Dermatology Case No 27. Alopecia Areata.

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Dermatology Case No 27. Alopecia Areata.

চুল ঝরে পড়া একজন মানুষের জন্য খুবই বিব্রতকর একটা ব্যাপার, মানুষের সৌন্দর্যের অন্যতম হচ্ছে পুরো মাথা জুড়ে কালো চুল।

•Alopecia areata কি?

এটি একটি Auto immuno disease… hair follicle কে আক্রান্ত করে Hair loss induce করে, এখানে patch আকারে hair loss হয়

দেখা যাবে, scalp এর একটা নির্দিষ্ট জায়গা জুড়ে hair loss হয়ে আছে, তবে কোনো scaly or flaky lesion থাকেনা।

কারণ:

•Genetic কারণে Alopecia areata হতে পারে।

•আবার কিছু কিছু রিসার্চে দেখা গেছে, ভিটামিন বি এবং ডি এর অভাবও Alopecia areata aggravate করতে পারে।

Alopecia areata চিকিৎসা –

Treatment Management :-

topical steroid (clobetasol ointment)

Cream 1.Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Indications of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Dermasol is indicated for adults, elderly and children over 1 year in following dermatoses.

Psoriasis (excluding widespread plaque psoriasis)
Recalcitrant dermatoses
Lichen planus
Discoid lupus erythematosus
Other skin conditions which do not respond satisfactorily to less potent steroids.

Composition of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate Cream: Each gram cream contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Ointment: Each gram ointment contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Scalp Application: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Shampoo: Each gram shampoo contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Lotion: Each gram lotion contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Clobetasol Propionate Spray: Each gram spray contains Clobetasol Propionate BP 0.5 mg (0.05% w/w).

Pharmacology of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Clobetasol Propionate is a very potent topical corticosteroid. It has anti-inflammatory, antipruritic and vasoconstrictive properties. It shows anti-inflammatory activity via multiple mechanisms to inhibit late phase allergic reactions. It decreases the density of mast cells, chemotaxis and activation of eosinophils. It also reduces cytokine production and inhibits the metabolism of arachidonic acid.

Dosage of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Cream, Ointment: Adults, elderly and children over 1 year: Apply a thin layer of Clobetasol Propionate Cream or Ointment to the affected skin areas twice daily and rub in gently and completely. Repeated short courses of Clobetasol Propionate may be used to control exacerbations. In more resistant lesions, especially where there is hyperkeratosis, the effect of Clobetasol can be enhanced, if necessary, by occluding the treatment area with polythene film. Overnight occlusion only is usually adequate to bring about a satisfactory response.

Clobetasol Propionate is super-high potency topical corticosteroids; therefore, treatment should be limited to 2 consecutive weeks. The maximum weekly dose should not be exceeded 50 gm/week. In case of children, courses should be limited if possible to five days and reviewed weekly.

Spray: Apply required quantity of spray of once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Propionate scalp solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Propionate scalp solution for brief periods only.

Shampoo: It should be applied to the dry (not wet) scalp once a day to the affected areas only. It should be massaged gently into the lesions and left in place for 15 minutes before lathering and rinsing. Treatment should be limited to 4 consecutive weeks. Total dosage of shampoo should not exceed 50 g per week. Under 18 years this preparation is not recommended.

Scalp Solution: Apply required quantity of spray of Clobetasol Scalp Solution once or twice daily to the affected areas of the scalp and gently rub in. The total dose applied should not exceed 50 ml weekly. If necessary, Clobetasol Scalp Solution may be massaged into the scalp using the tips of the fingers. Therapy should be discontinued if no response is noted after one week or as soon as the lesion heals. It is advisable to use Clobetasol Scalp Solution for brief periods only.

Administration of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Route of administration: Cutaneous. Creams are especially appropriate for moist or weeping surfaces. Ointments are especially appropriate for dry, lichenified or scaly lesions.

Interaction of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Co-administered drugs that can inhibit CYP3A4 (eg ritonavir, itraconazole) have been shown to inhibit the metabolism of corticosteroids leading to increased systemic exposure.

