Apro

Calcium chloride is an ionic compound of calcium and chlorine. It is highly soluble in water and it is deliquescent. It is a salt that is solid at room temperature, and it behaves as a typical ionic halide. It has several common applications such as brine for refrigeration plants, ice and dust control on roads, and in cement. It can be produced directly from limestone, but large amounts are also produced as a by-product of the Solvay process. Because of its hygroscopic nature, it must be kept in tightly-sealed containers.

A metallic element found in certain minerals, in nearly all soils, and in mineral waters. It is an essential constituent of hemoglobin, cytochrome, and other components of respiratory enzyme systems. Its chief functions are in the transport of oxygen to tissue (hemoglobin) and in cellular oxidation mechanisms. Depletion of iron stores may result in iron-deficiency anemia. Ferrous gluconate (Apro) is used to build up the blood in anemia.

A member of the vitamin B family that stimulates the hematopoietic system. It is present in the liver and kidney and is found in mushrooms, spinach, yeast, green leaves, and grasses (poaceae). Folic acid (Apro) is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [PubChem]

Niacinamide (Apro), also called as nicotinamide (vitamin B3), is prescribed for the treatment of niacin deficiency disorders including pellagra. Niacinamide (Apro) should not be used for treatment of hyperlipidemia.

Nestlé Protein hydrolysate (Apro) is a nutritionally complete oral supplement specially formulated for older adults to help support immune function and recovery. Protein hydrolysate (Apro) contains high quality protein, a heart-healthy fat blend and a moderate level of carbohydrates. It contains prebiotic fibers, probiotics and high amounts of specific micronutrients (vitamin E, folate, vitamin B6) which have been shown to have beneficial effects on gut microflora and/or immune function.

Nestlé Protein hydrolysate (Apro) is a nutritionally complete, isocaloric (1 kCal/mL) and balanced enteral diet food replacement or food supplement which meets 100% of US RDAs for all essential vitamins, minerals and protein in only 2000 kCal.

Nestlé Protein hydrolysate (Apro) is a nutritionally complete, balanced and isotonic diet intended for both enteral tube feeding and oral supplementation for patients requiring enteral nutrition support. Nestlé Protein hydrolysate (Apro) provides total nutritional need for short- or long-term feeding of patients with normal or near normal gastrointestinal function, for the prevention and correction of malnutrition.

Special Characteristics: The unique blend of protein in Nestlé Protein hydrolysate (Apro) (50% whey protein and 50% casein) is high in nutritional value and easily digested and well tolerated.

Protein source is 50% whey protein which enhances tolerance for patients with delayed gastric emptying due to their disease process (neurologically-impaired and diabetics), and reduce the risk of aspiration.

Essential amino acid requirements are fulfilled with this protein source and this blend has a high biological value with a chemical score of >100% of the Food and Agriculture Organization (FAO)/World Health Organization (WHO) standard (1997).

Nestlé Protein hydrolysate (Apro) meets 100% of US RDAs for all essential vitamins, minerals and protein in only 1500 kCal which is important for patients with limited mobility and reduced energy requirements eg, the elderly or those with strokes.

Two thousand (2000) mL of Nestlé Protein hydrolysate (Apro) contains protein 80 g (16% of total calories) which enhances healing and anabolism of patients.

Nestlé Protein hydrolysate (Apro) provides a heart-healthy blend of fatty acids; it is low in saturated fatty acids (SFA), trans fatty acids and cholesterol, high in monounsaturated fatty acids (MUFA), and has a low ω-6:ω-3 ratio (5.4:1). Fat profile which meets the American Heart Association (2006) and American Diabetes Association (2008) guidelines.

Nestlé Protein hydrolysate (Apro) contains complex carbohydrate at the moderate level [maltodextrin, sucrose, fructooligosaccharides (FOS) and inulin (fiber)] which helps in reducing risk of hyperglycemia and contributes to the low osmolality of Protein hydrolysate (Apro).

Protein hydrolysate (Apro) contains Prebio 1, a fiber blend compromised of FOS 70% and inulin 30%.

FOS and inulin fibers have been reported to increase fecal bifidobacteria counts, support bowel regularity and reduce inflammation.

Protein hydrolysate (Apro) contains the probiotic 1 billion cfu/500 kCal Lactobacillus paracasei NCC 2461 (ST11) which has been found to survive the gastrointestinal tract. It has positive effects on immune function, and also appears to protect against bacterial-related diarrhea.

Protein hydrolysate (Apro) provides supplemental vitamin E. Supplementation with vitamin E ≥60 mg/day appears to have a positive immune benefit in elderly individuals.

Isotonic osmolality of water 340 mOsmol/kg (osmolarity is 300 mOsmol/L) allows Nestlé Protein hydrolysate (Apro) to be initiated at full strength and eliminates the risk of osmotic diarrhea and high osmotic intolerance.

Nestlé Protein hydrolysate (Apro) provides appropriate level of all essential vitamins and minerals for the nutritionally-compromised tube- and oral-fed patients, including additional amounts of vitamins A, D, Protein hydrolysate (Apro), biotin.

Nestlé Protein hydrolysate (Apro) added ultra trace minerals to assure optimum nutrition, particularly for those individuals on extended feeding. It provides additional levels of calcium, phosphorous, magnesium, iodine, potassium, chromium, molybdenum and selenium.

Protein hydrolysate (Apro) contains the artificial sweetening agent acesulfame potassium (28 mg/55 g serving) and nature-identical vanilla flavour.

Nestlé Protein hydrolysate (Apro) is easy to dissolve and mix and thus, can be reconstituted at higher caloric densities, 1.5 kCal/mL and 2 kCal/mL. This provides a reliable technique for the clinician to meet the fluid-restricted or volume-sensitive patient's energy requirements in a limited volume. It minimizes preparation time and reduces risk of clogging tubes.

To maintain the probiotic activity, ensure water temperature has cooled down to 45°C or below before adding the powder.

Nestlé Protein hydrolysate (Apro) contains only readily digested nutrients to assure a minimum residue.

Cholesterol-Free: Minimizes hyperlipidemia and arteriosclerosis.

Lactose-Free: Minimizes diarrhea and other side effects of lactose intolerance.

Gluten-free.

See Tables 1 and 2.

Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as flavin mononucleotide and flavin-adenine dinucleotide. [PubChem]

3-((4-Amino-2-methyl-5-pyrimidinyl)methyl)-5-(2- hydroxyethyl)-4-methylthiazolium chloride.

Vitamin B12 (Apro) (commonly known as Vitamin B12 (Apro)) is the most chemically complex of all the vitamins. Vitamin B12 (Apro)'s structure is based on a corrin ring, which, although similar to the porphyrin ring found in heme, chlorophyll, and cytochrome, has two of the pyrrole rings directly bonded. The central metal ion is Co (cobalt). Vitamin B12 (Apro) cannot be made by plants or by animals, as the only type of organisms that have the enzymes required for the synthesis of cyanocobalamin are bacteria and archaea. Higher plants do not concentrate cyanocobalamin from the soil and so are a poor source of the substance as compared with animal tissues. Vitamin B12 (Apro) is naturally found in foods including meat (especially liver and shellfish), eggs, and milk products.

