Nuhenz

Benfotiamine (Nuhenz) (rINN, or S-benzoylthiamine O-monophoshate) is a synthetic S-acyl derivative of thiamine (vitamine B1). After absorption, Benfotiamine (Nuhenz) can be dephosphorylated by cells bearing an ecto-alkaline phosphatase to the lipid-soluble S-benzoylthiamine. Benfotiamine (Nuhenz) should not be confused with allithiamine, a naturally occurring thiamine disulfide derivative with a distinct pharmacological profile.

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 (Nuhenz) is used in the treatment and prevention of folate deficiencies and megaloblastic anemia. [PubChem]

Mecobalamin (Nuhenz)/Mecobalamin (Nuhenz)-1500 also contains the following inactive ingredients: Lactose, maize starch, microcrystalline cellulose, povidone (K-30), purified talc, anhydrous colloidal silica, hypromellose, macrogol, titanium dioxide, isopropyl alcohol, dicholoromethane, red iron oxide and yellow iron oxide.

Pyridoxine hydrochloride (Nuhenz) is the 4-methanol form of vitamin B6 and is converted to pyridoxal 5-phosphate in the body. Pyridoxal 5-phosphate is a coenzyme for synthesis of amino acids, neurotransmitters (serotonin, norepinephrine), sphingolipids, aminolevulinic acid. Although Pyridoxine hydrochloride (Nuhenz) and vitamin B6 are still frequently used as synonyms, especially by medical researchers, this practice is erroneous and sometimes misleading. [PubChem]

is used for its antoxidant effects in the treatment of diabetic neuropathy. It has been tried in the treatment of liver dysfunction and in subacute necrotising encephalopathy. Beneficial results have been claimed in amanitin poisoning after ingestion of the mushroom Amanita phalloides, but such use is controversial

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

Folic acid (Nuhenz) 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 (Nuhenz) 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.

Mecobalamin (Nuhenz) (doxacurium chloride) is a long-acting neuromuscular blocking agent, indicated to provide skeletal muscle relaxation as an adjunct to general anesthesia, for endotracheal intubation or to facilitate mechanical ventilation.

* Sideroblastic anaemia

* Treatment and prophylaxis of vitamin B6 deficiency states

Alpha-lipoic acid is a naturally occurring fatty acid that can be found in many foods such as yeast, spinach, broccoli, potatoes, and organ meats such as liver or kidney.

Alpha-lipoic acid has been used as a nutritional supplement and antioxidant.

Not all uses for alpha-lipoic acid have been approved by the FDA. Alpha-lipoic acid should not be substituted for medications prescribed for you by your doctor.

Alpha-lipoic acid is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Alpha-lipoic acid may also be used for purposes not listed in this product guide.

Not all uses for alpha-lipoic acid have been approved by the FDA. Alpha-lipoic acid should not be substituted for medications prescribed for you by your doctor.

Alpha-lipoic acid is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Talk with a doctor, pharmacist, herbalist, or other healthcare provider before using alpha-lipoic acid if you have kidney or liver disease, diabetes, low blood sugar (hypoglycemia), or a thyroid disorder.

Use alpha-lipoic acid as directed on the label, or as your healthcare provider has prescribed. Do not use this product in larger amounts or for longer than recommended.

Taking alpha-lipoic acid may lower your blood sugar. Tell your doctor, pharmacist, herbalist, or other healthcare provider if you have symptoms such as hunger, weakness, nausea, irritability, dizziness, headache, blurred vision, confusion, sweating, fast heart rate, or fainting.

Less serious side effects are more likely to occur, and you may have none at all.

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 (Nuhenz) (vitamin B 9) is necessary for strong blood.

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

Some conditions may increase your need for Folic acid (Nuhenz). 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 (Nuhenz).

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

Some studies have found that Folic acid (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) is given by or under the direction of your health care professional. Another form of Folic acid (Nuhenz) is available without a prescription.

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

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

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

Pyridoxine hydrochloride (Nuhenz) may also be used for purposes not listed in this medication guide.

Usual Adult Dose for Dietary Supplement

Alpha-lipoic acid 300 mg oral capsule:

1 capsule once or twice daily.

Alpha-lipoic acid 50 mg oral tablet:

1 tablet orally per day with a meal.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Data not available

Oral

Alcoholic neuropathy; Diabetic neuropathy

Adult: 100 mg 4 times daily.

