Multi Vitamin Infusion M.V.I. Pediatric

Generic name: Vitamins (Multiple/Injectable)

Drug class: Vitamin and mineral combinations

Dosage form: Injectable solution

Root of administration: Intravenous (IV) infusion

Dose:

• For infants and children up to 11 years of age: The typical daily maintenance dose is the entire contents of Vial 1 (4 mL) and Vial 2 (1 mL) added to not less than 100 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection. For infants weighing ≥ 1500 g and < 3 kg, the daily dose is 65% of the contents of Vial 1 and Vial 2, and for infants weighing < 1500 g, the daily dose is 30% of the contents of Vial 1 and Vial 2, each added to not less than 100 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection. The resulting solution should be refrigerated unless administered immediately and used within 24 hours. Unused portions should be discarded. Some vitamins in this product, particularly vitamins A, D, and riboflavin, are light-sensitive; exposure to light should be minimized. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Mechanism of action: This multivitamin infusion provides essential vitamins required for various metabolic processes, supporting growth, development, and overall health in pediatric patients. It aids in maintaining normal resistance and repair processes by supplying necessary vitamins that may be deficient in patients receiving parenteral nutrition or those in stress situations.

Drug usage cases:

• Daily multivitamin maintenance dosage for infants and children up to 11 years of age receiving parenteral nutrition.
• Situations requiring intravenous administration, such as surgery, extensive burns, fractures, severe infectious diseases, and comatose states, which may alter the body’s metabolic demands and lead to nutrient depletion.

Drug contraindications:

• Known hypersensitivity to any of the vitamins or excipients in this product.
• Pre-existing hypervitaminosis.
• Prior to blood sampling for detection of megaloblastic anemia, as the folic acid and cyanocobalamin in the vitamin solution can mask serum deficits.

Side effects:

• Allergic reactions, including rash, hives, itching, swelling, and difficulty breathing.
• Gastrointestinal disturbances such as nausea, vomiting, or diarrhea.
• Headache, dizziness, or blurred vision.
• Elevated blood sugar levels in diabetic patients.
• Injection site reactions, including pain, redness, or swelling.

Warnings:

• This product contains aluminum, which may be toxic. Aluminum may accumulate to toxic levels with prolonged parenteral administration, especially in patients with impaired kidney function. Premature neonates are particularly at risk due to immature kidneys and high calcium and phosphate requirements, which contain aluminum.
• Caution should be exercised when administering this multivitamin formulation to patients on warfarin sodium-type anticoagulant therapy, as vitamin K may antagonize the hypoprothrombinemic response to anticoagulant drugs. Periodic monitoring of prothrombin time is essential in determining the appropriate dosage of anticoagulant therapy.
• Vitamin A may adhere to plastic, resulting in inadequate vitamin A administration in the doses recommended with this product. Additional vitamin A supplementation may be required, especially in low birth weight infants.
• In patients receiving parenteral multivitamins, blood vitamin concentrations should be periodically monitored to determine if vitamin deficiencies or excesses are developing.
• Polysorbates have been associated with the E-Ferol syndrome (thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension, and metabolic acidosis) in low birth weight infants.
• Physical incompatibilities exist with alkaline solutions or moderately alkaline drugs such as acetazolamide, chlorothiazide sodium, aminophylline, and sodium bicarbonate. This product is not physically compatible with ampicillin and may not be compatible with tetracycline HCl. Folic acid is unstable in the presence of calcium salts such as calcium gluconate. Direct addition to intravenous fat emulsions is not recommended. Consult appropriate references for listings of physical compatibility of solutions and drugs with this vitamin infusion. In such circumstances, admixture or Y-site administration with vitamin solutions should be avoided.
• Some vitamins in this product may decrease the activity of certain antibiotics, including erythromycin, kanamycin, streptomycin, doxycycline, and lincomycin. Bleomycin is inactivated in vitro by ascorbic acid and riboflavin.
• Folic acid may lower the serum concentration of phenytoin, resulting in increased seizure frequency. Conversely, phenytoin may decrease serum folic acid concentrations and should be avoided in pregnancy. Folic acid may decrease the patient’s response to methotrexate therapy.
• Pyridoxine may decrease the efficacy of levodopa by increasing its metabolism. Concomitant administration of hydralazine or isoniazid may increase pyridoxine requirements.
• In patients with pernicious anemia, the hematologic response to vitamin B12 therapy may be inhibited by concomitant administration of chloramphenicol.
• Vitamin K may antagonize the hypoprothrombinemic effect of oral anticoagulants.

Use during pregnancy or breastfeeding: Pregnant and lactating patients should follow the U.S. Recommended Daily Allowances for their condition, as their vitamin requirements may exceed those of nonpregnant and nonlactating patients.