MULTI VITAMIN AND MINERAL

A daily multivitamin/mineral supplement can improve micronutrient status, plasma antioxidant capacity and cytokine production in healthy, free-living older adults

The recommended daily dose of one tablet per day  must not be exceeded unless under the supervision of a Doctor or Pharmacist.
A slight yellow discolouration of urine may be noticed. This effect is harmless and is due to the vitamin B2 contained in the preparation.

None anticipated

No cases of overdosage due to Multivitamin and Mineral Eff. Tablets have been reported. Any symptoms which may be observed due to the ingestion of large quantities of tablets.

• Formation of bone and teeth

• Muscle contraction
• Normal functioning of many enzymes
• Blood clotting
• Normal heart rhythm

Ascorbic acid (Vit C)
- Oral Absorption and Distribution Absorption is mediated by saturable sodium-dependent vitamin C transporters (SVCTs) in the small intestine.  At moderate intakes (30–180 mg/day), absorption is 70–90% efficient, but drops to <50% at doses above 1 g/day. Plasma concentrations typically return to a steady-state baseline of 70–85 µmol/L within 24 hours. 
- Elimination and Excretion Renal clearance is the dominant elimination pathway.  The kidneys tightly reabsorb vitamin C at low plasma levels, but this mechanism saturates at higher concentrations, leading to quantitative urinary excretion of unmetabolized ascorbate.
                         
Nicotinamide 

• Absorption and Peak Concentration

Oral absorption is rapid, with peak plasma concentrations typically reached within 0.75 to 3 hours after ingestion. 

• Elimination and Half-Life

The elimination half-life is dose-dependent, ranging from approximately 1.5 hours for a 1-g dose to 7–9 hours for 4–6 g doses. 

• Metabolism and Distribution

Nicotinamide undergoes extensive hepatic metabolism, with primary metabolites including nicotinamide N-oxide, 2-pyridone, and 1-methylnicotinamide. It distributes widely.                                       
 
Thiamine nitrate (Vit B1)

• Absorption and Bioavailability

Active Transport: Dominant at low doses; historically estimated to limit single-dose absorption to 4.8–8.3 mg, though newer data suggests passive pathways significantly increase uptake at higher doses. 
Passive Diffusion: Becomes significant at pharmacological doses, allowing for linear, non-saturable absorption up to 1500 mg. 
Bioavailability: Oral thiamine hydrochloride has a bioavailability of approximately 3.7% to 5.3% at standard doses, but higher doses result in disproportionately higher plasma concentrations. 

• Distribution and Elimination

Distribution: Thiamin is widely distributed in the body, with limited storage (approximately 20–30 mg total). It crosses into red blood cells rapidly, maintaining equilibrium between plasma and whole blood. 
Half-Life: The elimination half-life is short, ranging from 1 to 12 hours (specifically ~2.97–4.78 hours in high-dose studies), necessitating regular intake or dosing. 

• Excretion: Excess thiamin is primarily excreted by the kidneys as free thiamin and metabolites. At physiological doses, excretion is minimal, but saturation leads to significant urinary recovery (e.g., 53% of a dose within 24 hours for some formulations). 

                       
Riboflavine Sodium Phosphate -Eqiv. Riboflavin( Vit B2)                        

• Absorption of riboflavin occurs via a saturable, active transport mechanism in the proximal small intestine. The absorption half-life is approximately 1.1 hours, and uptake is facilitated by bile salts, meaning consumption with a meal improves bioavailability. 

Distribution involves rapid conversion into flavocoenzymes; riboflavin is phosphorylated to flavin mononucleotide (FMN) in the gastrointestinal mucosa, erythrocytes, and liver, which is then converted to flavin adenine dinucleotide (FAD) in the liver.  In blood plasma, about 60% of 

• FAD and FMN is protein-bound, and the vitamin readily crosses the placenta. 
• Elimination is characterized by a short biological half-life of 66 to 84 minutes following oral or intravenous administration.  Urinary excretion is the primary removal pathway, accounting for approximately half of the overall clearance from plasma, with about 9% of usual physiologic doses excreted unchanged.