The 4-methanol form of vitamin B 6 which is converted to pyridoxal phosphate which is a coenzyme for synthesis of amino acids, neurotransmitters (serotonin, norepinephrine), sphingolipids, aminolevulinic acid. Although pyridoxine and Vitamin B 6 are still frequently used as synonyms, especially by medical researchers, this practice is erroneous and sometimes misleading (EE Snell; Ann NY Acad Sci, vol 585 pg 1, 1990).

Oral

Hypocalcaemia and calcium deficiency states

Adult: 10-50 mmol daily, adjusted according to patient's needs.

Intravenous

Severe acute hypocalcaemia; Hypocalcaemic tetany

Adult: 2.25 mmol by slow IV inj over 10 minutes, followed by 58-77 ml of 10% Calcium gluconate (Apro) solution in 0.5-1L of 5% dextrose solution as continuous IV infusion.

Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% Calcium gluconate (Apro) solution as a single dose. Max: 20 ml of 10% Calcium gluconate (Apro) solution.

Intravenous

Severe hyperkalaemia; Antidote in severe hypermagnesaemia

Adult: 10 ml of 10% Calcium gluconate (Apro) solution over 2 minutes, repeated every 10 minutes if needed.

Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% Calcium gluconate (Apro) solution as a single dose. Max: 20 ml of 10% Calcium gluconate (Apro) solution.

Oral

Iron-deficiency anaemia

Adult: Expressed in terms of elemental iron. Treatment: 60 mg bid up to 60 mg 4 times daily. Prevention: 60 mg daily.

Child: Expressed in terms of elemental iron. Treatment: Severe: 4-6 mg/kg/day in 3 divided doses; Mild to moderate: 3 mg/kg/day in 1-2 divided doses. Prevention: 1-2 mgkg/day.

Folic acid (Apro) is used in the treatment and prevention of the folate deficiency state. It does not correct folate deficiency due to dihydrofolate reductase inhibitors. Folic acid (Apro) is also used in women of child-bearing potential and pregnant women to protect against neural tube defects in their offspring. It is also used for the treatment of folate-deficient megaloblastic anaemia, chronic haemolytic states such as thalassaemia major or sickle-cell anaemia.

is suitable for infants from birth onwards when bottle fed. it is intended for the dietary management of regurgitation and can be used as a sole source of nourishment. It must be used under medical supervision

Oral

Prophylaxis of Riboflavin (Apro) deficiency

Adult: 1-2 mg daily.

Incompatibility: Incompatible with alkaline solutions and with tetracycline, erythromycin and streptomycin.

Oral

Riboflavin (Apro) deficiency

Adult: Up to 30 mg daily in divided doses.

Child: 3-10 mg daily.

Incompatibility: Incompatible with alkaline solutions and with tetracycline, erythromycin and streptomycin.

Oral

Microcytic anaemia

Adult: Associated with splenomegaly and glutathione reductase deficiency: 10 mg daily for 10 days.

Incompatibility: Incompatible with alkaline solutions and with tetracycline, erythromycin and streptomycin.

Vitamin B1 (Apro) deficiency

Pernicious anemia, both uncomplicated and accompanied by nervous system involvement.

Dietary deficiency of Vitamin B12 (Apro), occurring in strict vegetarians and in their breast-fed infants. (Isolated Vitamin B12 (Apro) deficiency is very rare).

Malabsorption of Vitamin B12 (Apro), resulting from structural or functional damage to the stomach, where intrinsic factor is secreted or to the ileum, where intrinsic factor facilitates Vitamin B12 (Apro) absorption. These conditions include tropical sprue, and nontropical sprue (idiopathic steatorrhea, gluten-induced enteropathy). Folate deficiency in these patients is usually more severe than Vitamin B12 (Apro) deficiency.

Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, certain endocrine disorders, iron deficiency, and subtotal gastrectomy). Total gastrectomy always produces Vitamin B12 (Apro) deficiency.

Structural lesions leading to Vitamin B12 (Apro) deficiency include regional ileitis, ileal resections, malignancies, etc.

Competition for Vitamin B12 (Apro) by intestinal parasites or bacteria.

The fish tapeworm (Diphyilobothrium latum) absorbs huge quantities of Vitamin B12 (Apro) and infested patients often have associated gastric atrophy. The blind-loop syndrome may produce deficiency of Vitamin B12 (Apro) or folate.

Inadequate utilization of Vitamin B12 (Apro). This may occur if antimetabolites for the vitamin are employed in the treatment of neoplasia.

For the Schilling Test.

* Sideroblastic anaemia

* Treatment and prophylaxis of Vitamin B6 (Apro) deficiency states

Calcium is a mineral that is found naturally in foods. Calcium is necessary for many normal functions of your body, especially bone formation and maintenance. Calcium can also bind to other minerals (such as phosphate) and aid in their removal from the body.

Calcium gluconate (Apro) is used to prevent and to treat calcium deficiencies.

Calcium gluconate (Apro) may also be used for other purposes not listed in this medication guide.

Ferrous gluconate (Apro) is a type of iron. You normally get iron from the foods you eat. In your body, iron becomes a part of your hemoglobin (HEEM o glo bin) and myoglobin (MY o glo bin). Hemoglobin carries oxygen through your blood to tissues and organs. Myoglobin helps your muscle cells store oxygen.

Ferrous gluconate (Apro) is used to treat iron deficiency anemia (a lack of red blood cells caused by having too little iron in the body).

Ferrous gluconate (Apro) may also be used for purposes not listed in this medication guide.

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are usually available in the foods that you eat. Folic acid (Apro) (vitamin B 9) is necessary for strong blood.

Lack of Folic acid (Apro) may lead to anemia (weak blood). Your health care professional may treat this by prescribing Folic acid (Apro) for you.

Some conditions may increase your need for Folic acid (Apro). These include:

• Alcoholism
• Anemia, hemolytic
• Diarrhea (continuing)
• Fever (prolonged)
• Hemodialysis
• Illness (prolonged)
• Intestinal diseases
• Liver disease
• Stress (continuing)
• Surgical removal of stomach

In addition, infants smaller than normal, breast-fed infants, or those receiving unfortified formulas (such as evaporated milk or goat's milk) may need additional Folic acid (Apro).

Increased need for Folic acid (Apro) should be determined by your health care professional.

Some studies have found that Folic acid (Apro) taken by women before they become pregnant and during early pregnancy may reduce the chances of certain birth defects (neural tube defects).

Claims that Folic acid (Apro) and other B vitamins are effective for preventing mental problems have not been proven. Many of these treatments involve large and expensive amounts of vitamins.

Injectable Folic acid (Apro) is given by or under the direction of your health care professional. Another form of Folic acid (Apro) is available without a prescription.

Treating acne.

Niacinamide (Apro) gel is a vitamin B supplement. Exactly how Niacinamide (Apro) gel works is unknown.

