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Pronunciation |
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(VYE
ta min
aye) |
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U.S. Brand
Names |
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Aquasol A®; Del-Vi-A®;
Palmitate-A® 5000
[OTC] |
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Generic
Available |
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Yes |
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Synonyms |
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Oleovitamin A |
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Pharmacological Index |
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Vitamin, Fat Soluble |
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Use |
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Treatment and prevention of vitamin A deficiency |
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Pregnancy Risk
Factor |
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A/X (if dose exceeds RDA recommendation) |
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Pregnancy/Breast-Feeding
Implications |
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Clinical effect on the fetus: Excessive use of vitamin A shortly before and
during pregnancy could be harmful to babies |
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Contraindications |
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Hypervitaminosis A, hypersensitivity to vitamin A or any component; pregnancy
if dose exceeds RDA recommendations |
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Warnings/Precautions |
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Evaluate other sources of vitamin A while receiving this product; patients
receiving >25,000 units/day should be closely monitored for
toxicity |
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Adverse
Reactions |
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1% to 10%:
Dermatologic: Drying or cracking of skin
Endocrine & metabolic: Hypercalcemia
Gastrointestinal: Weight loss
Ocular: Visual changes
Miscellaneous: Hypervitaminosis A |
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Overdosage/Toxicology |
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Symptoms of acute ingestion of >12,000 international units/kg or chronic
overdose (eg, adults: 25,000 units/day for 2-3 weeks) include increased
intracranial pressure (headache, altered mental status, blurred vision), bulging
fontanelles in infants, jaundice, ascites, cutaneous desquamation; symptoms of
acute overdose (12,000 units/kg) include nausea, vomiting, and diarrhea; toxic
signs of an overdose commonly respond to drug discontinuation and generally
return to normal spontaneously within a few days to weeks.
Treat intracranial hypertension from chronic exposure, if needed; for acute
exposure, use gut decontamination and treat symptomatically
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Drug
Interactions |
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Decreased effect: Cholestyramine decreases absorption of vitamin A; neomycin
and mineral oil may also interfere with vitamin A absorption
Increased toxicity: Retinoids may have additive adverse effects
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Stability |
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Protect from light |
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Mechanism of
Action |
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Needed for bone development, growth, visual adaptation to darkness,
testicular and ovarian function, and as a cofactor in many biochemical
processes |
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Pharmacodynamics/Kinetics |
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Absorption: Vitamin A in dosages not exceeding physiologic
replacement is well absorbed after oral administration; water miscible
preparations are absorbed more rapidly than oil preparations; large oral doses,
conditions of fat malabsorption, low protein intake, or hepatic or pancreatic
disease reduces oral absorption
Distribution: Following oral absorption, large amounts concentrate for
storage in the liver; appears in breast milk
Metabolism: Conjugated with glucuronide, undergoes enterohepatic circulation
Elimination: In feces via biliary elimination |
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Usual Dosage |
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RDA:
<1 year: 375 mcg
1-3 years: 400 mcg
4-6 years: 500 mcg*
7-10 years: 700 mcg*