 
Calcium Pantothenate    -Eqiv. Panthothenic Acid (Vit B5)                             
 -  Absorption and Transport Pantothenic acid (Vitamin B5) is rapidly absorbed in the intestine, primarily via a saturable, sodium-dependent active transport system.  At typical dietary levels, bioavailability is approximately 50%; however, at high doses, the transport system saturates, and absorption occurs via passive diffusion.  Peak plasma concentrations are reached within 1 to 2 hours post-dose, and food consumption can delay this absorption peak by approximately 2 hours. 
- Distribution and Metabolism Upon absorption, pantothenic acid is delivered directly into the bloodstream and distributed into extracellular fluids. It is rapidly taken up by tissues, including the liver, where it is converted into coenzyme A (CoA) and phosphopantetheine.  The synthesis of CoA is regulated by pantothenate kinase, which is inhibited by end products CoA and acyl CoA. In humans, the vitamin is widely distributed, with normal whole-blood concentrations ranging from 1.6 to 2.7 μmol/L. 
Excretion and Pharmacokinetics The primary route of elimination is urinary excretion, with approximately 70% of an oral dose excreted unchanged.  Low urinary excretion (<1 mg/day) suggests deficiency.  
 
Pyridoxine hydrochloride ( Vit B6)

• Pyridoxine (Vitamin B6) is rapidly and nearly completely absorbed from the gastrointestinal tract, with an estimated oral bioavailability of 100%.  It undergoes extensive metabolism in the liver, where it is inactivated to 4-pyridoxic acid, while its active form, pyridoxal-5'-phosphate (PLP), is highly protein-bound and stored primarily in the liver, with lesser amounts in muscle and brain. 
• The elimination half-life varies by form: inactive 4-pyridoxic acid has a long elimination half-life of approximately 15 to 20 days, whereas the half-life of free pyridoxine is much shorter (around 0.5 hours for the parent compound, though total body half-life estimates range up to 20–33 days due to tissue storage).  
• Excess vitamin B6 is excreted rapidly in the urine as 4-pyridoxic acid and, at high doses, as unchanged pyridoxine, facilitated by active tubular secretion       

 
Ergocalciferol (Vit D2)

• Ergocalciferol is readily absorbed from the gastrointestinal tract, particularly in the presence of bile salts, with an estimated bioavailability of 80%.  It is highly lipid-soluble and binds to specific alpha-globulins in the blood, leading to rapid distribution throughout the body and storage in adipose tissue, liver, and muscle. 

   The drug is inactive until it undergoes hepatic hydroxylation by the enzyme vitamin D 25-hydroxylase to form 25-hydroxyvitamin D2 (calcifediol).  This metabolite is then further metabolized in the kidneys to the active form, 1,25-dihydroxyvitamin D2 (calcitriol). 

• Regarding elimination and half-life, the circulating 25-hydroxyvitamin D has a half-life of approximately 2 to 3 weeks, while the active 1,25-dihydroxyvitamin D has a half-life of about 4 hours.  The onset of action typically occurs within 12 to 24 hours, though therapeutic effects may take 10 to 14 days to manifest.

                        
d-alpha-Tocopheryl Acetate ( Vit E) 

• Absorption and Bioavailability

   Fractional absorption of d-alpha-tocopherol is approximately 55–70%, depending on dietary fat intake and formulation.
  Time to peak concentration for oral d-alpha-tocopherol is typically 7–12 hours.

• Bioavailability is enhanced by dietary fat (e.g., 40% fat meals) and nanoformulations, which improve uptake and reduce the slow chylomicron secretion process.
• Distribution and Elimination

   d-alpha-tocopherol is swiftly distributed to all lipoprotein fractions (TRL, LDL, HDL) after reaching the liver via VLDL.
   
