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1 increases in deficiency states. Absorption of some lipid-soluble vitamins may require
bile acids.
PDF Page #1
MULTIPLE VITAMINS Distribution: Widely distributed; cross the placenta and enter breast milk. Fat-sol-
uble vitamins (A, D, E, and K) are stored in fatty tissues and the liver.
multiple vitamins (oral) Metabolism and Excretion: Utilized in various biologic processes. Excess
Adavite, Certagen, Dayalets, Hexavitamin, LKV Drops, Multi-75, Multi-Day, Nutrox, amounts of water-soluble vitamins (B vitamins, vitamin C, and folic acid) are ex-
One-A-Day, Optilets, Poly-Vi-Sol, Quintabs, Ru-lets, Sesame Street Vitamins, creted unchanged by the kidneys.
Sigtab, Syrvite, Tab-A-Vite, Therabid, Theragran, Thera Multi-Vitamin, Theravee, Half-life: Unknown.
Theravim, Theravite, Therems, Unicaps, Vita-Bob, Vita-Kid, Zymacap TIME/ACTION PROFILE
multivitamin infusion (intravenous) ROUTE ONSET PEAK DURATION
B complex with C and B, Cernevit-12, Multi Vitamin Concentrate, M.V.I.-12, M.V.I. PO unknown unknown unknown
Pediatric IV unknown unknown unknown
Classification Contraindications/Precautions
Therapeutic: vitamins Contraindicated in: Hypersensitivity to preservatives, colorants, or additives, in-
Pregnancy Category UK cluding tartrazine, saccharin, and aspartame (oral forms); Some products contain
alcohol and should be avoided in patients with known intolerance.
Use Cautiously in: Patients with anemia of undetermined cause.
Indications
PO: Treatment and prevention of vitamin deficiencies. Special formulations are avail- Adverse Reactions/Side Effects
able for patients with particular needs, including: Prenatal multiple vitamins (with In recommended doses, adverse reactions are extremely rare GU: urine discolor-
larger doses of folic acid), Preconceptional multiple vitamins, Multiple vitamins with ation (preparations with B vitamins). Misc: allergic reactions to preservatives, addi-
iron, Multiple vitamins with fluoride, Multiple vitamins with other minerals or trace tives, or colorants.
elements. IV Treatment and prevention of vitamin deficiencies in patients who are un- Interactions
able to ingest oral feedings or vitamins. Drug-Drug: Large amounts of vitamin B may interfere with the beneficial effect of
Action levodopa.
Contain fat-soluble vitamins (A, D, and E) and most water-soluble vitamins (B-com- Route/Dosage
plex vitamins B1, B2, B3, B5, B6, B12, vitamin C, biotin, and folic acid). These vitamins PO (Adults and Children): 1 dose unit (tablet/capsule/dropperful)/day or amount
are a diverse group of compounds necessary for normal growth and development. recommended by individual manufacturer.
Many act as coenzymes or catalysts in numerous metabolic processes. Liquid prod- IV (Adults and Children): Amount sufficient to meet RDA for age group. Usually
ucts do not contain folic acid. Therapeutic Effects: PO: Prevention of deficiency added to large-volume parenteral or total parenteral nutrition (hyperalimentation)
or replacement in patients whose nutritional status is questionable. IV: Replacement solution.
in patients who are unable to ingest oral feedings or vitamins.
NURSING IMPLICATIONS
Pharmacokinetics Assessment
Absorption: Well absorbed from the GI tract after oral administration; some pro- ● Assess patient for signs of nutritional deficiency before and throughout therapy.
cesses are active, some are passive. Absorption of water-soluble vitamins generally Patients at risk include geriatric patients and those who are debilitated, burned, or
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 bine, folic acid, furosemide, gentamicin, glycopyrrolate, heparin, hydrocortisone,
imipenem cilastatin, indomethacin, isoproterenol, ketorolac, labetalol, lidocaine,
unable to take oral nutrition and those with malabsorption syndromes or chronic magnesium sulfate, mannitol, meperidine, metaraminol, methicillin, methox- PDF Page #2
alcoholism. amine, methyldopate, methylprednisolone, metoclopramide, metoprolol, micon-
● Toxicity and Overdose: Toxicity rarely occurs with multivitamin preparations azole, midazolam, minocycline, morphine, nafcillin, nalbuphine, naloxone, nitro-
because of the small amounts per unit of fat-soluble vitamins. For symptoms, see prusside, norepinephrine, ondansetron, oxacillin, oxytocin, papaverine,
individual vitamin entries. penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentol-
● If overdose occurs, treatment includes induction of emesis or gastric lavage, cal- amine, phenylephrine, phytonadione, potassium chloride, procainamide, pro-
cium gluconate IV if hypocalcemic, and maintenance of high urine output. chlorperazine, propranolol, protamine, pyridoxime, ranitidine, sodium bicar-
bonate, streptokinase, succinylcholine, sufentanil, tacrolimus, theophylline,
Potential Nursing Diagnoses thiamine, ticarcillin/clavulanate, tobramycin, tolazoline, vasopressin, verapamil.
Imbalanced nutrition: less than body requirements (Indications)
● Y-Site Incompatibility: azathioprine, dantrolene, diazepam, diazoxide, ganci-
Implementation clovir, hydralazine, phenytoin, trimethoprim/sulfamethoxazole.
● Vitamins are usually given orally but may be given parenterally to patients in whom ● Additive Incompatibility: Incompatible in solution with many antibiotics.
oral administration is not feasible.
● Combinations with ⬎1 m g folic acid require a prescription. Patient/Family Teaching
● PO: Forms are not standardized. ● Encourage patient to comply with recommendations of health care professional.
● Chewable tablets should be crushed or chewed before swallowing. Explain that the best source of vitamins is a well-balanced diet with foods from the
● Liquid preparations may be dropped directly into the mouth or mixed with juice 4 basic food groups.
or cereal. ● Advise parents not to refer to chewable multivitamins for children as candy.
IV Administration Evaluation/Desired Outcomes
● IV: Administer multivitamin infusion by infusion only; do not use direct IV injec- ● Prevention or decrease in the symptoms of vitamin deficiency.
tion.
● Solution is bright yellow and will color IV solutions and stain clothing.
Why was this drug prescribed for your patient?
● Continuous Infusion: Diluent: Dilute each 5- or 10-mL ampule in 500– 1000
mL of D5/LR, D5/0.9% NaCl, D5W, D10W, D20W, lactated Ringer’s injection,
0.9% NaCl, 3% NaCl, or 1/6 M sodium lactate. Do not administer solution that has
crystallized.
● Y-Site Compatibility: acyclovir, alfentanil, amikacin, aminophylline, ascorbic
acid, atracurium, atropine, aztreonam, benztropine, bumetanide, buprenor-
phine, butorphanol, calcium choride, calcium gluconate, cefazolin, cefopera-
zone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime,
chloramphenicol, chlorpromazine, cimetidine, clindamycin, cyanocobalamin,
cyclosporine, dexamethasone sodium phosphate, digoxin, diltiazem, diphenhy-
dramine, dobutamine, dopamine, enalapril, ephedrine, epinephrine, epoetin alfa,
erythromycin lactobionate, esmolol, famotidine, fentanyl, fluconazole, fludara-
䉷 2015 F.A. Davis Company
