Becadex

Vitamin A (Becadex) (Glucoenergan, Reactivan) is a stimulant which was developed in the 1960s as an appetite suppressant, but was later withdrawn for this application due to problems with dependence and abuse. It is around half the potency of dexamphetamine, and is prescribed at a dose of 10-60mg, although abusers of the drug tend to rapidly develop tolerance and escalate their dose. Reactivan is still rarely used for treating depressive day-time fatigue, lack of concentration and lethargy, particularly in individuals who have chronic medical conditions, as its favourable safety profile makes it the most suitable drug in some cases.

A central respiratory stimulant with a brief duration of action. (From Martindale, The Extra Pharmocopoeia, 30th ed, p1225)

A six carbon compound related to glucose. It is found naturally in citrus fruits and many vegetables. Ascorbic acid is an essential nutrient in human diets, and necessary to maintain connective tissue and bone. Its biologically active form, Vitamin C (Becadex), functions as a reducing agent and coenzyme in several metabolic pathways. Vitamin C (Becadex) is considered an antioxidant.

Vitamin A (Becadex) injection is effective for the treatment of Vitamin A (Becadex) deficiency.

The parenteral administration is indicated when the oral administration is not feasible as in anorexia, nausea, vomiting, pre- and postoperative conditions, or it is not available as in the "Malabsorption Syndrome" with accompanying steatorrhea.

Pediatric Use: Vitamin A (Becadex) treatment for deficiency states has been recognized as an especially effective and important therapy in the pediatric population.

Vitamin A (Becadex) supplementation for deficiency states in this population has been addressed by the Committee on Clinical Practice Issues of the American Society for Clinical Nutrition, by the American Society for

Parenteral and Enteral Nutrition, and by the World Health Organization.

Pernicious anaemia, peripheral neuritis especially diabetic and alcoholic polyneuritis, trigeminal neuritis, vomiting of pregnancy, Vitamin B (Becadex) complex deficiency, anorexia, agranulocytosis, radiation sickness, coeliac and idiopathic, steatorrhoea which are usually accompanied by malabsorption of Vitamin B (Becadex) 12 and during administration of broad-spectrum antibiotics.

For systemic use of Vitamin C (Becadex): prevention and treatment of hypo- and avitaminosis of Vitamin C (Becadex); providing increased need for Vitamin C (Becadex) during growth, pregnancy, lactation, with heavy loads, fatigue and during recovery after prolonged severe illness; in winter with an increased risk of infectious diseases.

For intravaginal use: chronic or recurrent vaginitis (bacterial vaginosis, nonspecific vaginitis) caused by the anaerobic flora (due to changes in pH of the vagina) in order to normalize disturbed vaginal microflora.

This medicine is indicated in all conditions where there is a disturbance of calcium metabolism due to impaired 1-α hydroxylation such as when there is reduced renal function. The main indications are:

a) Renal osteodystrophy

b) Hyperparathyroidism (with bone disease)

c) Hypoparathyroidism

d) Neonatal hypocalcaemia

e) Nutritional and malabsorptive rickets and osteomalacia

f) Pseudo-deficiency (D-dependent) rickets and osteomalacia

g) Hypophosphataemic Vitamin D (Becadex) resistant rickets and osteomalacia

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. Vitamin A (Becadex) is needed for night vision and for growth of skin, bones, and male and female reproductive organs. In pregnant women Vitamin A (Becadex) is necessary for the growth of a healthy fetus.

Lack of Vitamin A (Becadex) may lead to a rare condition called night blindness (problems seeing in the dark), as well as dry eyes, eye infections, skin problems, and slowed growth. Your health care professional may treat these problems by prescribing Vitamin A (Becadex) for you.

Some conditions may increase your need for Vitamin A (Becadex). These include:

• Diarrhea
• Eye diseases
• Intestine diseases
• Infections (continuing or chronic)
• Measles
• Pancreas disease
• Stomach removal
• Stress (continuing)

In addition, infants receiving unfortified formula may need Vitamin A (Becadex) supplements.

Vitamin A (Becadex) absorption will be decreased in any condition in which fat is poorly absorbed.

Increased need for Vitamin A (Becadex) should be determined by your health care professional.

Claims that Vitamin A (Becadex) is effective for treatment of conditions such as acne or lung diseases, or for treatment of eye problems, wounds, or dry or wrinkled skin not caused by lack of Vitamin A (Becadex) have not been proven. Although Vitamin A (Becadex) is being used to prevent certain types of cancer, some experts feel there is not enough information to show that this is effective, particularly in well-nourished individuals.

Injectable Vitamin A (Becadex) is given by or under the supervision of a health care professional. Other forms of Vitamin A (Becadex) are available without a prescription.