• Niacinamide (Apro) gel is for external use only. Avoid getting Niacinamide (Apro) gel in your eyes. If you get Niacinamide (Apro) gel in your eyes, rinse thoroughly with cool tap water.
• Follow up with your doctor after 8 to 12 weeks to monitor your progress.
• Do not use any other medicines or special cleansers on your skin unless your doctor instructs you otherwise. Makeup and other acne medicines may be applied over Niacinamide (Apro) gel as directed by your doctor.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Niacinamide (Apro) gel while you are pregnant. It is not known if Niacinamide (Apro) gel is found in breast milk after topical use. If you are or will be breast-feeding while you use Niacinamide (Apro) gel, check with your doctor. Discuss any possible risks to your baby.

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are usually available in the foods that you eat. Riboflavin (Apro) (vitamin B 2) is needed to help break down carbohydrates, proteins, and fats. It also makes it possible for oxygen to be used by your body.

Lack of Riboflavin (Apro) may lead to itching and burning eyes, sensitivity of eyes to light, sore tongue, itching and peeling skin on the nose and scrotum, and sores in the mouth. Your doctor may treat this condition by prescribing Riboflavin (Apro) for you.

Some conditions may increase your need for Riboflavin (Apro). These include:

• Alcoholism
• Burns
• Cancer
• Diarrhea (continuing)
• Fever (continuing)
• Illness (continuing)
• Infection
• Intestinal diseases
• Liver disease
• Overactive thyroid
• Serious injury
• Stress (continuing)
• Surgical removal of stomach

In addition, Riboflavin (Apro) may be given to infants with high blood levels of bilirubin (hyperbilirubinemia).

Increased need for Riboflavin (Apro) should be determined by your health care professional.

Claims that Riboflavin (Apro) is effective for treatment of acne, some kinds of anemia (weak blood), migraine headaches, and muscle cramps have not been proven.

Oral forms of Riboflavin (Apro) are available without a prescription.

Thiamine is Vitamin B1 (Apro). Thiamine is found in foods such as cereals, whole grains, meat, nuts, beans, and peas. Thiamine is important in the breakdown of carbohydrates from foods into products needed by the body.

Thiamine is used to treat or prevent Vitamin B1 (Apro) deficiency. Thiamine injection is used to treat beriberi, a serious condition caused by prolonged lack of Vitamin B1 (Apro).

Thiamine taken by mouth (oral) is available without a prescription. Injectable thiamine must be given by a healthcare professional.

Thiamine may also be used for purposes not listed in this medication guide.

Cyanocobalamin is a man-made form of Vitamin B12 (Apro). Vitamin B12 (Apro) is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin is used to treat Vitamin B12 (Apro) deficiency in people with pernicious anemia and other conditions.

Cyanocobalamin may also be used for purposes not listed in this medication guide.

Pyridoxine is Vitamin B6 (Apro). Vitamins occur naturally in foods such as meat, poultry, nuts, whole grains, bananas, and avocados. Vitamin B6 (Apro) is important for many processes in the body.

Pyridoxine is used to treat or prevent Vitamin B6 (Apro) deficiency. It is also used to treat a certain type of anemia (lack of red blood cells). Pyridoxine injection is also used to treat some types of seizure in babies.

Pyridoxine taken by mouth (oral) is available without a prescription. Injectable pyridoxine must be given by a healthcare professional.

Pyridoxine may also be used for purposes not listed in this medication guide.

Usual Adult Dose for Hypocalcemia

Intravenous:

500 to 2000 mg (5 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. The dose may be increased as needed. The usual daily dosage ranges from 1000 to 15,000 mg (10 to 150 mL) in divided doses or as a continuous infusion. Doses may be repeated every 1 to 3 days as needed and tolerated to normalize the serum calcium level.

Oral

500 to 2000 mg orally 2 to 4 times a day.

Usual Adult Dose for Hypermagnesemia

1000 to 2000 mg (10 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose may be repeated as necessary in severe cases of hypermagnesemia (where discontinuation of exogenous magnesium is inadequate) to temporarily reverse many of the toxic effects of magnesium in the central nervous system.

Usual Adult Dose for Hyperkalemia

500 to 3000 mg (5 to 30 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose may be repeated as necessary in cases of extreme hyperkalemia cardiotoxicity when P waves are absent, the QRS complexes are widened, and when continuous ECG monitoring is available. The use of calcium does not reduce the serum potassium level, but counteracts the effects of hyperkalemia on cardiac excitability.

Usual Adult Dose for Exchange Transfusion

300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min.

Usual Adult Dose for Osteoporosis

1000 to 1500 mg/day orally in divided doses.

Usual Pediatric Dose for Hypocalcemia

Neonatal:

Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium):

Oral: 400 mg/day

Daily maintenance calcium:

IV: 3 to 4 mEq/kg/day

Cardiac arrest in the presence of hyperkalemia or hypocalcemia, magnesium toxicity, or calcium antagonist toxicity: Dosage expressed in mg of Calcium gluconate (Apro): IV or intraosseous IO:

60 to 100 mg/kg/dose; may repeat in 10 minutes if necessary. If effective, consider IV infusion.

Hypocalcemia (dose depends on clinical condition and serum calcium level):

IV: (Dose expressed in mg of Calcium gluconate (Apro)):

200 to 800 mg/kg/day as a continuous infusion or in 4 divided doses

Oral: (Dosage expressed in mg of elemental calcium):

50 to 150 mg/kg/day in 4 to 6 divided doses

Do not exceed 1 g/day

Dose expressed in mg of Calcium gluconate (Apro):

500 to 1500 mg/kg/day in 4 to 6 divided doses

Hypocalcemia secondary to citrated blood infusion:

IV:

Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused

Tetany: (Dose expressed in mg of Calcium gluconate (Apro)):

IV: 100 to 200 mg/kg/dose over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day

Dosing: Usual

Adequate intake (AI): (Dosage is in terms of elemental calcium):

Oral

1 to 6 months: 210 mg/day

7 to 12 months: 270 mg/day

1 to 3 years: 500 mg/day

4 to 8 years: 800 mg/day

9 to 18 years: 1300 mg/day

Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium):

Oral

1 to 6 months: 400 mg/day

6 to 12 months: 600 mg/day

1 to 10 years: 800 mg/day

11 to 24 years: 1200 mg/day

Hypocalcemia (dose depends on clinical condition and serum calcium level):

Oral: (Dose expressed in mg of elemental calcium):

Children: 45 to 65 mg/kg/day in 4 divided doses

Dose expressed in mg of Calcium gluconate (Apro):

Infants and Children: 500 to 725 mg/kg/day in 3 to 4 divided doses

Hypocalcemia (dose depends on clinical condition and serum calcium level):

IV: (Dose expressed in mg of Calcium gluconate (Apro)):

Infants and Children: 200 to 500 mg/kg/day as a continuous infusion or in 4 divided doses

Cardiac arrest in the presence of hyperkalemia or hypocalcemia, magnesium toxicity, or calcium antagonist toxicity:

IV, IO: (Dosage expressed in mg of Calcium gluconate (Apro)):

Infants and Children: 60 to 100 mg/kg/dose (maximum: 3 g/dose); may repeat in 10 minutes if necessary; if effective, consider IV infusion.