Biotin ( Vit H)

• Biotin is rapidly absorbed after oral ingestion, reaching peak plasma concentrations within 1 to 2 hours.  It exhibits a linear pharmacokinetic profile over typical supplemental doses, with an effective serum half-life of approximately 15 hours, though this can range from 1.8 to 18.8 hours depending on the dose.  Steady-state concentrations are generally achieved after 3 days of continuous supplementation. 

  Peak serum levels are dose-dependent. Normal baseline circulating concentrations in supplemented individuals are very low, typically ranging from 0.1 to 0.8 ng/mL. 

• Elimination occurs primarily through urinary excretion, with clearance potentially impaired in individuals with renal dysfunction.  

                                   
Folic Acid   

• Folic acid is primarily absorbed in the proximal jejunum via active transport. Synthetic folic acid is at least 85% absorbed when consumed with food,

   Upon absorption, folic acid is transported in the plasma mainly as 5-methyl tetrahydrofolate (5-MTHF), which is the form taken up by tissues.  The liver stores approximately 5 to 10 mg of folate, sufficient for about 3 to 4 months, and converts folate into active tetrahydrofolate derivatives through dihydrofolate reductase action,

• Excretion occurs mainly in the urine, with small amounts in bile. Peak serum levels of folic acid occur 30–60 minutes after oral administration, and the half-life and clearance are influenced by the conversion rate of folic acid to active forms.                                                                                  

 
Calcium ( as carbonate 284 mg and pantothenate 8mg )

• The pharmacokinetics of calcium involve absorption primarily in the intestines, distribution where 99% is stored in the skeleton and 1% in extracellular fluids, and elimination via feces (80%) and urine (20%).  

Oral bioavailability varies by salt form and is influenced by food and anions; The intestinal residence time can be prolonged by certain foods or anions, which may enhance absolute bioavailability.
Iron (as ferrous gluconate)

• Oral Iron Absorption is tightly regulated by the duodenal enterocytes and hepcidin levels, with typical absorption limited to 1–2 mg/day in steady-state conditions, though this can rise to 80–95% in iron deficiency.  High oral doses exceed the active absorption capacity (~25–30 mg/day), leading to passive paracellular uptake that causes gastrointestinal side effects without proportionally increasing bioavailability. 

                     
Zinc (as sulfate) 

• Absorption and Bioavailability

  Incompletely absorbed from the digestive tract. Approximately 20% to 30% of the oral dose reaches systemic circulation. Peak plasma concentrations are typically achieved within a couple of hours following ingestion.
  Shows enteric recycling and homeostatic regulation via endogenous gastrointestinal secretion.

• Distribution

  Around 50% to 80% binds to albumin, with smaller amounts bound to amino acids and α?-macroglobulins.  Widely distributed in the body. High concentrations accumulate in the hair, eyes, prostate and male reproductive organs, and bones. Lower levels appear in the liver, kidneys, and skeletal muscle. Can cross the placenta and pass into breast milk.

• Excretion

  Primarily excreted via the feces (about 40% or more of unabsorbed and secreted zinc). Small amounts are eliminated through urine and perspiration.                                        
 
Magnesium (as sulfate dried) 

• Absorption

   Mostly absorbed in the small intestine (jejunum and ileum).
   Oral absorption ranges from 30% to 50%, depending on the body's magnesium status and the dose.

• Distribution

   Total body magnesium is about 24 grams. About 60% resides in bones, 39% in intracellular spaces (muscles and soft tissues), and less than 1% in extracellular fluid (blood plasma/serum). About 30% to 40% of serum magnesium binds to plasma proteins (mostly albumin).

• Metabolism

   Magnesium is an elemental ion and does not undergo hepatic metabolism by the cytochrome P450 system.

• Excretion

   The kidneys are the main regulators of magnesium balance. The kidneys reabsorb most filtered magnesium in the loop of Henle and distal convoluted tubule, excreting the excess in urine. Small amounts are lost through the gastrointestinal tract (feces) and sweat.               
 
Copper ( as Copper Gluconate )

• Absorption

  Copper is absorbed primarily in the small intestine via active transport and passive diffusion.
  Animal studies show that peak plasma levels of copper occur about 1.5 hours after oral administration. Organic copper salts like copper gluconate are readily soluble and absorbed, though overall uptake is tightly regulated by homeostatic mechanisms in the gut.