Ascorbic acid (Vitamin C (Becadex)) occurs naturally in foods such as citrus fruit, tomatoes, potatoes, and leafy vegetables. Vitamin C (Becadex) is important for bones and connective tissues, muscles, and blood vessels. Vitamin C (Becadex) also helps the body absorb iron, which is needed for red blood cell production.

Ascorbic acid is used to treat and prevent Vitamin C (Becadex) deficiency.

Ascorbic acid 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 available in the foods that you eat. Vitamin D (Becadex) is necessary for strong bones and teeth.

Lack of Vitamin D (Becadex) may lead to a condition called rickets, especially in children, in which bones and teeth are weak. In adults it may cause a condition called osteomalacia, in which calcium is lost from bones so that they become weak. Your doctor may treat these problems by prescribing Vitamin D (Becadex) for you. Vitamin D (Becadex) is also sometimes used to treat other diseases in which calcium is not used properly by the body.

Ergocalciferol is the form of Vitamin D (Becadex) used in vitamin supplements.

Some conditions may increase your need for Vitamin D (Becadex). These include:

• Alcoholism
• Intestine diseases
• Kidney disease
• Liver disease
• Overactivity of the parathyroid glands with kidney failure
• Pancreas disease
• Surgical removal of stomach

In addition, individuals and breast-fed infants who lack exposure to sunlight, as well as dark-skinned individuals, may be more likely to have a Vitamin D (Becadex) deficiency. Increased need for Vitamin D (Becadex) should be determined by your health care professional.

Alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are forms of Vitamin D (Becadex) used to treat hypocalcemia (not enough calcium in the blood). Alfacalcidol, calcifediol, and calcitriol are also used to treat certain types of bone disease that may occur with kidney disease in patients who are undergoing kidney dialysis.

Claims that Vitamin D (Becadex) is effective for treatment of arthritis and prevention of nearsightedness or nerve problems have not been proven. Some psoriasis patients may benefit from Vitamin D (Becadex) supplements; however, controlled studies have not been performed.

Injectable Vitamin D (Becadex) is given by or under the supervision of a health care professional. Some strengths of ergocalciferol and all strengths of alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are available only with your doctor's prescription. Other strengths of ergocalciferol are available without a prescription. However, it may be a good idea to check with your health care professional before taking Vitamin D (Becadex) on your own. Taking large amounts over long periods may cause serious unwanted effects.

Usual Adult Dose for Vitamin A (Becadex) Deficiency

Initial dose: 100,000 Units intramuscularly once a day for 3 days

Maintenance dose: 50,000 Units intramuscularly once a day for 2 weeks

Use: Treatment of Vitamin A (Becadex) deficiency when oral administration is not feasible or not available (e.g. anorexia, nausea, vomiting, pre- or post-operative conditions, "Malabsorption Syndrome" with accompanying steatorrhea)

Usual Adult Dose for Vitamin/Mineral Supplementation

US Recommended Dietary Allowance (RDA):

Adult male: 900 mcg retinol activity equivalents (RAE) (3000 international units [IU])

Tolerable Upper Intake Level (UL): 3000 mcg RAE (10,000 IU)

Adult female: 700 mcg RAE (2330 IU)

UL: 3000 mcg RAE (10,000 IU)

Comments:

-The Vitamin A (Becadex) RDA is given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A carotenoids.

-The body converts all dietary Vitamin A (Becadex) into retinol; 2 mcg of beta-carotene from dietary supplements is converted to 1 mcg of retinol.

-The tolerable upper intake level is the maximum daily intake that is unlikely to have adverse health effects.

Usual Pediatric Dose for Vitamin A (Becadex) Deficiency

Infants (under 1 year): 7500 to 15,000 Units intramuscularly once a day

Duration of therapy: 10 days

1 to 8 years: 17,500 to 35,000 Units intramuscularly once a day

Duration of therapy: 10 days

Adult dose:

Initial dose: 100,000 Units intramuscularly once a day for 3 days

Maintenance dose: 50,000 Units intramuscularly once a day for 2 weeks

Use: Treatment of Vitamin A (Becadex) deficiency when oral administration is not feasible or not available (e.g. anorexia, nausea, vomiting, pre- or post-operative conditions, "Malabsorption Syndrome" with accompanying steatorrhea)

Usual Pediatric Dose for Vitamin/Mineral Supplementation

US Recommended Dietary Allowance (RDA):

0 to 6 months: 400 mcg retinol activity equivalents (RAE) (1332 international units [IU])

Tolerable Upper Intake Level (UL): 600 mcg RAE (2000 IU)