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 (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) to patients with undiagnosed anemia, since Folic acid (Nuhenz) 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.

Mecobalamin (Nuhenz) SHOULD ONLY BE ADMINISTERED INTRAVENOUSLY.

Mecobalamin (Nuhenz), like other long-acting neuromuscular blocking agents, displays variability in the duration of its effect. The potential for a prolonged clinical duration of neuromuscular block must be considered when Mecobalamin (Nuhenz) is selected for administration. The dosage information provided below is intended as a guide only. Doses should be individualized. Factors that may warrant dosage adjustment include: advancing age, the presence of kidney or liver disease, or obesity (patients weighing ≥ 30% more than ideal body weight for height). The use of a peripheral nerve stimulator will permit the most advantageous use of Mecobalamin (Nuhenz), minimize the possibility of overdosage or underdosage, and assist in the evaluation of recovery.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.

Adults

Initial Doses

When administered as a component of a thiopental/narcotic induction-intubation paradigm as well as for production of long-duration neuromuscular block during surgery, 0.05 mg/kg (2 × ED95) Mecobalamin (Nuhenz) produces good-to-excellent conditions for tracheal intubation in 5 minutes in approximately 90% of patients. Lower doses of Mecobalamin (Nuhenz) may result in a longer time for development of satisfactory intubation conditions. Clinically effective neuromuscular block may be expected to last approximately 100 minutes on average (range: 39 to 232) following 0.05 mg/kg Mecobalamin (Nuhenz) administered to patients receiving balanced anesthesia.

An initial Mecobalamin (Nuhenz) dose of 0.08 mg/kg (3 × ED95) should be reserved for instances in which a need for very prolonged neuromuscular block is anticipated. In approximately 90% of patients, good-to-excellent intubation conditions may be expected in 4 minutes after this dose; however, clinically effective block may be expected to persist for as long as 160 minutes or more (range: 110 to 338).

If Mecobalamin (Nuhenz) is administered during steady-state isoflurane, enflurane, or halothane anesthesia, reduction of the dose of Mecobalamin (Nuhenz) by one third should be considered.

When succinylcholine is administered to facilitate tracheal intubation in patients receiving balanced anesthesia, an initial dose of 0.025 mg/kg (ED95) Mecobalamin (Nuhenz) provides about 60 minutes (range: 9 to 145) of clinically effective neuromuscular block for surgery. For a longer duration of action, a larger initial dose may be administered.

Maintenance Doses

Maintenance dosing will generally be required about 60 minutes after an initial dose of 0.025 mg/kg Mecobalamin (Nuhenz) or 100 minutes after an initial dose of 0.05 mg/kg Mecobalamin (Nuhenz) during balanced anesthesia. Repeated maintenance doses administered at 25% T1 recovery may be expected to be required at relatively regular intervals in each patient. The interval may vary considerably between patients. Maintenance doses of 0.005 and 0.01 mg/kg Mecobalamin (Nuhenz) each provide an average 30 minutes (range: 9 to 57) and 45 minutes (range: 14 to 108), respectively, of additional clinically effective neuromuscular block. For shorter or longer desired durations, smaller or larger maintenance doses may be administered.

Children

When administered during halothane anesthesia, an initial dose of 0.03 mg/kg (ED95) produces maximum neuromuscular block in about 7 minutes (range: 5 to 11) and clinically effective block for an average of 30 minutes (range: 12 to 54). Under halothane anesthesia, 0.05 mg/kg produces maximum block in about 4 minutes (range: 2 to 10) and clinically effective block for 45 minutes (range: 30 to 80). Maintenance doses are generally required more frequently in children than in adults. Because of the potentiating effect of halothane seen in adults, a higher dose of Mecobalamin (Nuhenz) may be required in children receiving balanced anesthesia than in children receiving halothane anesthesia to achieve a comparable onset and duration of neuromuscular block. Mecobalamin (Nuhenz) has not been studied in pediatric patients below the age of 2 years.

Compatibility

Y-site Administration

Mecobalamin (Nuhenz) Injection may not be compatible with alkaline solutions with a pH greater than 8.5 (e.g., barbiturate solutions).