Contraindications

Rosacea, acne vulgaris and perioral dermatitis. Primary cutaneous viral infections (e.g. herpes simplex, chickenpox).
Hypersensitivity to the preparation.
The use of Clobetasol Propionate skin preparations is not indicated in the treatment of primarily infected skin lesions caused by infection with fungi (e.g. candidiasis, tinea), or bacteria (e.g.impetigo): perianal and genital pruritus.
Dermatoses in children under one year of age, including dermatitis and napkin eruptions.

Side Effects of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

As with other topical corticosteroids prolonged use of large amounts, or treatment of extensive areas can result in sufficient systemic absorption to produce the features of hypercorticism.
Prolonged and intensive treatment with a highly active corticosteroid preparation may cause local atrophic changes in the skin such as thinning, striae and dilatation of the superficial blood vessels, particularly when occlusive dressings are used or when skin folds are involved.
In rare instances, treatment of psoriasis with corticosteroids (or its withdrawal) is thought to have provoked the pustular form of the disease.
There are reports of pigmentation changes and hypertrichosis with topical steroids. Dermasol is usually well tolerated, but if signs of hypersensitivity appear, application should be stopped immediately. Exacerbation of symptoms may occur.

Pregnancy & Lactation

There are limited data from the use of Clobetasol Propionate cream in pregnant women. Topical administration of corticosteroids to pregnant animals can cause abnormalities of foetal development. The relevance of this finding to humans has not been established. However, the administration of Clobetasol Propionate Cream during pregnancy and lactation should only be considered if the expected benefit to the mother outweighs the possible risks of treatment.

It is unknown whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Clobetasol Propionate Cream is administered to a nursing woman.

Precautions & Warnings

Long-term continuous topical therapy should be avoided where possible, particularly in infants and children, as adrenal suppression can occur readily even without occlusion. If used in childhood or on the face, courses should be limited if possible to five days and occlusion should not be used.

The face, more than other areas of the body, may exhibit atrophic changes after prolonged treatment with potent topical corticosteroids. This must be borne in mind when treating such conditions as psoriasis, discoid lupus erythematosus and severe eczema.

If applied to the eye lids, care is needed to ensure that the preparation does not enter the eye, as glaucoma or cataract might result.

Topical corticosteroids may be hazardous in psoriasis for a number of reasons including rebound relapses, development of tolerance, risk of generalised pustular psoriasis and development of local or systemic toxicity due to impaired barrier function of the skin. If used in psoriasis careful patient supervision is important.

Appropriate anti-microbial therapy should be used whenever treating inflammatory lesions which have become infected. Any spread of infection requires withdrawal of topical corticosteroid therapy and systemic administration of anti-microbial agents. Bacterial infection is encouraged by the warm, moist conditions induced by occlusive dressings, and so the skin should be cleansed before a fresh dressing is applied.

Use in Special Populations of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

In infants and children under 12 years of age, long-term continuous topical corticosteroid therapy should be avoided where possible, as adrenal suppression can occur. Children are more susceptible to the use of topical corticosteroids which develops atrophic changes.

Overdose Effects of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Acute overdosage is very unlikely to occur, however, in the case of chronic over-dosage or misuse the features of hypercortisolism may occur and in this situation topical steroid should be discontinued.

Therapeutic Class of Cream:-Dermasol 0.05% 20gm tube (AS A Clobetasol Propionate AS A Other Topical corticosteroids).

Other Topical corticosteroids

BD dose —12weeks

Intra lesional Triamcinolone in severe case

Ointment 2.Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Injection 2.Cenolon IM/IA 40MG/ML 1ml Vial (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Indications of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Aristocort topical preparation is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid responsive dermatoses including atopic dermatitis, contact dermatitis, eczematous dermatitis, neurodermatitis, seborrheic dermatitis, insect bites, lichen simplex chronicus, exfoliative dermatitis, stasis dermatitis, nummular eczema, psoriasis and pruritus ani and vulvae.

Pharmacology of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Triamcinolone Acetonide (a derivative of Triamcinolone) in a compatible base. Topical steroids are primarily effective because of their anti-inflammatory, antipruritic & vasoconstrictive actions.

Dosage & Administration of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

A small amount of Triamcinolone is gently rub to the affected area 1-2 times daily. Some cases of eczematised psoriasis may be treated more effectively by the application of Triamcinolone under an occlusive dressing.