7 to 12 months: 500 mcg RAE (1665 IU)

UL: 600 mcg RAE (2000 IU)

1 to 3 years: 300 mcg RAE (1000 IU)

UL: 900 mcg RAE (3000 IU)

4 to 8 years: 400 mcg RAE (1332 IU)

UL: 900 mcg RAE (3000 IU)

9 to 13 years: 600 mcg RAE (2000 IU)

UL: 1700 mcg RAE (5667 IU)

14 to 18 years, male: 900 mcg RAE (3000 IU)

UL: 2800 mcg RAE (9333 IU)

14 to 18 years, female: 700 mcg RAE (2330 IU)

UL: 2800 mcg RAE (9333 IU)

Comments:

-The Vitamin A (Becadex) RDA is given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A carotenoids.

-The body converts all dietary Vitamin A (Becadex) into retinol; 2 mcg of beta-carotene from dietary supplements is converted to 1 mcg of retinol.

-The tolerable upper intake level is the maximum daily intake that is unlikely to have adverse health effects.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

US Recommended Dietary Allowance (RDA):

Pregnancy:

14 to 18 years: 750 mcg retinol activity equivalents (RAE) (2500 international units [IU])

UL: 2800 mcg RAE (9333 IU)

18 to 50 years: 770 mcg RAE (2564 IU)

UL: 3000 mcg RAE (10,000 IU)

Lactation:

14 to 18 years: 1200 mcg RAE (2564 IU)

UL: 2800 mcg RAE (9333 IU)

18 to 50 years: 1300 mcg RAE (4329 IU)

UL: 3000 mcg RAE (10,000 IU)

Comments:

-The Vitamin A (Becadex) RDA is given as mcg of retinol activity equivalents (RAE) to account for the different bioactivities of retinol and provitamin A carotenoids.

-The body converts all dietary Vitamin A (Becadex) into retinol; 2 mcg of beta-carotene from dietary supplements is converted to 1 mcg of retinol.

-The tolerable upper intake level is the maximum daily intake that is unlikely to have adverse health effects.

Precautions

CONTRAINDICATIONS:

-Administration of the intramuscular formulation intravenously

-Hypervitaminosis A

-Hypersensitivity to any of the ingredients

-The safety of doses exceeding 6000 units Vitamin A (Becadex) in pregnancy has not been established. Use of high doses in pregnancy or patients who may become pregnant is contraindicated. Doses above the recommended dietary allowance (RDA) may cause fetal harm; fetal abnormalities (central nervous system, eye, and palate malformations) were seen in animal overdose models. If patients become pregnant, apprise them of potential fetal harms.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Further information

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

Medical Disclaimer

Initially 3ml i.m daily. Subsequently 2-3 times/week.

This medication administered orally, IM, IV, intravaginally.

For the prevention of deficiency conditions Vitamin C (Becadex) dose is 25-75 mg / day, for the treatment - 250 mg / day or more in divided doses.

For intravaginal used ascorbic acid drugs in appropriate dosage forms.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule,

Oral:

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Vitamin D (Becadex): 1.25 MG (50000 UT) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), soybean oil]

Vitamin D (Becadex): 250 MCG (10000 UT) [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, gelatin (bovine)]

Vitamin D (Becadex): 625 MCG (25000 UT) [contains soybean oil]

Dialyvite Vitamin D (Becadex) 5000: 125 MCG (5000 UT)

Pronutrients Vitamin D3: 25 MCG (1000 UT) [contains soybean oil]

Weekly-D: 1.25 MG (50000 UT) [contains fd&c red #40]

Generic: 1.25 MG (50000 UT), 250 MCG (10000 UT)

Capsule,

Oral [preservative free]:

Vitamin D (Becadex): 125 MCG (5000 UT) [dairy free, dye free, egg free, gluten free, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Generic: 10,000 units, 125 MCG (5000 UT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Liquid,

Oral:

Aqueous Vitamin D (Becadex): 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains corn oil, methylparaben, polysorbate 80]

Bio-D-Mulsion: 10 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

Bio-D-Mulsion Forte: 50 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

BProtected Pedia D-Vite: 10 mcg/mL (50 mL) [alcohol free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; cherry flavor]

Vitamin D (Becadex): 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains polysorbate 80]

D-Vita: 10 mcg/mL (50 mL [DSC]) [alcohol free, gluten free, lactose free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; fruit flavor]

D-Vite Pediatric: 10 mcg/mL (50 mL) [alcohol free, gluten free, lactose free, no artificial color(s), sugar free; contains disodium edta, polysorbate 80, propylene glycol, saccharin sodium, sodium benzoate]

