vitamins A, D, E, and K)
• Do not freeze
• Use immediately after opening or reconstitution
• Discard any unused portion after 24 hours
• For compounded solutions: Follow specific manufacturer instructions for storage and handling