Not scheduled (OTC); Schedule H only if combined with scheduled drugs

Oral, Intramuscular, Intravenous

• Tablets/Capsules: Various combinations (B-complex, B-complex with C, A to Z formulations)

• Soft gel capsules: Fat-soluble vitamin combinations with minerals

• Syrups: Various paediatric and adult formulations (typically 100 mL, 200 mL bottles)

• Oral drops: Paediatric formulations (15 mL, 30 mL bottles)

• Injections: B-complex with or without Vitamin C (2 mL, 3 mL ampoules)

Important Note: No single standardised composition exists for multivitamins. Formulations vary significantly among manufacturers. Always verify exact component list and strength before prescribing.

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

1. Nutritional Deficiency States (Combined or Mixed Vitamin Deficiency)

Applicable settings: Post-illness recovery, inadequate dietary intake, elderly with poor nutrition, chronic alcoholism, post-surgical supplementation, chronic illness

Adults — Oral Formulations:

Parameter Dosing

Starting dose 1 tablet/capsule once daily after meals

Titration Not applicable

Usual maintenance dose 1 tablet/capsule once daily

Maximum dose 1 tablet twice daily (short-term only; avoid prolonged high-dose use)

Duration Until deficiency corrected and dietary intake adequate

Clinical Notes:

• Select formulation based on specific deficiency pattern

• Avoid exceeding RDA for fat-soluble vitamins (A, D, E, K)

• Duration individualised based on underlying cause

1. Parenteral Multivitamin Therapy (Severe Deficiency or Malabsorption)

Indication: Severe deficiency states, malabsorption syndromes, post-operative patients unable to take oral nutrition, critically ill patients

Parameter Dosing

Starting dose 2 mL IM or slow IV once daily (as per specific product composition)

Titration Not applicable

Usual maintenance dose 2 mL IM/IV once daily

Maximum dose As per product labelling; typically 2–3 mL/day

Duration 3–7 days; switch to oral formulation when feasible

Clinical Notes:

• Confirm specific vitamin content before administration

• IV administration should be slow; dilute in compatible IV fluids if required

• Monitor for injection site reactions

1. Prophylactic Supplementation in At-Risk Populations

Applicable populations: Dialysis patients, chronic malabsorptive conditions, restricted diets, elderly in institutional care

Parameter Dosing

Starting dose 1 tablet once daily

Titration Not applicable

Usual maintenance dose 1 tablet once daily

Maximum dose 1 tablet once daily

Secondary Indications – Adults Only (Off-label)

Indication Dose Duration Notes Evidence Basis

Supportive therapy in chronic alcohol use disorder 1 tablet daily (ensure adequate thiamine and folate content) Long-term Specialist only – OFF-LABEL; thiamine supplementation often requires separate high-dose therapy Indian addiction medicine practice

Adjunctive nutritional support in chronic wounds 1 tablet daily Until wound healing OFF-LABEL Empirical use in Indian surgical practice

PAEDIATRIC DOSING (Specialist Only)

Primary Indication: Vitamin Supplementation in At-Risk Children

Applicable settings: Malnutrition, convalescence, inadequate dietary intake, chronic illness

0–6 months Oral drops 0.25 mL once daily 0.25 mL once daily 0.5 mL/day

6–12 months Oral drops 0.5 mL once daily 0.5 mL once daily 1 mL/day

1–3 years Drops or syrup 1 mL once daily 1–2 mL once daily 2 mL/day

4–6 years Syrup or chewable tablet 2.5 mL syrup OR 1 chewable tablet daily Same as starting 5 mL or 1 tablet/day

7–12 years Syrup or tablet 5 mL syrup OR 1 tablet daily Same as starting 1 tablet/day

12 years Adult tablet 1 tablet daily 1 tablet daily As per adult dosing

Titration: Not applicable

Safety Monitoring:

• Avoid fat-soluble vitamin excess (particularly Vitamin A and D)

• Monitor for gastrointestinal tolerance

• Assess dietary intake and address underlying nutritional gaps

Minimum Age: Drops and syrups may be used from birth under paediatrician supervision. Tablets generally suitable for children ≥5 years.

Secondary Indications – Paediatrics (Off-label)

Indication Dose Notes Evidence Basis

Supportive therapy in severe acute malnutrition (SAM) As per WHO/IAP SAM protocol; multivitamin as part of therapeutic feeding Specialist only – OFF-LABEL; part of comprehensive nutritional rehabilitation IAP/WHO guidelines for SAM management

Clear Statement: Not routinely recommended for "immunity boosting" or cognitive enhancement without documented deficiency. Use below 6 months only under paediatrician supervision.

Dialysis (haemodialysis/peritoneal) Water-soluble vitamin supplementation often required; avoid excessive Vitamin A; use renal-specific formulations if available

Note: Avoid high-dose Vitamin C in CKD (oxalate accumulation risk).

• Known hypersensitivity to any component of the formulation

• Hypervitaminosis A or D

• Haemochromatosis or iron overload states (for iron-containing formulations)

• Wilson's disease (for copper-containing formulations)

• Severe hepatic disease with risk of Vitamin A toxicity

• Chronic kidney disease — risk of fat-soluble vitamin accumulation

• Diabetes mellitus — some formulations contain glucose or sorbitol

• History of kidney stones — caution with high Vitamin C content

• Concurrent use of other vitamin supplements — risk of exceeding RDA

• Gout or hyperuricaemia — some formulations contain niacin

• Pernicious anaemia — folic acid may mask B12 deficiency; ensure B12 adequacy

Parameter Details

Safety Statement Safe when used in formulations designed for pregnancy with appropriate RDA levels

Preferred alternatives Use prenatal-specific multivitamins containing folic acid 400–500 mcg, iron 30–60 mg, and Vitamin A ≤5000 IU/day

When may be used Throughout pregnancy for nutritional supplementation

What to monitor Iron status, folic acid adequacy, Vitamin D levels

Caution: Avoid formulations with Vitamin A >5000 IU/day (teratogenicity risk).