Occlusive dressing technique: Gently rub a small amount of Triamcinolone on the lesion until it disappears. Then reapply, leaving a thin coating and cover with a pliable non porous film. For convenience apply Triamcinolone intermittently (12 hour occlusion during the night) followed by reapplication without occlusion, during the day.

Pediatric use: Triamcinolone should not be used in children under 8 years. Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children. As children are more likely to get side effects, they should not normally be treated for longer than 5 days.

Contraindications of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Triamcinolone Acetonide is contraindicated in those patients with a history of hypersensitivity to any of the components of the preparation. It is also contraindicated in tuberculosis of the skin, fungus infections and viral diseases of the skin (Herpes simplex, chickenpox and vaccinia), perioral dermatitis, rosacea and ulcerative conditions.

Side Effects of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

The following local side effects have been reported with topical corticosteroids, either with or without occlusive dressings: burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis and allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae and miliaria.

Pregnancy & Lactation of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether topical administration of corticosteroid could result in sufficient systemic absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman.

Precautions & Warnings of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

If reactions or idiosyncrasies are encountered, Aristocort should be discontinued. The use of topical steroids on infected areas should be attended with caution and careful observation, bearing in mind the potential spreading of infections by anti-inflammatory steroids and the possible advisability of discontinuing steroid therapy and/or initiating antibacterial measures.

Aristocort should not be used on healthy skin or over large areas of skin and not to be used in the eye as there is potential risk of glaucoma and cataract. When steroids are applied for long periods of time (more than 4 weeks) the occurrence of atrophic striae is likely. Prolonged use on flexures and intertriginous areas is undesirable. Children may absorb proportionately larger amounts of topical corticosteroids and thus may be more susceptible to systemic toxicity. In infants, long term continuous topical steroid therapy should be avoided. Adrenal suppression can occur even without occlusion.

Overdose Effects of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Topically applied corticosteroids can be absorbed in sufficient amounts to produce systemic effects e.g., mild, reversible suppression of adrenal function, ecchymoses of the skin, peptic ulceration, hypertension, aggravation of infection, hirsutism, acne, edema and muscle weakness

Therapeutic Class of Ointment:-Aristocort 0.1% 10gm tube (AS A Triamcinolone Acetonide AS A Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations)

Corticosteroid, Glucocorticoids, Triamcinolone & Combined preparations

(Trialon inj,2-3wk apart for 8wk)

•Topical Minoxidil

(Hairgrow 2%/ xenogrwo 2% Scalp lotion নামে পাওয়া যায়।দিনে ২ বার করে ১২ সপ্তাহ)

Scalp Lotion 3.Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Indications of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Xenogrow topical solution is indicated for the treatment of-

Male androgenetic alopecia (male pattern hair loss) on the top of the scalp (vertex).
Female androgenetic alopecia (female pattern hair loss) on the top of the scalp.

Pharmacology of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Minoxidil topical solution has been shown to stimulate hair growth in males with androgenetic alopecia. The basic change in androgenetic alopecia is the conversion of terminal, non-vellus hair to vellus hair, i.e., hair which is thinner, shorter and less pigmented.

Although the exact mechanism of action of Minoxidil in the treatment of androgenetic alopecia is not known, there may be more than one mechanism by which Minoxidil topical solution stimulates hair growth; they include:

vasodilation of the micro circulation around the hair follicles which may stimulate hair growth;
direct stimulation of the hair follicle cells to enter into a proliferative phase;
resting phase (telogen); follicles being stimulated to pass into growth phase (anagen) follicles.

Dosage & Administration of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Minoxidil 2% Solution: A total dose of 1 mL (7 sprays) Minoxidil topical 2% solution (20 mg Minoxidil) should be applied twice per day to the scalp, beginning at the center of the affected area. This dose should be used regardless of the size of the affected area. The total daily dose should not exceed 2 mL (40 mg Minoxidil). Suitable for men and women use.

Minoxidil Topical 5% Solution: Apply 1 mL (7 sprays) 2 times a day directly onto the scalp in the hair loss area. It should be used for men only.

