Forceval Capsules can be used for the following indications:
1.
As a therapeutic nutritional adjunct where the intake of vitamins and
minerals is suboptimal, e.g. in the presence of organic disease such as
malignancy and immune deficiency syndromes, such as AIDS.
2.
As a therapeutic nutritional adjunct in conditions where the absorption
of vitamins and minerals is suboptimal, e.g. malabsorption,
inflammatory bowel disease and fistulae, short bowel syndrome and
Crohn's disease, and where concurrent medication decreases vitamin and
mineral absorption.
3.
As a therapeutic nutritional adjunct in convalescence from illness,
e.g. where anorexia or cachexia exists and following chemo- or
radio-therapy.
4.
As a therapeutic nutritional adjunct in convalescence from surgery, e.g.
where nutritional intake continues to be inadequate.
5.
As a therapeutic nutritional adjunct for patients on special or
restricted diets, e.g. in renal diets and where several food groups are
restricted in therapeutic weight reducing diets.
6. As a therapeutic nutritional adjunct where food intolerance exists, e.g. exclusion diets.
7. As an adjunct in synthetic diets, e.g. in phenylketonuria, galactosaemia and ketogenic diets.
The
following account summarises the pharmacological effects of the
vitamins and minerals in Forceval Capsules and describes the conditions
caused by deficiency of these.
Vitamin A
Vitamin
A plays an important role in the visual process. It is isomerised to
the 11-cis isomer and subsequently bound to the opsin to form the
photoreceptor for vision under subdued light. One of the earliest
symptoms of deficiency is night blindness which may develop into the
more serious condition xerophthalmia. Vitamin A also participates in the
formation and maintenance of the integrity of epithelial tissues and
mucous membranes. Deficiency may cause skin changes resulting in a dry
rough skin with lowered resistance to minor skin infections. Deficiency
of Vitamin A, usually accompanied by protein-energy malnutrition, is
linked with a frequency of infection and with defective immunological
defence mechanisms.
Vitamin D
Vitamin
D is required for the absorption of calcium and phosphate from the
gastro-intestinal tract and for their transport. Its involvement in the
control of calcium metabolism and hence the normal calcification of
bones is well documented. Deficiency of Vitamin D in children may result
in the development of rickets.
Vitamin B1 (Thiamine)
Thiamine
(as the coenzyme, thiamine pyrophosphate) is associated with
carbohydrate metabolism. Thiamine pyrophosphate also acts as a coenzyme
in the direct oxidative pathway of glucose metabolism. In thiamine
deficiency, pyruvic and lactic acids accumulate in the tissues. The
pyruvate ion is involved in the biosynthesis of acetylcholine via its
conversion to acetyl co-enzyme A through a thiamine-dependent process.
In thiamine deficiency, therefore, there are effects on the central
nervous system due either to the effect on acetylcholine synthesis or to
the lactate and pyruvate accumulation. Deficiency of thiamine results
in fatigue, anorexia, gastro-intestinal disturbances, tachycardia,
irritability and neurological symptoms. Gross deficiency of thiamine
(and other Vitamin B group factors) leads to the condition beri-beri.
Vitamin B2 (Riboflavine)
Riboflavine
is phosphorylated to flavine mononucleotide and flavine adenine
dinucleotide which act as co-enzymes in the respiratory chain and in
oxidative phosphorylation. Riboflavine deficiency presents with ocular
symptoms, as well as lesions on the lips and at angles of the mouth.
Vitamin B6 (Pyridoxine)
Pyridoxine,
once absorbed, is rapidly converted to the co-enzymes pyridoxal
phosphate and pyridoxamine phosphate which play an essential role in
protein metabolism. Convulsions and hypochromic anaemia have occurred in
infants deficient in pyridoxine.
Vitamin B12 (Cyanocobalamin)
Vitamin B12
is present in the body mainly as methylcobalamin and as
adenosylcobalamin and hydroxocobalamin. These act as co-enzymes in the
trans methylation of homocysteine to methionine; in the isomerisation of
methylmalonyl coenzyme to succinyl co-enzyme and with folate in several metabolic pathways respectively. Deficiency of Vitamin B12 interferes with haemopoiesis and produces megaloblastic anaemia.
Vitamin C (Ascorbic Acid)
Vitamin
C cannot be synthesised by man therefore a dietary source is necessary.
It acts as a cofactor in numerous biological processes including the
hydroxylation of proline to hydroxyproline. In deficiency, the formation
of collagen is, therefore, impaired. Ascorbic acid is important in the
hydroxylation of dopamine to noradrenaline and in hydroxylations
occurring in steroid synthesis in the adrenals. It is a reducing agent
in tyrosine metabolism and by acting as an electron donor in the
conversion of folic acid to tetrahydrofolic acid is indirectly involved
in the synthesis of purine and thymine. Vitamin C is also necessary for
the incorporation of iron into ferritin. Vitamin C increases the
phagocytic function of leucocytes; it possesses anti-inflammatory
activity and it promotes wound healing. Deficiency can produce scurvy.