Mecobalamin (Nuhenz) is compatible with:

• 5% Dextrose Injection, USP
• 0.9% Sodium Chloride Injection, USP
• 5% Dextrose and 0.9% Sodium Chloride Injection, USP
• Lactated Ringer's Injection, USP
• 5% Dextrose and Lactated Ringer's Injection
• Sufenta® (sufentanil citrate) Injection, diluted as directed
• Alfenta® (alfentanil hydrochloride) Injection, diluted as directed
• Sublimaze® (fentanyl citrate) Injection, diluted as directed

Mecobalamin (Nuhenz) diluted up to 1:10 in 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP has been shown to be physically and chemically stable when stored in polypropylene syringes at 5° to 25°C (41° to 77°F), for up to 24 hours. Since dilution diminishes the preservative effectiveness of benzyl alcohol, aseptic techniques should be used to prepare the diluted product. Immediate use of the diluted product is preferred, and any unused portion of diluted Mecobalamin (Nuhenz) should be discarded after 8 hours.

Usual Adult Dose for Drug Induced Vitamin/Mineral Deficiency:

Drug Induced Neuritis:

Cycloserine: 100 to 300 mg/day orally in divided doses.

Isoniazid or penicillamine: 100 to 200 mg/day orally for 3 weeks or 25 to 100 mg/day for prophylaxis.

Oral contraceptives: 25 to 30 mg/day orally.

Acute Intoxication:

Hydralazine: 25 mg/kg. One-third of the dose should be administered IM and the remainder administered as an IV infusion over 3 hours.

Isoniazid: 1 to 4 grams IV as a first dose, then 1 g IM every 30 minutes until the total required dose has been administered (given with other anticonvulsants as needed). The total dose administered should equal the amount of isoniazid ingested.

Mushroom ingestion (genus Gyromitra): 25 mg/kg IV infused over 15 to 30 minutes. Repeat as needed to a maximum total daily dose of 15 to 20 g.

Usual Adult Dose for Dietary Supplement:

Pyridoxine hydrochloride (Nuhenz) Deficiency:

10 to 25 mg/day orally, IM, or IV for 3 weeks followed by 2 to 5 mg/day from a multivitamin product.

Usual Adult Dose for Anemia:

Sideroblastic, hereditary: 200 to 600 mg orally daily. If adequate response obtained, dose may be decreased to 30 to 50 mg orally daily.

If therapeutic response is not obtained after 1 to 2 months of Pyridoxine hydrochloride (Nuhenz) therapy, a different therapy should be considered.

Usual Adult Dose for Nausea/Vomiting:

Nausea and vomiting of Pregnancy:

25 mg orally every 8 hours.

Usual Pediatric Dose for Drug Induced Vitamin/Mineral Deficiency:

Drug Induced Neuritis (cycloserine, isoniazid, hydralazine, penicillamine) :

Treatment: 10 to 50 mg/day.

Prophylaxis: 1 to 2 mg/kg/day

Acute Intoxication:

Hydralazine: 25 mg/kg: One-third of the dose should be administered IM and the remainder administered as an IV infusion over 3 hours.

Isoniazid: Acute ingestion of known amount: Initial: A total dose of Pyridoxine hydrochloride (Nuhenz) equal to the amount of isoniazid ingested (maximum dose: 70 mg/kg, up to 5 g); administer at a rate of 0.5 to 1 g/minute until seizures stop or the maximum initial dose has been administered; may repeat every 5 to 10 minutes as needed to control persistent seizure activity and/or CNS toxicity. If seizures stop prior to the administration of the calculated initial dose, infuse the remaining Pyridoxine hydrochloride (Nuhenz) over 4 to 6 hours. Acute ingestion of unknown amount: Initial: 70 mg/kg (maximum dose: 5 g); administer at a rate of 0.5 to 1 g/minute; may repeat every 5 to 10 minutes as needed to control persistent seizure activity and/or CNS toxicity.

Mushroom ingestion (genus Gyromitra): 25 mg/kg IV. Repeat as needed up to a maximum total dose of 15 to 20 g.

Usual Pediatric Dose for Dietary Supplement:

Pyridoxine hydrochloride (Nuhenz) Deficiency:

5 to 25 mg/day orally, IM, or IV for 3 weeks followed by 1.5 to 2.5 mg/day from a multivitamin product.