Interaction of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Xenogrow topical solution should not be used along with other topical agents known to alter the stratum corneum barrier such as tretinoin or dithranol, due to the enhanced absorption of Xenogrow. Although there is no clinical evidence, there exists the theoretical possibility of absorbed Xenogrow potentiating orthostatic hypotension caused by peripheral vasodilators.

Contraindications of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

History of sensitivity to Minoxidil
Treated or untreated hypertension
Scalp abnormality (including psoriasis and sunburn)
Shaved scalp
Occlusive dressings or other topical medical preparations are being used.

Side Effects of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Colds and respiratory infections
Rhinitis
Sinusitis
Coughing
Scaling
Itching
Rash

Pregnancy & Lactation of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Systemically absorbed Minoxidil is secreted in human milk. There are no adequate and well controlled studies in pregnant women. Animal studies have shown a risk to the fetus at exposure levels that are very high compared to those intended for human exposure.

Precautions & Warnings of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Xenogrow topical solution is for external use only. Apply only to scalp. Before applying this solution, the user should determine that the scalp is normal and healthy. Hands should be washed thoroughly after use. Inhalation of the spray should be avoided. This solution contains ethanol (alcohol), which will cause burning and irritation of the eye. In the event of accidental contact with sensitive surfaces (eye, abraded skin, mucous membranes), the area should be bathed with large amounts of cool tap water.

Therapeutic Class of Scalp Lotion:-Xenogrow 2% 60ml Bottle (AS A Minoxidil AS A Other scalp preparations).

Other scalp preparations

•Tablet 4. Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

1+0+1 (3 month).

Indications of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Floriz is indicated in-

Hair loss
Weak, brittle, splitting or soft nails
Eczema & dermatitis.

Pharmacology of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Biotin is an essential vitamin that is also known as vitamin H. It is involved in vital physiological function like fatty acid synthesis, amino acid catabolism and gluconeogenesis. It acts as a cofactor in the enzymatic carboxylation of pyruvate and acetyl-CoA. Biotin influences the growth and differentiation of epidermal cells and is therefore important for the formation and renewal of the skin, hair and nails. It functions as a coenzyme for mitochondrial carboxylases in hair roots and improves the keratin structure. Biotin deficiency may result in hair loss and a variety of systemic symptoms such as dermatitis, and aciduria. Biotin is one of the most prescribed nutritional supplements for any kind of hair loss.

Dosage & Administration of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Biotin dose varies depending on disease condition and age group.

In adults: Generally 1-3 tablets per day or as advised by the physician.

In children: biotin deficiency affects between 1 week and 2 years of age and usually exhibits seizures, hypotonia, developmental delay, ataxia, hyperventilation, and coma. In this case, 5-10 tablets daily, crushed and mixed with water or any kind of fruit juice or as advised by the physician.

Recommended dietary allowance:

Infants-

0-6 months: 5 mcg/day
7-12 months: 6 mcg/day

Children-

1-3 years: 8 mcg/day
4-8 years: 12 mcg/day

Males and females-

9-13 years: 20 mcg/day
14-18 years: 25 mcg/day
≥19 years: 30 mcg/day

Pregnancy: 30 mcg/day

Lactation: 35 mcg/day

Interaction of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

There are indications that anticonvulsant drugs lower the plasma level of Floriz. Antibiotic use may decrease the Floriz contribution to the body made by the microflora of the large intestine. Excessive consumption of raw egg whites interferes with Floriz absorption.

Contraindications of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Contraindicated in patients with known hypersensitivity to any of the ingredients.

Side Effects of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Well tolerated in the recommended dose. No Floriz toxicity has been reported in individuals supplemented with as much as 200 mg orally or 20mg intravenously per day.

Pregnancy & Lactation of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Sufficient clinical data is not available to use in pregnant women and lactating mother.

Therapeutic Class of Tablet:- Floriz 1000 mcg(vit-B7) (AS A Biotin Herbal and Nutraceuticals).