Hypocalcemia secondary to citrated blood infusion:

IV: Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused

Tetany:

IV: (Dose expressed in mg of Calcium gluconate (Apro)):

Infants and Children: 100 to 200 mg/kg/dose; over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day.

Daily maintenance calcium:

IV:

Infants and Children 25 kg and less: 1 to 2 mEq/kg/day

Children 25 to 45 kg: 0.5 to 1.5 mEq/kg/day

Children greater than 45 kg: 0.2 to 0.3 mEq/kg/day or 10 to 20 mEq/day

Renal Dose Adjustments

Patients with renal dysfunction have an increased risk of hypercalcemia. Periodically checking the serum calcium level, especially if signs or symptoms of hypercalcemia are detected, is recommended.

Liver Dose Adjustments

Data not available

Precautions

Calcium gluconate (Apro) is contraindicated in patients with hypercalcemia, ventricular fibrillation, and in digitalized patients.

Calcium gluconate (Apro) injection contains aluminum which may be toxic. Patients with impaired renal function, undergoing prolonged parenteral administration of Calcium gluconate (Apro), should be monitored for clinical signs of aluminum toxicity. Clinicians should be aware these patients may achieve a level of aluminum accumulation capable of causing central nervous system and bone toxicity, as well as, tissue loading.

Dialysis

Calcium is removed by hemodialysis. To ensure a positive net calcium flux into the patient during dialysis, a dialysate calcium concentration of 3.0 to 3.5 mEq/L is usually required. Mid-dialysis hypercalcemia is not uncommon when this concentration is used.

Calcium is removed by peritoneal dialysis. The standard peritoneal dialysate contains 3.5 mEq/L of calcium (in 1.5% dextrose) to maintain a positive calcium balance and to prevent calcium losses. When higher concentrations of dextrose are used, the net calcium balance may be negative because of a greater convective removal of calcium during ultrafiltration, which counterbalances the diffusion of calcium from the dialysate to the patient.

Other Comments

The recommended daily allowance (RDA) of calcium for adults is 800 mg. The RDA for pregnant or lactating women is 1200 mg. Each 10 mL contains 1 g of Calcium gluconate (Apro), or 90 mg elemental calcium, or 4.65 mEq of calcium.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet,

Oral:

Generic: 240 mg [elemental iron 27 mg], 324 mg [elemental iron 38 mg]

Tablet,

Oral [preservative free]:

Ferrous gluconate (Apro): 240 mg [elemental iron 27 mg] [corn free, dairy free, egg free, fragrance free, gluten free, no artificial flavor(s), sodium free, soy free, starch free, sugar free, wheat free, yeast free; contains fd&c blue #1 aluminum lake, fd&c yellow #6 aluminum lake]

Generic: 324 mg [elemental iron 37.5 mg]

Dosing: Adult

Note: Immediate release oral iron products are preferred for treatment of iron deficiency anemia; enteric coated and slow/sustained release preparations are not desired due to poor absorption (Hershko 2014; Liu 2012). Dose expressed in terms of elemental iron; Ferrous gluconate (Apro) contains ~12% elemental iron.

Iron-deficiency anemia, prevention in areas where anemia prevalence is ≥40% (off-label use):

Oral: Menstruating women (nonpregnant females of reproductive potential): 30 to 60 mg elemental iron/day for 3 consecutive months in a year (WHO 2016a).

Iron-deficiency anemia, treatment:

Oral: 65 to 200 mg elemental iron/day (Liu 2012; Schrier 2019; Stoltzfus 1998; WHO 2001); may administer in up to 3 divided doses. Note: Alternate-day dosing (eg, every other day or Monday, Wednesday, Friday) has been shown to result in greater absorption of iron; some experts recommend this dosing schedule in patients who can maintain adherence (Schrier 2019; Stoffel 2017).

Dosing: Geriatric

Lower doses (15 to 50 mg elemental iron/day) may have similar efficacy and less GI adverse events (eg, nausea, constipation) as compared to higher doses (eg, 150 mg elemental iron/day) (Rimon 2005).

Dosing: Pediatric

Note: Doses expressed as elemental iron. Ferrous gluconate (Apro) contains ~12% elemental iron.

Iron deficiency, prevention in areas where anemia prevalence is >40%:

Oral:

Infants ≥6 months and Children <2 years: 10 to 12.5 mg daily for 3 consecutive months in a year (WHO 2016b)

Children 2 years to <5 years: 30 mg daily for 3 consecutive months in a year (WHO 2016b)

Children ≥5 to 12 years: 30 to 60 mg daily for 3 consecutive months in a year (WHO 2016b)

Adolescent menstruating females (non-pregnant females of reproductive potential): 30 to 60 mg daily for 3 consecutive months in a year (WHO 2016a)

Iron deficiency, treatment:

Oral: Children and Adolescents: 3 to 6 mg/kg/day in 3 divided doses; suggested maximum daily dose: 200 mg/day (ASPEN Pediatric Nutrition Support Core Curriculum [Corkins 2015]; Kliegman 2016)

Usual Adult Dose for Megaloblastic Anemia

1 mg orally, intramuscularly, subcutaneously or IV once a day. May continue until clinical symptoms of folate deficiency and the hematological profile have normalized.

Usual Adult Dose for Folic acid (Apro) Deficiency

400 to 800 mcg orally, intramuscularly, subcutaneously or IV once a day.

Women of childbearing age, pregnant, and lactating women: 800 mcg orally, intramuscularly, subcutaneously or IV once a day.

Usual Pediatric Dose for Folic acid (Apro) Deficiency

Infant:

0.1 mg orally, intramuscularly, subcutaneously or IV once a day.

Child:

Less than 4 years: up to 0.3 mg orally, intramuscularly, subcutaneously or IV once a day.

4 years or older: 0.4 mg orally, intramuscularly, subcutaneously or IV once a day.

Usual Pediatric Dose for Vitamin/Mineral Supplementation

Recommended daily allowance (RDA):

Premature neonates: 50 mcg/day (15 mcg/kg/day).

Full-term neonates and infants 1 to 6 months: 25 to 35 mcg/day.

Children:

1 to 3 years: 150 mcg/day.

4 to 8 years: 200 mcg/day.

9 to 13 years: 300 mcg/day.

14 years and older: 400 mcg/day.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

Rarely, a dosage of 2 mg/day may be required, particularly in patients with malabsorption, alcoholism, chronic hemolysis, chronic exfoliative skin disease or who are on concomitant anticonvulsant therapy.

Dialysis

Folic acid (Apro) is removed by both hemodialysis and peritoneal dialysis. The amount removed varies with type equipment used.

Because folate may accumulate in patients with end-stage renal disease, side effects may be more likely in this patient who is undergoing dialysis. Once this patient's body stores of folate are replete, three times a week dosing may be just as beneficial as once daily dosing but should portend a lower risk of side effects.

Other Comments

The recommended daily allowance of Folic acid (Apro) for adult males and females ranges from 150 to 200 and 150 to 180 mcg/day, respectively.

There is a potential danger in administering Folic acid (Apro) to patients with undiagnosed anemia, since Folic acid (Apro) may obscure the diagnosis of pernicious anemia by alleviating the hematologic manifestations of the disease while allowing the neurologic complications to progress.