D3 Vitamin: 10 mcg/mL (50 mL) [contains polysorbate 80, sodium benzoate]

Generic: 10 mcg/mL (50 mL, 52 mL)

Liquid,

Oral [preservative free]:

Generic: 125 mcg/mL (52 mL)

Liquid, Sublingual:

Generic: 5000 units/mL (60 mL)

Tablet,

Oral:

Delta D3: 10 MCG (400 UNIT) [gelatin free, gluten free, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Dialyvite Vitamin D3 Max: 1.25 MG (50000 UT) [scored]

Vitamin D3 Super Strength: 50 MCG (2000 UT) [gluten free]

Vitamin D3 Ultra Potency: 1.25 MG (50000 UT)

Generic: 10 MCG (400 UNIT), 125 MCG (5000 UT), 20 MCG (800 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT), 75 MCG (3000 UT)

Tablet,

Oral [preservative free]:

Generic: 5000 units, 10 MCG (400 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Tablet Chewable,

Oral:

Generic: 10 MCG (400 UNIT)

Tablet Chewable,

Oral [preservative free]:

Generic: 50 MCG (2000 UT)

Dosing: Adult

Note: 1 mcg = 40 units

Hypoparathyroidism (off-label use): Note: Active Vitamin D (Becadex) preparations (ie, alfacalcidol, calcitriol) in conjunction with calcium supplementation are recommended therapy. Addition of cholecalciferol (or ergocalciferol) may be considered for supplemental therapy (Endocrine Society [Brandi 2016]).

Osteoporosis, prevention (off-label use): Adults ≥50 years of age:

Oral: 800 to 1,000 units/day is recommended, through dietary sources and/or supplementation if needed (NOF [Cosman 2014]).

Vitamin D (Becadex) insufficiency/deficiency treatment (off-label use): Note: Repletion strategies may vary depending on desired target serum 25(OH)D levels as well as the clinical status of the patient. The optimal serum 25(OH)D level is controversial; the Institute of Medicine recommends a 25(OH)D level >20 ng/mL as sufficient in nearly all persons (IOM 2011), whereas others have suggested targeting a level of ~30 ng/mL to minimize the risk of fractures, particularly in patients with osteoporosis (AACE [Camacho 2016]; NOF [Cosman 2014]). However, some data suggest levels >40 ng/mL (median level in one trial: ~48 ng/mL) are associated with increased risk of falls in postmenopausal women (Sanders 2010; Smith 2017).

Therefore, some experts recommend a range of 20 to 40 ng/mL as a reasonable target in most patients (Dawson-Hughes 2018). In patients with normal absorption, for every 100 units/day of cholecalciferol, the serum 25(OH)D level is expected to increase by ~0.7 to 1 ng/mL after a few weeks (ASPEN [McKeever 2017]; Dawson-Hughes 2018). The dose-response declines as the 25(OH)D concentration increases above 40 ng/mL (100 nmol/L) (Dawson-Hughes 2018). The following recommendations are based primarily on expert opinion and clinical experience:

Initial dosing (according to baseline serum 25(OH)D level):

Serum 25(OH)D 20 to 30 ng/mL: Initial: Supplementation dosing:

Oral: 600 to 800 units once daily; a repeat serum 25(OH)D level is not required (Dawson-Hughes 2018) or 1,000 to 2,000 units once daily; may consider a repeat serum 25(OH)D level in ~3 months to determine if the target level has been achieved (Khan 2010).

Serum 25(OH)D 10 to <20 ng/mL: Initial:

Supplementation dosing:

Oral: 800 to 1,000 units once daily (Dawson-Hughes 2018)

OR

Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Serum 25(OH)D <10 ng/mL or in patients with deficiency symptoms: Initial: Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Maintenance dosing: Maintenance dosing is highly patient specific and dependent on target 25(OH)D level, and may range from: 600 to 800 units/day (Dawson-Hughes 2018) to 1,000 to 2,000 units/day (AACE [Camacho 2016]; NOF [Cosman 2014]).

Special populations (obese patients, patients on medications known to affect Vitamin D (Becadex) metabolism, patients with malabsorption syndromes or gastrectomy): Higher doses or longer durations may be necessary for adequate repletion (AACE [Camacho 2016]; Dawson-Hughes 2018).