• Distribution

  Once absorbed, copper enters the bloodstream and binds to serum proteins, primarily albumin and alpha-2-macroglobulin, for transport to the liver. Copper distributes rapidly into tissues, with the liver holding the highest concentration of the metal as a storage and processing site.
  Copper rapidly accumulates in specific brain regions like the striatum (peaking within 0.15 hours), though distribution is discrete.
  Inside cells, copper is integrated into cuproenzymes (such as superoxide dismutase and cytochrome c oxidase) via specific chaperone proteins.

• Metabolism and Excretion

  The liver incorporates the majority of systemic copper into ceruloplasmin, the major copper-carrying protein in the blood, or stores it bound to metallothionein.

• Copper is eliminated predominantly via biliary excretion into the gastrointestinal tract, which serves as the primary route for maintaining whole-body copper balance. Only a minor fraction is excreted through urine or sweat

     
Manganese ( as sulfate )   

• Absorption

  Absorbed primarily through the gastrointestinal tract (ingestion) and respiratory tract (inhalation), and directly via the olfactory nerve when inhaled. Intestinal absorption is low (typically 3% to 5% of dietary intake) and increases during deficiency or decreases with high intake. Shared transport pathways with iron mean that iron deficiency can enhance manganese absorption and alter blood clearance.

• Distribution

  Absorbed manganese is rapidly cleared from the bloodstream. Initially concentrates in the liver, pancreas, kidneys, and intestines. Manganese crosses the blood-brain barrier and accumulates in specific brain regions like the basal ganglia (globus pallidus and striatum), which are primary targets for neurotoxicity. Transported into cells and organelles via specific mechanisms (such as SLC30A10 and SPCA1) where the Golgi apparatus acts as a key regulatory and storage site.

• Metabolism and Excretion

  The human body maintains balance almost entirely by regulating excretion via the liver into the bile, which passes into the feces (enterohepatic circulation). Renal clearance is minimal, accounting for less than 0.01% to 1% of total body elimination. The elimination follows a biphasic pattern (a fast phase of a few days followed by a slow phase) with an overall whole-body half-life of 2 to 5 weeks in humans, depending on existing body stores.
                 
Chromium(as Chromium chloride)

• Absorption (Bioavailability): Oral absorption of chromium chloride is very low, estimated at approximately 0.13% to 0.4% of an ingested dose.
• Distribution: Once absorbed into the bloodstream, trivalent chromium is distributed widely into body tissues, with higher concentrations typically accumulating in the liver, kidney, spleen, and bone (femur)
• Elimination (Excretion): Absorbed chromium from chloride is eliminated rapidly, primarily through renal excretion in urine, with an excretion half-life of approximately 10 hours.   

Iodine ( as Potassium Iodine)             

• Absorption and Distribution

  Iodide is fast and nearly 100% absorbed in the upper gastrointestinal tract. Iodide enters the extracellular fluid and concentrates actively in the thyroid gland via the sodium-iodide symporter. It also distributes into gastric juice, breast milk, and salivary glands.

• Metabolism and Excretion

  Iodide is utilized by the thyroid gland to synthesize thyroid hormones or remains in an inorganic pool.
  The primary route of elimination is renal excretion through urine, with minor amounts lost via sweat, saliva, and tears




 

There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of this product information

No major incompatibilities are known

24 months

BRH  Multivitamin and Mineral Tablets are packed in polypropylene tubes including a desiccant and a white cap.
Store below 25⁰ C in a cool dry place. Do not use if safety seal around cap is broken or missing.
Keep out of reach of children. Read carefully the package insert before using

Multivitamin and Mineral Tablets are packed in polypropylene tubes including a desiccant and a white cap. Tube of 15 effervescent tablets.

To be allocated
 

BRIDGE HEALTHCARE PTY.LTD
Suite106/10 Edgeworth David Avenue, Hornsby NSW 2077, Australia.