Features include swollen inflamed gums, petechial haemorrhages and
subcutaneous bruising. The deficiency of collagen leads to development
of thin watery ground substances in which blood vessels are insecurely
fixed and readily ruptured. The supportive components of bone and
cartilage are also deficient causing bones to fracture easily and teeth
to become loose. Anaemia commonly occurs probably due to Vitamin C's
role in iron metabolism.
Vitamin E
Vitamin
E deficiency has been linked to disorders such as cystic fibrosis where
fat absorption is impaired. It is essential for the normal function of
the muscular system and the blood.
Nicotinamide
The
biochemical functions of nicotinamide as NAD and NADP (nicotinamide
adenine dinucleotide phosphate) include the degradation and synthesis of
fatty acids, carbohydrates and amino acids as well as hydrogen
transfer. Deficiency produces pellagra and mental neurological changes.
Calcium (Dicalcium Phosphate)
Calcium
is an essential body electrolyte. It is involved in the maintenance of
normal muscle and nerve function and essential for normal cardiac
function and the clotting of blood. Calcium is mainly found in the bones
and teeth. Deficiency of calcium leads to rickets, osteomalacia in
children and osteoporosis in the elderly.
Phosphorus (Dicalcium Phosphate)
Phosphate
plays important roles in the osteoblastic and osteoclastic reactions.
It interacts with calcium to modify the balance between these two
processes. Organic phosphate esters play a key role in the metabolism of
carbohydrates, fats and proteins and in the formation of 'high energy
phosphate' compounds. Phosphate also acts as a buffer and plays a role
in the renal excretion of sodium and hydrogen ions.
Pantothenic Acid
Pantothenic
acid is incorporated into co-enzyme A and is involved in metabolic
pathways involving acetylation which includes detoxification of drug
molecules and biosynthesis of cholesterol, steroid hormones,
mucopolysaccharides and acetylcholine. CoA has an essential function in
lipid metabolism.
Folic Acid
Folic
acid is reduced in the body to tetrahydrofolate which is a co-enzyme
for various metabolic processes, including the synthesis of purine and
pyrimidine nucleotides and hence in the synthesis of DNA. It is also
involved in some amino acid conversion and in the formation and
utilisation of formate. Deficiency of folic acid leads to megaloblastic
anaemia.
Vitamin H (d-Biotin)
Biotin is a co-enzyme for carboxylation during the metabolism of proteins and carbohydrates.
Selenium
Selenium
is an essential trace element, deficiency of which has been reported in
man. It is thought to be involved in the functioning of membranes and
the synthesis of amino acids. Deficiency of selenium in the diet of
experimental animals produces fatty liver followed by necrosis.
Iron
Iron,
as a constituent of haemoglobin, plays an essential role in oxygen
transport. It is also present in the muscle protein myoglobin and in the
liver. Deficiency of iron leads to anaemia.
Copper (Copper Sulphate)
Traces of copper are essential to the body as constituents of enzyme systems involved in oxidation reactions.
Magnesium (Magnesium Oxide)
Magnesium
is essential to the body as a constituent of skeletal structures and in
maintaining cell integrity and fluid balance. It is utilised in many of
the functions in which calcium is concerned but often exerts the
opposite effect. Some enzymes require the magnesium ion as a co-factor.
Potassium (Potassium Sulphate)
Potassium
is the principle cation of intracellular fluid and is intimately
involved in the cell function and metabolism. It is essential for
carbohydrate metabolism and glycogen storage and protein synthesis and
is involved in transmembrane potential where it is necessary to maintain
the resting potential in excitable cells. Potassium ions maintain
intracellular pH and osmotic pressure. Prolonged or severe diarrhoea may
lead to potassium deficiency.
Zinc (Zinc Sulphate)
Zinc
is a constituent of many enzymes and is, therefore, essential to the
body. It is present with insulin in the pancreas. It plays a role in DNA
synthesis and cell division. Reported effects of deficiency include
delayed puberty and hypogonadal dwarfism.
Manganese (Manganese Sulphate)
Manganese
is a constituent of enzyme systems including those involved in lipid
synthesis, the tricarboxylic acid cycle and purine and pyrimidine
metabolism. It is bound to arginase of the liver and activates many
enzymes.
Iodine (Potassium Iodide)
Iodine is an essential constituent of the thyroid hormones.
Chromium (Chromium Amino Acid Chelate 10%)
Chromium is an essential trace element involved in carbohydrate metabolism.
Molybdenum (Sodium Molybdate)
Molybdenum
is an essential trace element although there have been no reports of
deficiency states in man. Molybdenum salts have been used to treat
copper poisoning in sheep.