Parameter Details

Compatible with breastfeeding Yes — safe at recommended doses

Preferred alternatives Use postnatal/lactation-specific formulations

Expected drug levels in milk Low — water-soluble vitamins appear in milk proportional to maternal intake

What to monitor in infant Feeding tolerance, weight gain

Note: Excessive maternal intake is unnecessary; breast milk composition is generally adequate when maternal nutrition is reasonable.

Parameter Recommendation

Starting dose 1 tablet once daily (standard adult dose)

Titration Not required

Extra risks Increased risk of fat-soluble vitamin accumulation due to reduced hepatic/renal reserve; zinc-copper imbalance with prolonged use

Monitoring Renal function, B12 status (if on long-term PPIs), neurological status

Note: Avoid megavitamin therapy in elderly. Consider specific deficiency testing before long-term supplementation.

Interacting Drug Effect Management

Levodopa (without carbidopa) Pyridoxine (Vitamin B6) reduces levodopa efficacy by enhancing peripheral metabolism Avoid multivitamins with high B6 content; use levodopa-carbidopa combination instead

Retinoids (isotretinoin, acitretin) Additive Vitamin A toxicity risk Avoid concurrent use with Vitamin A-containing multivitamins

Warfarin Vitamin K in some formulations may reduce anticoagulant effect Choose Vitamin K-free formulations; monitor INR

Interacting Drug Effect Management

Tetracyclines, fluoroquinolones Zinc, calcium, magnesium, iron in multivitamins reduce antibiotic absorption Separate administration by at least 2–4 hours

Levothyroxine Iron, calcium, zinc may reduce levothyroxine absorption Separate by at least 4 hours

Antiepileptics (phenytoin, carbamazepine, phenobarbital) May deplete folate and Vitamin D; supplementation may be needed Consider supplementation; monitor drug levels

Proton pump inhibitors (long-term) Reduced B12 and iron absorption Consider B12 supplementation in chronic PPI users

Bisphosphonates Calcium and iron reduce bisphosphonate absorption Separate by at least 2 hours

• Nausea and dyspepsia

• Constipation or diarrhoea (especially iron-containing formulations)

• Metallic taste

• Dark-coloured stools (iron-containing formulations)

• Mild flushing (formulations with niacin)

• Bright yellow urine (riboflavin content — harmless)

Adverse Effect Notes

Hypervitaminosis A Hepatotoxicity, pseudotumor cerebri; occurs with prolonged high-dose or irrational use

Hypervitaminosis D Hypercalcaemia, nephrocalcinosis; monitor with prolonged supplementation

Iron overload Risk in haemochromatosis or prolonged high-dose iron supplementation

Anaphylaxis Rare; primarily with injectable formulations

During therapy Clinical response; gastrointestinal tolerance

Long-term (>6 months) Vitamin A, D levels if chronic high-dose use; B12 levels in at-risk populations; renal function in CKD; LFTs if hepatic disease

General Adult Formulations:

• Becosules (Pfizer)

• Supradyn (Abbott)

• Revital (Sun Pharma)

• Centrum (Pfizer)

• Zincovit (Apex)

• A to Z (Alkem)

• Nurokind Plus (Mankind)

• Neurobion Forte (Merck) — B-complex

Paediatric Formulations:

• Polybion Drops (Merck)

• Nutrolin B Plus Drops (Alkem)

• Becosules Syrup (Pfizer)

• Zincovit Drops (Apex)

Injectable Formulations:

• Neurobion Injection (Merck)

• Optineuron Injection (Abbott)

• Bevon Injection (Lupin)

Note: Composition varies significantly between brands. Verify component list before prescribing.

NLEM Status: Not listed under NLEM; wide price variation in private market

• Match formulation to need: Select based on specific deficiency pattern — avoid generic "one-size-fits-all" prescribing

• Avoid duplication: Do not prescribe multivitamin along with separate B-complex, B12, or Vitamin D unless specific deficiency requires higher doses

• Pregnancy-specific formulations: Always use prenatal vitamins with appropriate folic acid, iron, and limited Vitamin A content

• Timing matters for interactions: Separate from antibiotics, levothyroxine, and bisphosphonates by 2–4 hours

• Not a substitute for diet: Counsel patients that supplements do not replace balanced nutrition

• Parenteral route: Reserve for genuine malabsorption or inability to take oral nutrition — not for routine "energy boosting"

multivitamin; nutritional supplement; vitamin deficiency; B-complex; paediatric vitamins; pregnancy vitamins; geriatric nutrition; injectable vitamins; OTC supplement; India

RxIndia v1.0 — 10 Jun 2025

• CDSCO Product Listings

• Indian Pharmacopoeia

• IAP Guidelines for Micronutrient Supplementation

• MoHFW National Guidelines on Infant and Young Child Feeding

• AIIMS Hospital Drug Formulary

• API Textbook of Medicine, 11th Edition

• WHO Model Formulary (supportive reference for paediatric dosing)

• Indian tertiary centre specialist practice protocols