Usual Pediatric Dose for Seizures:

Pyridoxine hydrochloride (Nuhenz)-dependent seizures:

10 to 100 mg PO, IM, or IV initially, followed by 2 to 100 mg orally daily.

do not use in the treatment of leber disease or tobaco intoxication.

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

Because it may mask the hematologic abnormalities while neurological damage progresses, Folic acid (Nuhenz) 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 (Nuhenz) 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.

Mecobalamin (Nuhenz) (doxacurium chloride) is contraindicated in patients with known hypersensitivity to the product and its components. Mecobalamin (Nuhenz) (doxacurium chloride) is contraindicated for use in premature infants because the formulation contains benzyl alcohol.

See also:
What is the most important information I should know about Pyridoxine hydrochloride (Nuhenz)?

Contraindications for Vitamin B6 (Pyridoxine hydrochloride (Nuhenz))

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

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

• Folic acid (Nuhenz) may be administered as an injection by your health care professional.
• If you are using Folic acid (Nuhenz) 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 (Nuhenz), 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 (Nuhenz).

Use Pyridoxine hydrochloride (Nuhenz) (vitamin b6) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Pyridoxine hydrochloride (Nuhenz) (vitamin b6) is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Pyridoxine hydrochloride (Nuhenz) (vitamin b6) at home, carefully follow the injection procedures taught to you by your health care provider.
• If Pyridoxine hydrochloride (Nuhenz) (vitamin b6) contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.
• Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.
• If you miss a dose of Pyridoxine hydrochloride (Nuhenz) (vitamin b6) and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Pyridoxine hydrochloride (Nuhenz) (vitamin b6).

Alpha lipoic acid (Nuhenz) (ALA) is used to enhance effects of primary antidiabetic therapy (adjuvant therapy) in patients with diabetes as it lowers blood glucose by binding to insulin (a hormone that controls blood sugar level in the body) receptor in the body which leads to increase glucose utilization. Also, due to its antioxidant activity, ALA is used to treat nerve damage due to uncontrolled blood sugar level that causes pain, tingling, or numbness over hands and feet (diabetic neuropathy). ALA is used as an antioxidant as an adjuvant treatment of HIV, cancer, liver ailments, and various other conditions.

Beri Beri, Wenicke-korsakoff syndrome. diabetic neuropathy.

Folic acid (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) either through their diet or supplements to prevent infant spinal cord birth defects.

How to use Folic acid (Nuhenz)

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.

Use: Labeled Indications

Pyridoxine hydrochloride (Nuhenz) deficiency: Treatment and prevention of Pyridoxine hydrochloride (Nuhenz) (vitamin B) deficiency.

Off Label Uses

Ethylene glycol poisoning

The American Academy of Clinical Toxicology guidelines recognize the lack of human clinical data for this use and consider Pyridoxine hydrochloride (Nuhenz) as an adjunctive cofactor therapy in ethylene glycol poisoning without a formal or evidence-based recommendation, especially in patients who may have vitamin deficiencies (eg, patients with alcoholism). Additional data may be necessary to further define the role of Pyridoxine hydrochloride (Nuhenz) in this condition.

Peripheral neuropathy associated with isoniazid therapy for Mycobacterium tuberculosis (prevention)

Based on the Department of Health and Human Services (DHHS) Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, Pyridoxine hydrochloride (Nuhenz) is effective and recommended in the prevention of peripheral neuropathy associated with isoniazid therapy for Mycobacterium tuberculosis.

none known

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

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 (Nuhenz). Folic acid (Nuhenz) supplements can correct the anemia associated with vitamin B12 deficiency. Unfortunately, Folic acid (Nuhenz) 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 (Nuhenz) should not exceed 1000 micrograms (g, sometimes mcg) per day to prevent Folic acid (Nuhenz) from masking symptoms of vitamin B12 deficiency. It is important for older adults to be aware of the relationship between Folic acid (Nuhenz) 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 (Nuhenz).

Antibiotics: The use of antibiotics may alter the intestinal microflora and may decrease the possible contribution of Mecobalamin (Nuhenz) by certain inhabitants of the microflora (eg, Lactobacillus spp) to the body's requirement for the vitamin. This may particularly be a problem for vegetarians. Garlic, onions, leeks, bananas, asparagus and artichokes, among other vegetables and fruits, contain inulins which promote the growth of certain colonic bacteria including Lactobacillus spp.