>10 years: 800-1000 mcg*
Male: 1000 mcg
Female: 800 mcg
* mcg retinol equivalent (0.3 mcg retinol = 1 unit vitamin A)
Vitamin A supplementation in measles (recommendation of the World Health
Organization): Children: Oral: Administer as a single dose; repeat the next day
and at 4 weeks for children with ophthalmologic evidence of vitamin A
deficiency:
6 months to 1 year: 100,000 units
>1 year: 200,000 units
Note: Use of vitamin A in measles is recommended only for patients 6
months to 2 years of age hospitalized with measles and its complications
or patients >6 months of age who have any of the following risk factors
and who are not already receiving vitamin A: immunodeficiency, ophthalmologic
evidence of vitamin A deficiency including night blindness, Bitot's spots or
evidence of xerophthalmia, impaired intestinal absorption, moderate to severe
malnutrition including that associated with eating disorders, or recent
immigration from areas where high mortality rates from measles have been
observed
Note: Monitor patients closely; dosages >25,000 units/kg have been
associated with toxicity
Severe deficiency with xerophthalmia: Oral:
Children 1-8 years: 5000-10,000 units/kg/day for 5 days or until recovery
occurs
Children >8 years and Adults: 500,000 units/day for 3 days, then 50,000
units/day for 14 days, then 10,000-20,000 units/day for 2 months
Deficiency (without corneal changes): Oral:
Infants <1 year: 100,000 units every 4-6 months
Children 1-8 years: 200,000 units every 4-6 months
Children >8 years and Adults: 100,000 units/day for 3 days then 50,000
units/day for 14 days
Malabsorption syndrome (prophylaxis): Children >8 years and Adults: Oral:
10,000-50,000 units/day of water miscible product
Dietary supplement: Oral:
Infants up to 6 months: 1500 units/day
Children:
6 months to 3 years: 1500-2000 units/day
4-6 years: 2500 units/day
7-10 years: 3300-3500 units/day
Children >10 years and Adults: 4000-5000 units/day |
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Reference Range |
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1 RE = 1 retinol equivalent; 1 RE = 1 mg retinol
or 6
mg beta-carotene; Normal levels of Vitamin A in serum
=
80-300 units/mL |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Take exactly as directed; do not take more than the recommended dose. Take
with meals. Do not use mineral oil or other vitamin A supplements without
consulting prescriber. Report persistent nausea, vomiting, or loss of appetite;
excessively dry skin or lips; headache or CNS irritability; loss of hair; or
changes in vision. |
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Nursing
Implications |
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Do not administer by I.V. push; patients receiving >25,000 units/day
should be closely monitored for toxicity |
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Dosage Forms |
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Capsule: 10,000 units [OTC], 25,000 units, 50,000 units
Drops, oral (water miscible) [OTC]: 5000 units/0.1 mL (30 mL)
Injection: 50,000 units/mL (2 mL)
Tablet [OTC]: 5000 units |
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References |
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Braitberg G, Curry SC, and Kunkel DB,
"Liver Pathology in Fatal Vitamin A Toxicity," Clin Toxicol, 1995,
33(5):551-2.
Cetaruk EW and Aaron CK, "Hazards of Nonprescription Medications," Emerg
Med Clin North Am, 1994, 12(2):483-510.
Committee on Infectious Diseases, "Vitamin A in the Treatment of Measles,"
Pediatrics, 1993, 91(5):1014-5.
de Francisco A, Chakraborty J, Chowdhury HR, et al,
"Acute Toxicity of Vitamin A Given With Vaccines in Infancy," Lancet,
1993, 342(8870):526-7.
DeMaeyer EM,
"The WHO Programme of Prevention and Control of Vitamin A Deficiency, Xerophthalmia, and Nutritional Blindness,"
Nutr Health, 1986, 4(2):105-12.
Hussey GD and Klein M,
"A Randomized, Controlled Trial of Vitamin A in Children With Severe Measles,"
N Engl J Med, 1990, 323(3):160-4.
Kowalski TE, Falestiny M, Furth E, et al,
"Vitamin A Hepatotoxicity: A Cautionary Note Regarding 25,000 IU Supplements,"
Am J Med, 1994, 97(6):523-8.
LaMantia RS and Andrews CE, "Acute Vitamin A Intoxication," South Med
J, 1981, 74(8):1012-4.
Nesher G and Zuckner J,
"Rheumatologic Complications of Vitamin A and Retinoids," Semin Arthritis
Rheum, 1995, 24(4):291-6.
Sanders TA, "Vitamin A and Pregnancy," Lancet, 1990, 336(8727):1375.
White JM, "Vitamin A-Induced Anaemia," Lancet, 1984, 2(8402):573.
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