Vitamin D (Becadex) deficiency/insufficiency in patients with chronic kidney disease (off-label use):

Oral:

Note: In patients without severe and progressive hyperparathyroidism, including chronic kidney disease stages G3 to G5 and dialysis or transplant patients, KDIGO guidelines recommend correcting Vitamin D (Becadex) deficiency and insufficiency with treatment strategies recommended for the general population using cholecalciferol (or ergocalciferol) while avoiding hypercalcemia and ensuring phosphate levels are in the normal range. An individualized monitoring approach to direct treatment is also recommended (KDIGO 2009; KDIGO 2017). In patients in whom serum parathyroid hormone levels are progressively rising and remain persistently elevated despite correction of modifiable factors (eg, hyperphosphatemia, Vitamin D (Becadex) deficiency), calcitriol or Vitamin D (Becadex) analogs are suggested instead of cholecalciferol (or ergocalciferol) (KDOQI commentary [Uhlig 2010]).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Vitamin D (Becadex) deficiency, prevention (eg, Rickets prevention): (AAP [Folsom 2017]; AAP [Wagner 2008]; Munns 2016):

Oral:

Breast-fed infants (fully or partially):

Oral: 400 units/day beginning in the first few days of life. Continue supplementation until infant is weaned to ≥1,000 mL/day or 1 qt/day of Vitamin D (Becadex)-fortified formula or whole milk (after 12 months of age)

Formula-fed infants ingesting <1,000 mL of Vitamin D (Becadex)-fortified formula:

Oral: 400 units/day

Children and Adolescents without adequate intake:

Oral: 400 to 600 units/day.

Vitamin D (Becadex) deficiency, treatment:

Oral:

Infants:

Oral: 2,000 units daily for 6 weeks to achieve a serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 400 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Children and Adolescents:

Oral: 2,000 units daily for 6 to 8 weeks to achieve serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 600 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Vitamin D (Becadex) deficiency in cystic fibrosis, prevention and treatment:

Oral:

CF guidelines (Tangricha [CF Foundation] 2012):

Recommended initial daily intake to maintain serum 25(OH)D level ≥30 ng/mL:

Infants:

Oral: 400 to 500 units/day

Children ≤10 years:

Oral: 800 to 1,000 units/day

Children >10 years and Adolescents:

Oral: 800 to 2,000 units/day

Dosing adjustment for serum 25(OH)D level between 20 to 30 ng/mL and patient adherence established (Step 1 increase):

Infants:

Oral: 800 to 1,000 units/day

Children ≤10 years:

Oral: 1,600 to 3,000 units/day

Children >10 years and Adolescents:

Oral: 1,600 to 6,000 units/day

Dosing adjustment for serum 25(OH)D level <20 ng/mL or persistently between 20 to 30 ng/mL and patient adherence established (Step 2 increase):

Infants: Increase up to a maximum 2,000 units/day

Children ≤10 years: Increase to a maximum of 4,000 units/day

Children >10 years and Adolescents: Increase to a maximum of 10,000 units/day

Alternate dosing (Hall 2010):

Initial dose: Serum 25(OH)D level ≤30 ng/mL

Infants:

Oral: 8,000 units/

Children and Adolescents:

Oral: 800 units/day

Medium-dose regimen: Serum 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units/week for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units/week for 12 weeks

High-dose regimen: Repeat 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units twice weekly for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units twice weekly for 12 weeks

Vitamin D (Becadex) insufficiency or deficiency associated with CKD (stages 2 to 5, 5D), treatment; serum 25 hydroxyvitamin D [25(OH)D] level ≤30 ng/mL (KDOQI Guidelines 2009):

Oral:

Serum 25(OH)D level 16 to 30 ng/mL: Infants, Children, and Adolescents: 2,000 units/day for 3 months or 50,000 units every month for 3 months

Serum 25(OH)D level 5 to 15 ng/mL: Infants, Children, and Adolescents: 4,000 units/day for 12 weeks or 50,000 units every other week for 12 weeks

Serum 25(OH)D level <5 ng/mL: Infants, Children, and Adolescents: 8,000 units/day for 4 weeks then 4,000 units/day for 2 months for total therapy of 3 months or 50,000 units/week for 4 weeks followed by 50,000 units 2 times/month for a total therapy of 3 months

Maintenance dose [once repletion accomplished; serum 25(OH)D level >30 ng/mL]: Infants, Children, and Adolescents: 200 to 1,000 units/day

Nutritional rickets, treatment: Limited data available (Munns 2016): Administer in combination with calcium supplementation:

Daily therapy (preferred):

Infants:

Oral: 2,000 units daily for ≥3 months, followed by maintenance dose of 400 units daily

Children:

Oral: 3,000 to 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Adolescents:

Oral: 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Single-dose therapy:

Infants ≥3 months:

Oral: 50,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 400 units daily

Children:

Oral: 150,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

Adolescents:

Oral: 300,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

See also:
What is the most important information I should know about Vitamin A (Becadex)?