Cholestyramine:

Colchicine: Colchicine may cause decreased absorption of Mecobalamin (Nuhenz).

Colestipol:

H₂-Blockers (Cimetidine, Famotidine, Nizatidine, Ranitidine): Chronic use of H₂-blockers may result to decreased absorption of Mecobalamin (Nuhenz). They are unlikely to affect the absorption of supplemental B₁₂.

Metformin: Metformin may decrease the absorption of Mecobalamin (Nuhenz). This possible effect may be reversed with oral calcium supplementation.

Nitrous Oxide: Inhalation of the anesthetic agent nitrous oxide (not to be confused with nitric oxide) can produce a functional deficiency. Nitrous oxide forms a complex with cobalt in Mecobalamin (Nuhenz), the cofactor for methionine synthase, resulting in inactivation of the enzyme.

Para-Amino Salicylic Acid: Chronic use of the anti-tuberculosis drug may decrease the absorption of Mecobalamin (Nuhenz).

Potassium Chloride: It has been reported that potassium chloride may decrease the absorption of Mecobalamin (Nuhenz).

Proton Pump Inhibitors (Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole): Chronic use of proton pump inhibitors may result in decreased absorption, naturally found in food sources.

See also:
What other drugs will affect Pyridoxine hydrochloride (Nuhenz)?

Cycloserine, isoniazid, hydralazine, oral contraceptives, penicillamine

Increased need for Pyridoxine hydrochloride (Nuhenz).

Levodopa

Decreased effect of levodopa. (Interaction does not occur with levodopa/carbidopa in combination with Pyridoxine hydrochloride (Nuhenz).)

Phenytoin

Phenytoin serum levels may be decreased.

Incompatibility

Incompatible with alkaline solutions, iron salts and oxidizing agents (parenteral).

Laboratory Test Interactions

May result in false-positive urobilinogen in the spot test using Ehrlich reagent.

See also:
What are the possible side effects of Alpha lipoic acid (Nuhenz)?

Nausea, Abdominal pain, Allergic reaction, Diarrhoea, Vertigo, Vomiting

anaphylactic reactions rarely, severe cases can cause death, urine yellow colouration,peripheral neuropathy in case of prolonged useage, arrythmias,

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

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

Folic acid (Nuhenz) is relatively nontoxic in man. Rare instances of allergic responses to Folic acid (Nuhenz) 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 (Nuhenz) 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 (Nuhenz) therapy.

In an uncontrolled study, orally administered Folic acid (Nuhenz) 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 (Nuhenz) 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.

The most frequent adverse effect of nondepolarizing blocking agents as a class consists of an extension of the pharmacological action beyond the time needed for surgery and anesthesia. This effect may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiratory insufficiency and apnea which require manual or mechanical ventilation until recovery is judged to be clinically adequate. Inadequate reversal of neuromuscular block from Mecobalamin (Nuhenz) (doxacurium chloride) is possible, as with all nondepolarizing agents. Prolonged neuromuscular block and inadequate reversal may lead to postoperative complications.

Observed in Clinical Trials

Adverse experiences were uncommon among the 1034 surgical patients and volunteers who received Mecobalamin (Nuhenz) (doxacurium chloride) and other drugs in US clinical studies in the course of a wide variety of procedures conducted during balanced or inhalational anesthesia. The following adverse experiences were reported in patients administered Mecobalamin (Nuhenz) (doxacurium chloride) (all events judged by investigators during the clinical trials to have a possible causal relationship):

Incidence Greater than 1%

None

Incidence Less than 1%

Observed During Clinical Practice

There have been post-marketing reports of severe allergic reactions (anaphylactic and anaphylactoid reactions) with the use of neuromuscular blocking agents of which Mecobalamin (Nuhenz) (doxacurium chloride) is a member. These reactions, in some cases, have been life threatening and fatal. Because these reactions were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency.

See also:
What are the possible side effects of Pyridoxine hydrochloride (Nuhenz)?

CNS

Neuropathy; unstable gait; drowsiness; somnolence.

EENT

Perioral numbness.

Miscellaneous

Numbness of feet; decreased sensation to touch, temperature or vibration; paresthesia; low serum Pyridoxine hydrochloride (Nuhenz) levels; burning/stinging at IM injection site; photoallergic reaction; ataxia.