Herbal and Nutraceuticals

•Cap- D-rise 20000 IU

( সপ্তাহে ১ টা করে 12 weeks) [incase of vitamin D deficiency ]

Capsule 4.D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Vitamin D3 deficiency can occur in people whose exposure to sunlight is limited and in those whose diet is deficient in vitamin D3.
Vitamin D3 is essential for the effective calcium and phosphate absorption required for healthy bones and teeth, preventing rickets, osteomalacia and osteoporosis.
Vitamin D3 is also essential to prevent pre-eclampsia during pregnancy and breast feeding as it is an essential nutrient for a growing infant.
Vitamin D3 has vital role on immunity boost up

Pharmacology Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

The active form of Vitamin D3, Calcitriol, exerts its effect by binding to the Vitamin D receptors (VDRs) which are widely distributed through many body tissues.Vitamin D3 has a half life of about 50 days as it is fat soluble.Vitamin D3 is absorbed in the small intestine and bound to specific a-globulins and transported to the liver where it is metabolised to 25-hydroxy Vitamin D3 (Calcidiol). A second hydroxylation to 1,25-dihydroxy Vitamin D3 (Calcitriol) occurs in the kidney. This metabolite is responsible for the vitamin’s ability to increase the absorption of calcium. Non-metabolised Vitamin D3 is stored in tissues such as fat and muscle.Vitamin D3 is eliminated via faeces and urine.

Dosage & Administration Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

For capsule: Adults:

Treatment of Vitamin D3 deficiency: 40000 IU once weekly for 7 weeks. Doses for maintenance therapy is 1400-2000 IU/day. To confirm the target level of 25 hydroxyvitamin D, measurement of it should be determined 3-4 months after initiating the maintenance therapy.
Prevention of Vitamin D3 deficiency: 20000 IU every 4 weeks. Higher doses may be required in certain situations.
Addition to specific therapy for osteoporosis: 20000 IU once a month.

For capsule: Children (12-18 years):

Treatment of Vitamin D3 deficiency: 20000 IU once every 2 weeks for 6 weeks.
Prevention of Vitamin D3 deficiency: 20000 IU every 6 weeks.

For film-coated tablet: 1000 IU (1-2 tablets) daily, or as directed by physician. Take the medicine with food or within 1 hour after a meal.

For oroflash or chewable tablets: 1000 IU to 2000 IU daily, or as directed by physician. Take the medicine with food or within 1 hour after a meal. Place the tablet in mouth swallow after chewing.

For Syrup:
For patients with risk of Cholecalciferol deficiency:

0-1 yr: 400 IU/ day (2 ml)
>1 Yr: 600 lU/ day (3 ml)

For Cholecalciferol deficient patients:

0-1 yr: 2000 IU/ day (+50000 IU/week ) for 6 weeks
1 -18 yrs: 2000 IU/ day for 6 weeks.

Injection: Prevention:

Infants receiving Vitamin D enriched milk: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. every 6 months.
Nursed infants or infants not receiving Vitamin D enriched milk or young children up to 5 years of age: 1 ampoule (1 ml) i.e. 2,00000 I.U. every 6 months.
Adolescents: 1 ampoule (1 ml) i.e. 2,00000 I.U. every 6 months during winter.
Pregnancy: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. from the 6th or 7th month of pregnancy.
Elderly: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. every 3 months. Digestive disorders, concomitant treatment with antiepileptics & other particular condition not described above; ½ ampoule (0.5 ml) i.e. 1,00000 I.U. or 1 ampoule (1 ml) i.e. 2,00000 I.U. every 3 or 6 months.

Injection: Vitamin D deficiency:

1 ampoule (1 ml) i.e. 2,00000 I.U. which can be repeated 1 to 6 months later. Or, as directed by the registered physician.

Interaction Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Many drugs cause Vitamin D3 deficiencies because they interfere with the absorption and metabolism of Vitamin D3 and includes Magnesium containing Antacids, Digoxin, Thiazide Diuretics, Cholestyramine, Cholistipol, Phenytoin, Phenobarbital, Orlistat,and Mineral Oil. Also, Corticosteroids, such as Prednisolone increase the need for Vitamin D3.

Contraindications Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Vitamin D3 is contraindicated in all diseases associated with hypercalcaemia. It is also contraindicated in patients with known hypersensitivity to Vitamin D3 (or medicines of the same class) and any of the excipients. It is contraindicated if there is evidence of Vitamin D3 toxicity.

Side Effects Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Symptoms rarely include anorexia, lassitude, nausea & vomiting, diarrhea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine.