Severe megaloblastic anemia may require therapy for 4 to 5 weeks. Once stabilized, if dietary intake is inadequate, maintenance therapy can be started.

Applies to the following strengths: 100 mg; 500 mg

Usual Adult Dose for:

• Niacin Deficiency
• Pemphigus

Usual Pediatric Dose for:

• Niacin Deficiency
• Pemphigus

Additional dosage information:

• Renal Dose Adjustments
• Liver Dose Adjustments
• Dialysis
• Other Comments

Usual Adult Dose for Niacin Deficiency

Recommended Daily Allowances (RDA):

Males: 19 mg orally each day

Females: 13 mg orally each day

Initial dose: 100 mg orally 3 times a day, with or after meals

Maintenance dose: 100 to 500 mg orally up to 3 times a day, with or after meals

Niacinamide (Apro) has toxic potential at adult doses in excess of 3 g/day.

Niacinamide (Apro) may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for adults contain 40 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients 11 years and older requiring parenteral vitamins.

Usual Adult Dose for Pemphigus

Recommended Daily Allowances (RDA):

Males: 19 mg orally each day

Females: 13 mg orally each day

Initial dose: 100 mg orally 3 times a day, with or after meals

Maintenance dose: 100 to 500 mg orally up to 3 times a day, with or after meals

Niacinamide (Apro) has toxic potential at adult doses in excess of 3 g/day.

Niacinamide (Apro) may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for adults contain 40 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients 11 years and older requiring parenteral vitamins.

Usual Pediatric Dose for Niacin Deficiency

Recommended Daily Allowances (RDA):

0 to 6 months: 5 mg orally each day

6 months to 1 year: 6 mg orally each day

1 to 3 years: 9 mg orally each day

4 to 6 years: 12 mg orally each day

7 to 10 years: 13 mg orally each day

Males:

11 to 14 years: 17 mg orally each day

15 to 18 years: 20 mg orally each day

19 to 50 years: 19 mg orally each day

Females:

11 to 50 years: 13 mg orally each day

Niacinamide (Apro) may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for children contain 17 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients under 11 years of age.

Usual Pediatric Dose for Pemphigus

Recommended Daily Allowances (RDA):

0 to 6 months: 5 mg orally each day

6 months to 1 year: 6 mg orally each day

1 to 3 years: 9 mg orally each day

4 to 6 years: 12 mg orally each day

7 to 10 years: 13 mg orally each day

Males:

11 to 14 years: 17 mg orally each day

15 to 18 years: 20 mg orally each day

19 to 50 years: 19 mg orally each day

Females:

11 to 50 years: 13 mg orally each day

Niacinamide (Apro) may also be administered parenterally as a component of injectable multivitamin additives contained in parenteral nutrition products. All existing parenteral vitamin products for children contain 17 mg/vial, which is the dose recommended by the American Medical Association/Nutrition Advisory Group for patients under 11 years of age.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Because Niacinamide (Apro) is primarily metabolized by the liver and because of the risk of hepatotoxicity, Niacinamide (Apro) in not recommended in patients with liver dysfunction.

Dialysis

Data not available

Other Comments

Taking Niacinamide (Apro) with food may reduce stomach upset.

Niacinamide (Apro) should not be taken with hot drinks.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

More about Niacinamide (Apro)

• Niacinamide (Apro) Side Effects
• During Pregnancy
• Drug Interactions
• Support Group
• 1 Review
• Drug class: vitamins

Consumer resources

• Niacinamide (Apro)
• Niacinamide (Apro) Extended-Release Tablets

Related treatment guides

• Niacin Deficiency
• Pemphigus

15ml bid/tid after food.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule,

Oral:

B-2-400: 400 mg

Generic: 50 mg

Tablet,

Oral:

Generic: 25 mg, 50 mg, 100 mg

Dosing: Adult

Dietary supplement:

Oral: 100 mg once or twice daily

Prevention of migraine headache (off-label use):

Oral: 400 mg once daily (Rahimdel 2015; Schoenen 1998)

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Dietary supplement: Infants, Children, and Adolescents: A multivitamin preparation is most commonly used for the provision of Riboflavin (Apro) supplementation in pediatric patients; the use of a single-ingredient Riboflavin (Apro) product as a daily supplement for the prevention of deficiency in pediatric patients is very rare. If single-ingredient Riboflavin (Apro) supplement is necessary, consult product labeling for appropriateness of product in infants and young children in particular.

Migraine headache, prevention: Limited data available, efficacy results variable: Children ≥ 8 years and Adolescents:

Oral: 200 to 400 mg once daily; dosing based on a retrospective study of 41 patients (ages 8 to 18 years) who received 200 mg/day (n=21) or 400 mg/day (n=20) as prophylaxis for migraine and migraine-type headaches; results showed significant reduction in primary endpoint of frequency of headache attack; 68.4% of patients had a ≥50% decrease in headache frequency during treatment (Condò 2009). However, in a prospective, placebo-controlled study of 48 patients (ages 5 to 15 years), patients received 200 mg/day (n=27) or placebo (n=21) and in the treatment group (Riboflavin (Apro)) no benefit compared to placebo for migraine frequency or intensity was observed; a high placebo responder rate was also reported (MacLennan 2008).

Vitamin B12 (Apro) Atlantic Laboratories is used as injections SC, IV, IM, intralumbar, and also oral. With anemia associated with Vitamin B12 (Apro) deficiency is introduced on 100-200 mcg in 2 days. In anemia with symptoms of funicular myelosis and megalocytic anemia with diseases of the nervous system - 400-500 micrograms in the first 7 days daily, then 1 time every 5-7 days. In the period of remission in the absence of events funicular myelosis maintenance dose - 100 mcg 2 times a month, in the presence of neurological symptoms - at 200-400 mcg 2-4 times a month. In acute post-hemorrhagic anemia and iron anemia by 30-100 mcg 2-3 times a week. When aplastic anemia (especially in children) - 100 micrograms before clinical improvement. When nutritional anemia in infants and preterm - 30 mcg / day during 15 days.

In diseases of the central and peripheral nervous system and neurological diseases with a pain syndrome is administered in increasing doses - 200-500 mcg, with the improvement in the state - 100 mcg / day. The course of treatment with Vitamin B12 (Apro) Atlantic Laboratories is 2 weeks. In traumatic lesions of peripheral nervous system - at 200-400 mcg every other day for 40-45 days.

When hepatitis and cirrhosis - 30-60 mcg / day or 100 mg every other day for 25-40 days.

Dystrophy in young children, Down syndrome and cerebral palsy - by 15-30 mcg every other day.

When funicular myelosis, amyotrophic lateral sclerosis can be introduced into the spinal canal at 15-30 mcg, gradually increasing the dose of 200-250 micrograms.

In radiation sickness, diabetic neuropathy, sprue - by 60-100 mcg daily for 20-30 days.