The intravenous administration. Hypervitaminosis A. Sensitivity to any of the ingredients in this preparation. Use in Pregnancy: Safety of amounts exceeding 6,000 Units of Vitamin A (Becadex) daily during pregnancy has not been established at this time. The use of Vitamin A (Becadex) in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with overdosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin A (Becadex) in excess of the recommended dietary allowance is contraindicated in women who are or may become pregnant. If Vitamin A (Becadex) is used during pregnancy, or if the patient becomes pregnant while taking Vitamin A (Becadex), the patient should be apprised of the potential hazard to the fetus.

Due to its benzyl alcohol content, doxapram injection is contraindicated in neonates.

Vitamin B (Becadex) should not be used in patients with epilepsy or other convulsive disorders.

Vitamin B (Becadex) is contraindicated in patients with mechanical disorders of ventilation such as mechanical obstruction, muscle paresis, flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis or other conditions resulting in restriction of chest wall, muscles of respiration or alveolar expansion.

Vitamin B (Becadex) is contraindicated in patients with evidence of head injury or cerebral vascular accident and in those with significant cardiovascular impairment, severe hypertension, or known hypersensitivity to the drug or any of the injection components.

AV-block II and III degree, sinoatrial block, SSS, bradycardia (HR < 40 bpm), hypotension (in case of myocardial infarction, systolic blood pressure less than 100 mm Hg), cardiogenic shock, congestive heart failure IIB-III stages, acute heart failure, Prinzmetal's angina, lactation, concomitant use of MAO inhibitors, hypersensitivity to atenolol.

See also:
What is the most important information I should know about Vitamin D (Becadex)?

OTC labeling: Replesta products only: When used for self-medication, do not use if you have hypercalcemia, primary hyperparathyroidism, sarcoidosis, hypervitaminosis D, Williams syndrome, or are pregnant.

Documentation of allergenic cross-reactivity for Vitamin D (Becadex) is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Vitamin A (Becadex) is used to prevent or treat low levels of the vitamin in people who do not get enough of it from their diets. Most people who eat a normal diet do not need extra Vitamin A (Becadex). However, some conditions (such as protein deficiency, diabetes, hyperthyroidism, liver/pancreas problems) can cause low levels of Vitamin A (Becadex). Vitamin A (Becadex) plays an important role in the body. It is needed for growth and bone development and to maintain the health of the skin and eyesight. Low levels of Vitamin A (Becadex) may cause vision problems (such as night blindness) and permanent eye damage.

How to use Vitamin A (Becadex)

Take this vitamin by mouth with or without food, usually once daily. Follow all directions on the product package, or take as directed by your doctor. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Dosage is based on your age, medical condition, and response to treatment.

Use this vitamin regularly to get the most benefit from it. To help you remember, take it at the same time each day. Do not increase your dose or use this vitamin more often than recommended. Your condition will not improve any faster, and your risk of side effects will increase.

Tell your doctor if your condition persists or worsens. If you think you may have a serious medical problem, seek immediate medical attention.

This product is a combination of B vitamins used to treat or prevent vitamin deficiency due to poor diet, certain illnesses, alcoholism, or during pregnancy. Vitamins are important building blocks of the body and help keep you in good health. B vitamins include thiamine, riboflavin, niacin/niacinamide, vitamin B6, vitamin B12, folic acid, and pantothenic acid.

Some brands of B vitamins also contain ingredients such as vitamin C, vitamin E, biotin, or zinc. Consult your doctor or pharmacist if you have questions about the ingredients in your brand.

How to use Vitamin B (Becadex)

Take this medication by mouth, usually once daily or as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are taking a brand that contains vitamin C, take this medication by mouth with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise.

If you are taking chewable tablets, chew the tablet thoroughly before swallowing.

If you are taking extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

If you are taking a liquid product, use a medication-measuring device to carefully measure the dose. Do not use a household spoon. Some liquid products need to be shaken before each dose. Some products that contain vitamin B12 need to be placed under the tongue and held there before swallowing. Follow label directions carefully to get the most benefit.

Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day.

Ascorbic acid (Vitamin C (Becadex)) is used to prevent or treat low levels of Vitamin C (Becadex) in people who do not get enough of the vitamin from their diets. Most people who eat a normal diet do not need extra ascorbic acid. Low levels of Vitamin C (Becadex) can result in a condition called scurvy. Scurvy may cause symptoms such as rash, muscle weakness, joint pain, tiredness, or tooth loss.

Vitamin C (Becadex) plays an important role in the body. It is needed to maintain the health of skin, cartilage, teeth, bone, and blood vessels. It is also used to protect your body's cells from damage. It is known as an antioxidant.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This vitamin may also be used with other vitamins for a certain eye condition (macular degeneration).

