Zovia N

Approved Indications:

• Parenteral supplementation of essential vitamins (both water- and fat-soluble) in patients unable to meet nutritional requirements orally or enterally.
• Prevention and treatment of vitamin deficiencies in patients with prolonged illness, gastrointestinal disorders, surgery, trauma, sepsis, or during total parenteral nutrition (TPN).
• Nutritional support in critically ill or malnourished patients with increased metabolic demands.
• Postoperative recovery in cases where oral absorption is inadequate or contraindicated.

Clinically Accepted Off-label Uses:

• Nutritional support in cancer patients undergoing chemotherapy or radiotherapy.
• Management of malabsorption syndromes (e.g., Crohn’s disease, short bowel syndrome).
• Prevention of neurologic complications in chronic alcohol dependence (e.g., Wernicke’s encephalopathy).
• Supplementation in patients at risk of or recovering from refeeding syndrome.

Route: Intravenous (IV) infusion only

Adults:

• Usual dose: One vial of multivitamin (containing both water- and fat-soluble vitamins) diluted in 500–1000 mL of 0.9% Normal Saline
• Infuse over 6–12 hours once daily, based on clinical need

Pediatric Patients:

• Neonates and Infants: 0.5–1 mL/kg/day of multivitamin diluted in 0.9% Normal Saline (adjust total volume according to fluid requirements)
• Children (1–12 years): 1–2 mL/kg/day (maximum 5 mL/day), diluted in 250–500 mL of Normal Saline, infused over 6–12 hours

Elderly:

• Same as adult dosage; adjust based on comorbidities such as renal or cardiac impairment

Renal Impairment:

• Use cautiously; monitor for accumulation of fat-soluble vitamins (especially vitamins A and D)
• Adjust dosage or frequency if necessary

Hepatic Impairment:

• Use with caution; reduce dose if hepatic metabolism of fat-soluble vitamins is compromised
• Monitor liver function tests during prolonged use

Administration Notes:

• Use only after dilution
• Ensure compatibility before mixing with other IV medications
• Discard any unused portion
• Use an infusion pump for controlled administration

Multivitamin [Water & Fat Soluble] + Normal Saline provides a full spectrum of essential micronutrients that play critical roles in metabolic processes. Water-soluble vitamins (B-complex and C) act as coenzymes in carbohydrate, protein, and fat metabolism, supporting neurological function, energy production, and immune defense. Fat-soluble vitamins (A, D, E, K) are involved in vision, calcium regulation, antioxidant activity, and coagulation. Administered with isotonic saline, this formulation ensures immediate plasma availability, supporting nutritional repletion in patients with impaired oral or enteral absorption. It helps correct deficiencies and supports recovery in high-stress metabolic states.

Absorption:

• 100% bioavailable via IV infusion
• Immediate onset of action

Distribution:

• Water-soluble vitamins distribute rapidly in extracellular fluid and are not stored extensively
• Fat-soluble vitamins accumulate in the liver and adipose tissue

Metabolism:

• Water-soluble vitamins are minimally stored and either used in enzymatic reactions or excreted
• Fat-soluble vitamins are metabolized hepatically; some are converted to active forms

Elimination:

• Water-soluble: Excess excreted in urine
• Fat-soluble: Eliminated slowly via feces and bile; may accumulate with prolonged use

Half-life:

• Short for water-soluble (hours to a day); long for fat-soluble (days to weeks)

Pregnancy:

• Generally considered safe at recommended daily allowances
• Individual components (e.g., folic acid, vitamin D) are essential during pregnancy
• High-dose vitamin A should be avoided due to teratogenic potential

Lactation:

• Compatible with breastfeeding when used within recommended limits
• Vitamins may be excreted into breast milk in small amounts
• Avoid excessive cumulative dosing to prevent fat-soluble vitamin toxicity in infants

• Primary Class: Parenteral Nutritional Supplement
• Subclass: Combined Water- and Fat-Soluble Multivitamin with Isotonic Diluent

• Hypersensitivity to any component of the preparation (e.g., thiamine, polysorbate, preservatives)
• Hypervitaminosis A or D
• Conditions predisposing to fluid overload (e.g., congestive heart failure, renal failure)
• Severe hepatic insufficiency or cholestasis

• Monitor for allergic reactions, especially during the first dose
• Use caution in patients with renal or hepatic impairment
• Avoid concurrent use with other multivitamin preparations to prevent overdose
• Prolonged high-dose pyridoxine may lead to peripheral neuropathy
• Patients with fat malabsorption may require adjusted formulations or dosing
• Vitamin K content may affect anticoagulation in patients on warfarin

Common:

• Flushing, headache, nausea
• Mild irritation or pain at the injection site
• Yellow-orange discoloration of urine (due to riboflavin)

Less Common:

• Gastrointestinal discomfort
• Metallic taste
• Lightheadedness

Rare but Serious:

• Anaphylaxis (especially with thiamine)
• Hypervitaminosis A or D with prolonged high doses
• Vitamin B6-induced neuropathy (with prolonged or excessive use)
• Pulmonary edema or fluid overload in patients with cardiac or renal compromise

• Levodopa: Vitamin B6 (pyridoxine) may reduce effectiveness
• Warfarin: Vitamin K may reduce anticoagulant effect
• Alcohol: Increases demand for B-complex vitamins
• No significant CYP450 enzyme interactions
• Ensure compatibility when mixed with other IV medications

• ASPEN (American Society for Parenteral and Enteral Nutrition) 2024 recommends inclusion of both water- and fat-soluble vitamins in all TPN regimens
• WHO guidelines highlight the role of parenteral multivitamins in severe malnutrition and critically ill patients
• Reformulated preservative-free versions now available to reduce hypersensitivity risks
• New guidelines recommend early vitamin support in ICU patients with feeding intolerance

• Store at 15°C to 25°C (59°F to 77°F)
• Protect from light; sensitive vitamins (A, D, B2, C) degrade upon exposure
• Do not freeze
• Prepare fresh solution immediately before administration
• Use within 24 hours of mixing
• Keep vials tightly sealed until use