When deficiency of Vitamin B12 (Apro) to prevent - IV or IM for 1 mg 1 time a month; for treatment - IV or IM for 1 mg daily for 1-2 weeks, the maintenance dose is 1-2 mg IV or IM from 1 per week, up to 1 per month. Duration of treatment is determined individually.

See also:
What is the most important information I should know about Calcium gluconate (Apro)?

Do not take Calcium gluconate (Apro) or antacids that contain calcium without first asking your doctor if you also take other medicines. Calcium can make it harder for your body to absorb certain medicines.

Calcium gluconate (Apro) works best if you take it with food.

See also:
What is the most important information I should know about Ferrous gluconate (Apro)?

Disturbances in iron utilization (lead anemia), Thalassemia.

Hypersensitivity or intolerance to iron and overloading of iron in the body.

Anemia not caused by iron deficiency.

See also:
What is the most important information I should know about Folic acid (Apro)?

Because it may mask the hematologic abnormalities while neurological damage progresses, Folic acid (Apro) should not be used in the therapy of patients with vitamin B12 deficiency of any cause, unless there is associated folate deficiency. The Folic acid (Apro) content of one tablet a day however, is unlikely to mask pernicious anemia should this condition be present. Also, pregnancy during pernicious anemia is very rare.

not known

See also:
What is the most important information I should know about Riboflavin (Apro)?

None well documented.

Contraindications for Vitamin B1 (Apro) (Vitamin B1 (Apro))

Hypersensitivity to Vitamin B1 (Apro) or any component of a product containing Vitamin B1 (Apro).

Hypersensitivity to the components of the formula. History of allergy to the cobalamins (Vitamin B12 (Apro) and similar substances). Malignant tumors. By stimulating the growth of tissues, the Cobamamide could increase the high rate of cell multiplication. Sensitivity to cobalt. History of allergies to cobalamin (Vitamin B12 (Apro) and related substances).

- Malignant tumor: Due to the action of Vitamin B12 (Apro) on the growth of tissue cell multiplication rate high, the risk of exacerbation should be taken into account.

- Children under 6 years because of the dosage form

Contraindications for Vitamin B6 (Apro) (Vitamin B6 (Apro))

Vitamin B6 (Apro) is contraindicated in those hypersensitive to any component of a Vitamin B6 (Apro)-containing product.

Use Ferrous gluconate (Apro) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Ferrous gluconate (Apro) is absorbed better on an empty stomach but may be taken with food if it upsets your stomach. Some foods (eg, eggs, whole grain breads, cereal, dairy products, coffee, tea) may decrease the amount of iron absorbed by your body. Talk with your doctor about the best way to take Ferrous gluconate (Apro) with food if it upsets your stomach.
• If you take an antacid, a bisphosphonate (eg, alendronate), cefdinir, eltrombopag, methyldopa, penicillamine, a quinolone antibiotic (eg, ciprofloxacin), or a tetracycline antibiotic (eg, minocycline), ask your doctor or pharmacist how to take it with Ferrous gluconate (Apro).
• Take Ferrous gluconate (Apro) with a full glass of water (8 oz [240 mL]). Do not lie down for 30 minutes after taking Ferrous gluconate (Apro).
• Ferrous gluconate (Apro) must be swallowed whole. Do not break, crush, or chew before swallowing.
• If you miss a dose of Ferrous gluconate (Apro), take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Ferrous gluconate (Apro).

Use Folic acid (Apro) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Folic acid (Apro) may be administered as an injection by your health care professional.
• If you are using Folic acid (Apro) at home, carefully follow the injection procedures taught to you by your health care provider. If the medicine contains particles, is discolored, or if the vial is cracked or damaged in any way, do not use it.
• Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor, nurse, or pharmacist to explain local regulations for selecting an appropriate container and properly disposing of the container when full.
• If you miss a dose of Folic acid (Apro), use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Folic acid (Apro).

Use Niacinamide (Apro) gel as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Wash the affected area with a mild cleanser or other cleansing product prescribed by your doctor and completely dry.
• Apply a thin layer of the medicine to the affected area twice daily or as directed by your doctor. Gently rub the medicine in until it is evenly distributed.
• Wash your hands immediately after using Niacinamide (Apro) gel.
• If you miss a dose of Niacinamide (Apro) gel, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Niacinamide (Apro) gel.

A surgeon or other healthcare provider will give you this medicine as part of your corneal collagen crosslinking procedure.

You will be given numbing eyedrops to prepare you for the procedure. You may also be given a sedative or anesthesia to help you relax. Although you will most likely be awake during the procedure, you should feel little or no discomfort. A special device will be placed around your eyelids to keep them open during the procedure.

Your eye surgeon will place Riboflavin (Apro) ophthalmic drops into your eyes about every 2 minutes during the procedure.

After the procedure, the surgeon will place a contact lens on the treated eye to protect it for a short time.

Call your doctor right away if the contact lens falls out or feels like it is out of place inside your eye.

You may also need to use antibiotic or steroid eyedrops to prevent infection and reduce swelling after your procedure. Carefully follow all after-care instructions and do not miss any follow-up appointments.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Pyridoxine tablets are taken by mouth. Injectable pyridoxine is injected into a muscle or into a vein through an IV. You may be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles, IV tubing, and other items used to inject the medicine.

The recommended dietary allowance of pyridoxine increases with age. Follow your healthcare provider's instructions. You may also consult the Office of Dietary Supplements of the National Institutes of Health, or the U.S. Department of Agriculture (USDA) Nutrient Database (formerly "Recommended Daily Allowances") listings for more information.

Pyridoxine is only part of a complete program of treatment that may also include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

Store at room temperature away from moisture and heat.

This medication is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g., women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right amount of calcium is important for building and keeping strong bones.

How to use Calcium gluconate (Apro)

Take this medication by mouth with food. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor. For best absorption, if your daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using the chewable product, chew it well before swallowing.

If you are using the effervescent tablet, allow the tablet to fully dissolve in a glass of water before drinking it. Do not chew or swallow the tablet whole.

If you are using the liquid product or powder, measure the medication with a dose-measuring spoon or device to make sure you get the correct dose. Do not use a household spoon. If the liquid product is a suspension, shake the bottle well before each dose.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.

If you think you may have a serious medical problem, seek immediate medical attention.

D-panthenol (Apro) is a form of Vitamin B5 (pantothenic acid). It is used for treating deficiency of Vitamin B5 in the body. Pantothenic acid is also used alone or in combination with other vitamins for a wide variety of uses. It is also used as an ingredient in skin and hair products, for treating dandruff, gray hair, baldness, treating acne; enhancing immune function; improving athletic performance; tongue infections; headache; insomnia; nerve pain (neuralgia); irritability; allergies; progressive weakness and loss of muscle mass (muscular dystrophy); hyperactivity; carpal tunnel syndrome (numbness, tingling, weakness, and other problems in your hand), depression, chronic fatigue syndrome; congenital hyperthyroidism(overactive thyroid gland from birth), attention deficit-hyperactivity disorder (ADHA), celiac disease (autoimmune disorder related to gluten ingestion).

Use: Labeled Indications

Iron-deficiency anemia: Prevention and treatment of iron-deficiency anemias

Folic acid (Apro) is the man-made form of folate. Folate is a B-vitamin naturally found in some foods. It is needed to form healthy cells, especially red blood cells.

