Ascorbic acid/cholecalciferol/elderberry/melatonin/zinc citrate Disease Interactions

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of most anxiolytics, sedatives and hypnotics. Some of these changes include decreased inhibition, aggressiveness, agitation, and hallucinations. These drugs can cause or exacerbate mental depression and cause suicidal behavior and ideation. Therapy with these drugs should be administered cautiously in patients with a history of depression or other psychiatric disorders. Patients should be monitored for any changes in mood or behavior. It may be prudent to refrain from dispensing large quantities of medication to these patients.

Vitamin D analogs function to increase serum calcium concentrations and can exacerbate arrhythmias, particularly in patients receiving cardiac glycosides. Therapy with vitamin D analogs should be administered cautiously in patients with or predisposed to cardiac arrhythmias. Clinical monitoring of serum electrolyte concentrations and cardiac function is recommended.

Vitamin D analogs administered in the presence of hyperphosphatemia can result in precipitation of calcium-phosphate deposits within the vascular or renal systems or other soft tissue calcifications. A solubility product (Serum Calcium X Phosphate) should not exceed 70. Serum electrolyte concentrations should be corrected prior to vitamin D analog therapy and monitored during therapy.

Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.

Ergocalciferol, cholecalciferol, and calcifediol undergo renal biotransformation during metabolic activation. Renal impairment can alter metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as dihydrotachysterol (hepatic activation) and calcitriol (active form) may be considered in patients with compromised renal function.

Some hypnotic drugs can have an anticholinergic effect and should be used with caution in patients with glaucoma, and trouble urinating due to retention or enlarged prostate.

In general, anxiolytics, sedatives and hypnotics are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with these drugs should be administered cautiously in patients with liver disease (some are not recommended in severe liver impairment), and the dosage should be adjusted accordingly. Laboratory testing is recommended prior and during treatment.

Acute hemolysis following administration of high doses of ascorbic acid in patients with glucose-6-phosphate deficiency (G6PD) has been reported. Ascorbic acid should be administered cautiously and dosages modified in patients with G6PD.

Large doses of ascorbic acid have lead to hyperoxaluria in 5% of patients. Ascorbic acid can acidify urine resulting in precipitation of urate, cystine, or oxalate stones. Ascorbic acid should be administered cautiously and dosages modified in patients predisposed to renal stones. Clinical monitoring of urinalysis for pH and crystal formation is recommended.

Ascorbic acid preparations contain sodium. The sodium content should be considered when used in patients with sodium restricted diets and conditions require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

The trace metals, chromium and zinc, are excreted primarily in the urine. Selenium is partially excreted in the urine. Supplemental doses of these agents may need to be adjusted, reduced, or omitted in patients with renal dysfunction.

The trace metals manganese, chromium, copper, selenium, and zinc are absorbed in the GI tract from dietary sources and following administration of oral supplements. GI absorption may be decreased in patients with malabsorption syndromes. Therefore, larger dosages may be required when these supplements are given orally. Parenteral administration may be appropriate.

Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcifediol (requires renal activation) and calcitriol (active form) may be considered in patients with compromised hepatic function.

Ascorbic acid is removed by dialysis.