How to use Vitamin C (Becadex)

Take this vitamin by mouth with or without food, usually 1 to 2 times daily. Follow all directions on the product package, or take as directed by your doctor.

If you are taking the extended-release capsules, swallow them whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Take this product with a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise.

If you are taking the wafers or chewable tablets, chew them thoroughly and then swallow. If you are taking the lozenges, place the lozenge in your mouth and allow it to slowly dissolve.

If you are taking the powder, mix it thoroughly in the proper amount of liquid and stir well. Drink all of the liquid right away. Do not prepare a supply for future use. If you are using the liquid form of this vitamin, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

Dosage is based on your medical condition and response to treatment.

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

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

Vitamin D (Becadex) (ergocalciferol-D2, cholecalciferol-D3, alfacalcidol) is a fat-soluble vitamin that helps your body absorb calcium and phosphorus. Having the right amount of Vitamin D (Becadex), calcium, and phosphorus is important for building and keeping strong bones. Vitamin D (Becadex) is used to treat and prevent bone disorders (such as rickets, osteomalacia). Vitamin D (Becadex) is made by the body when skin is exposed to sunlight. Sunscreen, protective clothing, limited exposure to sunlight, dark skin, and age may prevent getting enough Vitamin D (Becadex) from the sun.

Vitamin D (Becadex) with calcium is used to treat or prevent bone loss (osteoporosis). Vitamin D (Becadex) is also used with other medications to treat low levels of calcium or phosphate caused by certain disorders (such as hypoparathyroidism, pseudohypoparathyroidism, familial hypophosphatemia). It may be used in kidney disease to keep calcium levels normal and allow normal bone growth. Vitamin D (Becadex) drops (or other supplements) are given to breast-fed infants because breast milk usually has low levels of Vitamin D (Becadex).

How to use Vitamin D (Becadex)

Take Vitamin D (Becadex) by mouth as directed. Vitamin D (Becadex) is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

If your doctor has prescribed this medication, take as directed by your doctor. Your dosage is based on your medical condition, amount of sun exposure, diet, age, and response to treatment.

Measure the liquid medication with the dropper provided, or use a medication-measuring spoon/device to make sure you have the correct dose. If you are taking the chewable tablet or wafers, chew the medication thoroughly before swallowing. Do not swallow whole wafers.

Certain medications (bile acid sequestrants such as cholestyramine/colestipol, mineral oil, orlistat) can decrease the absorption of Vitamin D (Becadex). Take your doses of these medications as far as possible from your doses of Vitamin D (Becadex) (at least 2 hours apart, longer if possible). It may be easiest to take Vitamin D (Becadex) at bedtime if you are also taking these other medications. Ask your doctor or pharmacist how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day if you are taking it once a day. If you are taking this medication only once a week, remember to take it on the same day each week. It may help to mark your calendar with a reminder.

If your doctor has recommended that you follow a special diet (such as a diet high in calcium), 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, get medical help right away.

See also:
What other drugs will affect Vitamin A (Becadex)?

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Some products that may interact with this vitamin include: acitretin, alitretinoin, bexarotene, cholestyramine, isotretinoin, tretinoin, other products that contain Vitamin A (Becadex) (such as multivitamins), warfarin.

Avoid taking Vitamin A (Becadex) at the same time as you take neomycin, orlistat, and mineral oil. If you take any of these medications, separate your doses from your dose of Vitamin A (Becadex) by at least 2 hours.

This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

If you are taking this product under your doctor's direction, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not stop, start, or change the dosage of any medicine before checking with them first.

Before using this product, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: altretamine, cisplatin, certain antibiotics (e.g., chloramphenicol), certain anti-seizure drugs (e.g., phenytoin), levodopa, other vitamin/nutritional supplements.

This product may interfere with certain laboratory tests (e.g., urobilinogen, intrinsic factor antibodies), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this product.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

In an application with barbiturates, primidone increases the excretion of ascorbic acid in the urine.

With the simultaneous use of oral contraceptives reduces the concentration of ascorbic acid in blood plasma.

In an application of Vitamin C (Becadex) with iron preparations ascorbic acid, due to its regenerative properties, transforms ferric iron in the bivalent, which improves its absorption.

Ascorbic acid in high doses can decrease urine pH that while the application reduces the tubular reabsorption of amphetamine and tricyclic antidepressants.

With the simultaneous use of aspirin reduces the absorption of ascorbic acid by about a third.

Vitamin C (Becadex) in an application with warfarin may decrease effects of warfarin.

With the simultaneous application of ascorbic acid increases the excretion of iron in patients receiving deferoxamine. In the application of ascorbic acid at a dose of 500 mg / day possibly left ventricular dysfunction.