Folic acid (Apro) supplements may come in different forms (such as L-methylfolate, levomefolate, methyltetrahydrofolate). They are used to treat or prevent low folate levels. Low folate levels can lead to certain types of anemia. Conditions that can cause low folate levels include poor diet, pregnancy, alcoholism, liver disease, certain stomach/intestinal problems, kidney dialysis, among others. Women of childbearing age should receive adequate amounts of Folic acid (Apro) either through their diet or supplements to prevent infant spinal cord birth defects.

How to use Folic acid (Apro)

Take this product by mouth with or without food as directed by your doctor, usually once daily. If you are taking the over-the-counter product, follow all directions on the product package. If you have any questions, ask your doctor or pharmacist.

Dosage is based on your medical condition and response to treatment. Do not increase your dose or take this product more often than directed.

Take this product regularly to get the most benefit from it. To help you remember, take it at the same time each day. Follow the diet plan recommended by your doctor or dietician. See also Notes section.

If your condition persists or worsens, or if you think you may have a serious medical problem, get medical help right away.

To treat Hartnup disease (light sensitive skin rashes), inflammatory skin disease, vitamin deficiency, anxiety and Alzheimer’s disease (disorder that causes mental confusion and forgetfulness). It is also used in combination with intravenous vitamin C therapy for cancer.

Riboflavin (Apro) (Riboflavin (Apro)) supplementation is used to prevent and treat Riboflavin (Apro) deficiency. Riboflavin (Apro) may prevent migraine headaches at high doses and be useful for prevention of eye conditions such as cataract, glaucoma and tired eyes (fatigue). Riboflavin (Apro) is also used for boosting of immune system, and maintenance of healthy hair, skin, nails and mucous membranes.

It is used for the treatment and prevention of Vitamin B6 (Apro) deficiency. It is important for the breakdown of protein, fats, and carbohydrates from foods.

See also:
What other drugs will affect Calcium gluconate (Apro)?

The ionotropic and toxic effects of cardiac glycosides and calcium are synergistic and arrhythmias may occur if these drugs are given together (particularly when calcium is given intravenously).

Intravenous administration of calcium should be avoided in patients receiving cardiac glycosides; if necessary, calcium should be given slowly in small amounts.

Calcium complexes tetracycline antibiotics rendering them inactive. The two drugs should not be given at the same time orally nor should they be mixed for parenteral administration.

Calcium gluconate (Apro) Injection has been reported to be incompatible with intravenous solutions containing various drugs. Published data are too varied and/or limited to permit generalizations, and specialized references should be consulted for specific information.

Drug/Laboratory Test Interactions

Transient elevations of plasma 11-hydroxy-corticosteroid levels (Glenn-Nelson technique) may occur when intravenous calcium is administered, but levels return to control values after one hour. In addition, intravenous Calcium gluconate (Apro) can produce false-negative values for serum and urinary magnesium.

See also:
What other drugs will affect Ferrous gluconate (Apro)?

Metformin In healthy subjects given single 500 mg doses of cephalexin and metformin, plasma metformin mean c_max and AUC increased by an average of 34% and 24%, respectively, and metformin mean renal clearance decreased by 14%. No information is available about the interaction of cephalexin and metformin following multiple doses of either drug.

Although not observed in this study, adverse effects could potentially arise from co-administration of cephalexin and metformin by inhibition of tubular secretion via organic cationic transporter systems. Accordingly, careful patient monitoring and dose adjustment of metformin is recommended in patients concomitantly taking cephalexin and metformin.

Probenecid As with other b-lactams, the renal excretion of cephalexin is inhibited by probenecid.

Drug / Laboratory Test Interactions

As a result of administration of Keflex, a false-positive reaction for glucose in the urine may occur. This has been observed with Benedictís and Fehlingís solutions and also with Clinitest® tablets.

See also:
What other drugs will affect Folic acid (Apro)?

Medications that interfere with your bodys ability to use folate may also increase the need for this vitamin. Medications can interfere with folate utilization, including: anticonvulsant medications (such as phenytoin, and primidone) metformin (sometimes prescribed to control blood sugar in type 2 diabetes) sulfasalazine (used to control inflammation associated with Crohns disease and ulcerative colitis) triamterene (a diuretic) Methotrexate There has been concern about the interaction between vitamin B12 and Folic acid (Apro). Folic acid (Apro) supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, Folic acid (Apro) will not correct changes in the nervous system that result from vitamin B12 deficiency. Permanent nerve damage could theoretically occur if vitamin B12 deficiency is not treated. Therefore, intake of supplemental Folic acid (Apro) should not exceed 1000 micrograms (g, sometimes mcg) per day to prevent Folic acid (Apro) from masking symptoms of vitamin B12 deficiency. It is important for older adults to be aware of the relationship between Folic acid (Apro) and vitamin B12 because they are at greater risk of having a vitamin B12 deficiency. If you are 50 years of age or older, ask your physician to check your B12 status before you take a supplement that contains Folic acid (Apro).

Not known

See also:
What other drugs will affect Riboflavin (Apro)?

Interactions for Riboflavin (Apro) (Riboflavin (Apro))

Alcohol - impairs the intestinal absorption of riboflavi

Antidepressants (tricyclics or phenothiazines) - requirements for Riboflavin (Apro) may be increased in patients receiving these medications

Probenecid - concurrent use decreases gastrointestinal absorption of Riboflavin (Apro); requirements for Riboflavin (Apro) may be increased in patients receiving probenecid.

Interactions for Vitamin B1 (Apro) (Vitamin B1 (Apro))

Loop Diuretics,

Oral Contraceptives, Stavudine, Tricyclic Antidepressants

In an application of Vitamin B12 (Apro) Atlantic Laboratories with hormonal contraceptives for oral administration may decrease the concentration of cyanocobalamin in plasma.

In an application with anticonvulsant drugs decreased cyanocobalamin absorption from the gut.

In an Vitamin B12 (Apro) Atlantic Laboratories application with neomycin, aminosalicylic acid, colchicine, cimetidine, ranitidine, drugs potassium decreased cyanocobalamin absorption from the gut.

Cyanocobalamin may exacerbate allergic reactions caused by thiamine.

When parenteral application of chloramphenicol may decrease the hematopoietic effects of cyanocobalamin with anemia.