Pregnancy & Lactation

Studies have shown safe use of doses up to 4000 IU during pregnancy. The recommended daily intake for pregnant women is 400 IU, however, in women who are considered to be Vitamin D3 deficient a higher dose may be required. During pregnancy women should follow the advice of their medical practitioner as their requirements may vary depending on the severity of their disease and their response to treatment

Vitamin D3 and its metabolites are excreted in breast milk. Overdose in infants induced by nursing mothers has not been observed; however, when prescribing additional vitamin D3 to a breast-fed child the practitioner should consider the dose of any additional vitamin D3 given to the mother.

Precautions & Warnings

Plasma-calcium concentration should be monitored at intervals in patients receiving high doses of Vitamin D3, in renal impairment, and during pregnancy & lactation. People using Digoxin and Thiazide Diuretics should consult a health care practitioner before supplementing with Vitamin D3. People with liver or kidney disease, primary hyperthyroidism, lymphoma, tuberculosis and granulomatous disease should consult a health care practitioner before supplementing with Vitamin D3.

Use in Special Populations

The safety & efficacy of Vitamin D3 in children under 12 years have not been established.

Overdose Effects

It can lead to hypervitaminosis D.

Therapeutic Class Indications of Capsule:-D-Rise 20000IU AS A Cholecalciferol (Vitamin D3).

Vitamin in bone formation, Vitamin-D preparations

•Multivitamin

Tablet 5.Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Indications of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Atoz Premium is indicated for the prevention and treatment of vitamins & minerals deficiencies. As a complete daily nutritional supplement, it is also indicated to meet the increased demand for vitamins and minerals in the conditions like physical and emotional stress, chronic diseases, infection illness, osteoporosis, injuries or wound, surgery, poor digestion, old age, pregnancy and lactation, poor appetite, excess dieting, exposure to environmental pollution, heavy exercise etc.

Composition of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Each tablet contains: Vitamin A 5000 IU, Vitamin C 60 mg, Vitamin D 400 IU, Vitamin E 30 IU, Vitamin K 25 mcg, Vitamin B1 (Thiamine) 1.5 mg, Vitamin B2 (Riboflavin) 1.7 mg, Vitamin B3 (Niacin) 20 mg, Vitamin B6 (Pyridoxine) 2 mg, Folic acid 400 mcg, Biotin 30 mcg, Pantothenate 10 mg, Calcium 162 mg, Iron 18 mg, Phosphorous 109 mg, Iodine 150 mcg, Magnesium 100 mg, Zinc 15 mg, Selenium 20 mcg, Copper 2 mg, Manganese 2 mg, Chromium 120 mcg, Molybdenum 75 mcg, Chloride 72 mg, Potassium 80 mg, Boron 150 mcg, Nickel 5 mcg, Silicon 2 mg, Tin 10 mcg, Vanadium 10 mcg, Lutein 250 mcg and Cyanocobalamin 6 mcg.

Pharmacology of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

This is a film coated tablet, which combines 32 high potency vitamins and minerals. This preparation maintains a healthy body and active life-style.

Dosage & Administration of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

One tablet daily or as recommended by the physician.

Interaction of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

No drug interactions have been reported.

Contraindications

This product is contraindicated in patients with known hypersensitivity to any of the ingredients.

Side Effects of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Generally, Atoz Premium is well tolerated. Diarrhoea may occasionally occur during treatment with beta carotene and the skin may assume a slightly yellow discoloration. Vitamin C and vitamin E may cause diarrhoea and other gastrointestinal disturbances.

Pregnancy & Lactation of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Recommended by the consultation with physician.

Precautions & Warnings

Long term intake of high level of vitamin A (excluding that sourced from beta carotene) may increase the risk of osteoporosis in postmenopausal women.

Therapeutic Class of Tablet:-Atoz Premium Multivitamin and Multiminarel AS A Multi-vitamin & Multi-mineral combined preparations

Multi-vitamin & Multi-mineral combined preparations

কন্ট্রোলে আসার পর Healthy Lifestyle maintain করতে হবে।স্ট্রেস মুক্ত থাকতে হবে।পর্যাপ্ত পরিমাণে ঘুমাতে হবে।

Raiyyan Tahsan Date:-28-01-2025 Tueday Time:12-25-55 PM

Raiyyan Tahsan

Raiyyan Tahsan