In an application with tetracycline is increased excretion of ascorbic acid in the urine.

There is a described case of reducing the concentration of fluphenazine in plasma in patients treated with ascorbic acid 500 mg 2 times / day.

May increase the concentration of ethinyl estradiol in the blood plasma in its simultaneous application in the oral contraceptives.

See also:
What other drugs will affect Vitamin D (Becadex)?

Aluminum Hydroxide: Vitamin D (Becadex) Analogs may increase the serum concentration of Aluminum Hydroxide. Specifically, the absorption of aluminum may be increased, leading to increased serum aluminum concentrations. Avoid combination

Bile Acid Sequestrants: May decrease the serum concentration of Vitamin D (Becadex) Analogs. More specifically, bile acid sequestrants may impair absorption of Vitamin D (Becadex) Analogs. Management: Avoid concomitant administration of Vitamin D (Becadex) analogs and bile acid sequestrants (eg, cholestyramine). Separate administration of these agents by several hours to minimize the potential risk of interaction. Monitor plasma calcium concentrations. Consider therapy modification

Calcium Salts: May enhance the adverse/toxic effect of Vitamin D (Becadex) Analogs. Monitor therapy

Cardiac Glycosides: Vitamin D (Becadex) Analogs may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

Danazol: May enhance the hypercalcemic effect of Vitamin D (Becadex) Analogs. Monitor therapy

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Consider therapy modification

Mineral Oil: May decrease the serum concentration of Vitamin D (Becadex) Analogs. More specifically, mineral oil may interfere with the absorption of Vitamin D (Becadex) Analogs. Management: Avoid concomitant, oral administration of mineral oil and Vitamin D (Becadex) analogs. Consider separating the administration of these agents by several hours to minimize the risk of interaction. Monitor plasma calcium concentrations. Consider therapy modification

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Vitamin D (Becadex) Analogs. Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Vitamin D (Becadex) Analogs. Avoid combination

Orlistat: May decrease the serum concentration of Vitamin D (Becadex) Analogs. More specifically, orlistat may impair absorption of Vitamin D (Becadex) Analogs. Management: Monitor clinical response (including serum calcium) to oral Vitamin D (Becadex) analogs closely if used with orlistat. If this combination must be used, consider giving the Vitamin D (Becadex) analog at least 2 hrs before or after orlistat. Consider therapy modification

Sucralfate: Vitamin D (Becadex) Analogs may increase the serum concentration of Sucralfate. Specifically, the absorption of aluminum from sucralfate may be increased, leading to an increase in the serum aluminum concentration. Avoid combination

Thiazide and Thiazide-Like Diuretics: May enhance the hypercalcemic effect of Vitamin D (Becadex) Analogs. Monitor therapy

Vitamin D (Becadex) Analogs: May enhance the adverse/toxic effect of other Vitamin D (Becadex) Analogs. Avoid combination

See also:
What are the possible side effects of Vitamin A (Becadex)?

This vitamin usually has no side effects when used in recommended doses. If you have any unusual effects, contact your doctor or pharmacist promptly.

A very serious allergic reaction to this vitamin is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Mild upset stomach or flushing may occur. These effects are usually temporary and may disappear as your body adjusts to this product. If any of these effects persist or worsen, contact your doctor or pharmacist promptly.

If your doctor has directed you to take this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Applies to ascorbic acid: oral capsule, oral capsule extended release, oral capsule liquid filled, oral granule, oral liquid, oral lozenge/troche, oral powder, oral powder for solution, oral powder for suspension, oral solution, oral syrup, oral tablet, oral tablet chewable, oral tablet extended release, oral wafer

As well as its needed effects, ascorbic acid (the active ingredient contained in Vitamin C (Becadex)) may cause unwanted side effects that require medical attention.

Severity: Moderate

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

Less common or rare: - with high doses

• Side or lower back pain

Minor Side Effects

Some ascorbic acid 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:

Less common or rare: - with high doses

• Diarrhea
• dizziness or faintness (with the injection only)
• flushing or redness of skin
• headache
• increase in urination (mild)
• nausea or vomiting
• stomach cramps

See also:
What are the possible side effects of Vitamin D (Becadex)?

Vitamin D (Becadex) at normal doses usually has no side effects. If you have any unusual effects, contact your doctor or pharmacist promptly.

If your doctor has directed you to take this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Too much Vitamin D (Becadex) can cause harmful high calcium levels. Tell your doctor right away if any of these signs of high Vitamin D (Becadex)/calcium levels occur: nausea/vomiting, constipation, loss of appetite, increased thirst, increased urination, mental/mood changes, unusual tiredness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.