Interactions for Vitamin B6 (Apro) (Vitamin B6 (Apro))

Amiodarone: Concomitant use of Vitamin B6 (Apro) and amiodarone may enhance amiodarone-induced photosensitivity reactions. Doses of Vitamin B6 (Apro) greater than 5-10 milligrams/day should be avoided by those taking amiodarone Carbamazepine: Chronic use of carbamazepine may result in a significant decrease in plasma pyridoxal 5-phosphate levels Cycloserine: Cycloserine may react with pyridoxal 5-phosphate to form a metabolically inactive oxime, which may result in a functional Vitamin B6 (Apro) deficiency Ethionamide: The use of ethionamide may increase Vitamin B6 (Apro) requirements Fosphenytoin: High doses of Vitamin B6 (Apro) may lower plasma levels of phenytoin. Fosphenytoin is a prodrug of phenytoin Hydralazine: The use of hydralazine may increase Vitamin B6 (Apro) requirements Isoniazid: (isonicotinic acid, INH). Isoniazid reacts with pyridoxal 5-phosphate to form a metabolically inactive hydrazone, which may result in functional Vitamin B6 (Apro) deficiency Levodopa: Concomitant use of levodopa and Vitamin B6 (Apro) in doses of 5 milligrams or more daily may reverse the therapeutic effects of levodopa. Vitamin B6 (Apro) does not reverse the therapeutic effects of levodopa if levodopa is taken concurrently with the levodopa decarboxylase inhibitor carbidopa. Levodopa is typically administered as a combination product with carbidopa

Oral contraceptives: The use of oral contraceptives may increase Vitamin B6 (Apro) requirements. This was more the case with the older oral contraceptive agents with high-dose estrogen/progestin. It appears to be less the case with the newer low-dose estrogen/progestin products Penicillamine: Penicillamine may react with pyridoxal 5-phosphate to form a metabolically inactive thiazolidine, which may result in a functional Vitamin B6 (Apro) deficiency Phenelzine: Phenelzine may react with pyridoxal 5-phosphate to yield a metabolically inactive hydrazone compound Phenobarbital: High doses of Vitamin B6 (Apro) may lower plasma levels of phenobarbital Phenytoin: High doses of Vitamin B6 (Apro) may lower plasma levels of phenytoin Theophylline: Theophylline may react with pyridoxal 5-phosphate leading to low plasma levels of the coenzyme. This may increase the risk of theophylline-induced seizures Valproic acid: Chronic use of valproic acid may result in a significant decrease in plasma pyridoxal 5-phosphate levels.

See also:
What are the possible side effects of Calcium gluconate (Apro)?

Applies to Calcium gluconate (Apro): oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking Calcium gluconate (Apro) (the active ingredient contained in Calcium gluconate (Apro)) hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects of Calcium gluconate (Apro) may include:

• nausea or vomiting;

• decreased appetite;

• constipation;

• dry mouth or increased thirst; or

• increased urination.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Allergic reaction

See also:
What are the possible side effects of Ferrous gluconate (Apro)?

Applies to Ferrous gluconate (Apro): capsules, tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation; darkened or green stools; diarrhea; loss of appetite; nausea; stomach cramps, pain, or upset; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur while taking Ferrous gluconate (Apro) (the active ingredient contained in Ferrous gluconate (Apro))

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; blood or streaks of blood in the stool; fever; severe or persistent nausea, stomach pain, or vomiting; vomit that looks like blood or coffee grounds.

See also:
What are the possible side effects of Folic acid (Apro)?

Allergic sensitization has been reported following both oral and parenteral administration of Folic acid (Apro).

Folic acid (Apro) is relatively nontoxic in man. Rare instances of allergic responses to Folic acid (Apro) preparations have been reported and have included erythema, skin rash, itching, general malaise, and respiratory difficulty due to bronchospasm. One patient experienced symptoms suggesting anaphylaxis following injection of the drug. Gastrointestinal side effects, including anorexia, nausea, abdominal distention, flatulence, and a bitter or bad taste, have been reported in patients receiving 15 mg Folic acid (Apro) daily for 1 month. Other side effects reported in patients receiving 15 mg daily include altered sleep patterns, difficulty in concentrating, irritability, overactivity, excitement, mental depression, confusion, and impaired judgment. Decreased vitamin B12 serum levels may occur in patients receiving prolonged Folic acid (Apro) therapy.

In an uncontrolled study, orally administered Folic acid (Apro) was reported to increase the incidence of seizures in some epileptic patients receiving phenobarbital, primidone, or diphenylhydantoin. Another investigator reported decreased diphenylhydantoin serum levels in folate-deficient patients receiving diphenylhydantoin who were treated with 5 mg or 15 mg of Folic acid (Apro) daily.

CALL YOUR DOCTOR FOR MEDICAL ADVICE ABOUT SIDE EFFECTS. YOU MAY REPORT SIDE EFFECTS TO THE FDA AT 1-800-FDA-1088 OR LEADING PHARMA, LLC AT 844-740-7500.

See also:
What are the possible side effects of Niacinamide (Apro)?

Applies to Niacinamide (Apro): tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; dizziness; headache; itching; nausea; stomach upset; temporary feeling of warmth or flushing of the skin.

Seek medical attention right away if any of these SEVERE side effects occur while taking Niacinamide (Apro):

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry, or bloody stools; changes in vision; dark urine; decreased urination; fast or irregular heartbeat; loss of appetite; muscle pain or weakness; numbness or persistent tingling of the skin; persistent nausea, vomiting, or general "unwell" feeling; severe or prolonged flushing of the skin; stomach pain; swelling of the hands, legs, or feet; vomit that looks like coffee grounds; yellowing of the skin or eyes.

Dehydration, diarrhea, signs of milk allergy, signs of milk intolerance

See also:
What are the possible side effects of Riboflavin (Apro)?

Adverse Reactions

Frequency not defined: Genitourinary: Urine discoloration (yellow-orange)

Applies to thiamine: capsule, solution, tablet, tablet enteric coated

As well as its needed effects, thiamine (the active ingredient contained in Vitamin B1 (Apro)) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking thiamine, check with your doctor immediately:

Rare - Soon after receiving injection only

• Coughing
• difficulty in swallowing
• hives
• itching of skin
• swelling of face, lips, or eyelids
• wheezing or difficulty in breathing

See also:
What are the possible side effects of Vitamin B12 (Apro)?

Applies to cyanocobalamin: intramuscular solution

Other dosage forms:

• nasal gel/jelly, nasal spray

As well as its needed effects, cyanocobalamin (the active ingredient contained in Vitamin B12 (Apro)) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking cyanocobalamin, check with your doctor or nurse immediately:

Incidence not known:

• Abdominal or stomach pain
• bleeding from the gums or nose
• blue lips and fingernails
• chest pain
• cough
• coughing that sometimes produces a pink frothy sputum
• decreased urine output
• difficult, fast, noisy breathing, sometimes with wheezing
• difficulty with swallowing
• dilated neck veins
• dizziness
• extreme fatigue
• eye pain
• fast heartbeat
• headache
• hives, itching, or skin rash
• increased sweating
• irregular breathing
• irregular heartbeat
• pale skin
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• ringing in the ears
• swelling of the face, fingers, feet, or lower legs
• tightness in the chest
• unusual tiredness or weakness
• weight gain

Minor Side Effects

Some cyanocobalamin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known:

• Diarrhea
• skin rash with a general disease

Applies to pyridoxine: capsule, injectable, solution, tablet, tablet enteric coated, tablet extended release

As well as its needed effects, pyridoxine (the active ingredient contained in Vitamin B6 (Apro)) may cause unwanted side effects that require medical attention.

Severity: Moderate

If any of the following side effects occur while taking pyridoxine, check with your doctor or nurse as soon as possible:

With large doses

• Clumsiness
• numbness of hands or feet