Results of using Pikovit multivitamin complexes in the neuropsychiatric department

Compound

Pikovit Forte 7+ lozenges No. 30

Compound

Active substances:

Excipients: mannitol, aspartame, Mandarin flavor, polysorbate 80, glycerol, castor oil, maltitol (maltitol is used in the production process in the form of a 75% solution), magnesium stearate, emulsion wax (Capol Pharma 600), povidone, colloidal anhydrous silicon dioxide, titanium dioxide (E171), betacarotene (E160a).
* — retinol palmitate concentrate, oil form, synthetic (1.7 Mio ME/g) contains: retinol palmitate, butylated hydroxyanisole, butylated hydroxytoluene. ** — α-tocopherol acetate 50% granule contains: 50% DL-α-tocopherol in a gelatin-carbohydrate matrix. *** — colecalciferol concentrate, oil form, (1 Mio ME/g) contains: colecalciferol, DL-α-tocopherol, medium-chain fatty acid triglycerides.

Pharmacokinetics

Water-soluble vitamins (groups B, C) are well absorbed in quantities that meet the daily needs of the body. Amounts exceeding tissue saturation levels are excreted in urine and sometimes in feces. Regular use of these vitamins is important to maintain adequate tissue concentrations since they accumulate in the body in limited quantities.

After oral administration, fat-soluble vitamins A and D are well absorbed in the small intestine in the presence of fat. Vitamin E absorption is quite weak (25-85% of the dose).

Indications for use

Recommended for use in children aged 7 years and older with increased body needs for vitamins:

• decreased concentration of attention due to increased fatigue in school-age children;
• increased physical activity (including when playing sports);
• increased need for vitamins against the background of decreased appetite;
• as part of complex therapy of diseases when prescribing antibiotics;
• increased need for vitamins with reduced seasonal consumption of vegetables and fruits.

Contraindications

• Hypersensitivity to the components of the drug;
• hypervitaminosis A and D;
• children under 7 years of age;
• PIKOVIT® FORTE contains aspartame, which contains phenylalanine, so the drug is not recommended for patients with phenylketonuria.

Directions for use and doses

The tablets should be kept in the mouth until completely dissolved.

Children over 7 years of age: 1 tablet once a day after meals.

For poor appetite, the child should be given 1 tablet per day for 2 months.

Storage conditions

At a temperature not exceeding 25 °C, in the original packaging. Keep out of the reach of children.

Best before date

3 years. Do not use the drug after the expiration date.

special instructions

If you need to take other vitamin preparations at the same time, you should consult your doctor.
Patients with diabetes can take PIKOVIT® FORTE. At the same time, it should be remembered that one lozenge contains 0.6 g of maltitol. Metabolism of maltitol requires insulin, although due to slow hydrolysis and absorption in the gastrointestinal tract, the need for insulin is low. The energy value of one lozenge is approximately 6 kJ (1.4 kcal).

Description

Multivitamin remedy.

Pharmacodynamics

Multivitamin remedy.

B vitamins (B1, B2, B6, B12, pantothenic acid and nicotinamide) are involved in the metabolism of carbohydrates, proteins and fats.

Folic acid (vitamin Bc) is necessary for normal synthesis, regeneration and functioning of blood cells.

Retinol (vitamin A) is necessary for the development of epithelial cells and the synthesis of visual pigment.

Colecalciferol (vitamin D) regulates calcium intake and promotes proper mineralization of bones and teeth.

Ascorbic acid (vitamin C) promotes the absorption of iron and takes part in many redox processes in the body.

Tocopherol (vitamin E) is a physiological antioxidant that protects cell membranes and supports cell function.

Side effects

Allergic reactions are possible. In such cases, you should stop taking the drug and consult your doctor.

PIKOVIT® FORTE contains 0.6 g of maltitol; therefore, taking doses higher than recommended may cause diarrhea.

If adverse reactions occur, you should stop taking the drug and consult your doctor.

Interaction

Vitamin C enhances the effect and side effects of antimicrobial agents from the sulfonamide group (including the appearance of crystals in the urine).

Pyridoxine (vitamin B6) reduces the antiparkinsonian effect of levodopa, as well as the effects of steroid hormones.

Isoniazid increases urinary excretion of pyridoxine.

Cycloserine, hydralazine and penicillamines are antagonists of vitamin B6.

Overdose

In case of an overdose that develops while taking high doses of the drug for more than 1 month, hypervitaminosis of vitamins A and D may develop.

Long-term use of high doses of vitamin B6 can cause the development of peripheral neuropathy.

Pharmacodynamics

A combined preparation containing a complex of vitamins and minerals, which are important factors in metabolic processes.

Vitamin A is involved in the synthesis of various substances (proteins, lipids, mucopolysaccharides) and ensures the normal function of the skin, mucous membranes, and the organ of vision.

Vitamin D3 plays an important role in maintaining the balance of calcium and phosphorus in the body.

Vitamin B1 normalizes the activity of the heart and contributes to the normal functioning of the nervous system.

Vitamin B2 promotes tissue regeneration processes, incl. skin cells.

Vitamin B6 helps maintain the structure and function of bones, teeth, and gums; influences erythropoiesis and promotes the normal functioning of the nervous system.

Vitamin B12 is involved in erythropoiesis and contributes to the normal functioning of the nervous system.

Vitamin B5 is part of coenzyme A, which plays an important role in the processes of acetylation and oxidation. Activates metabolic processes in tissues.

B vitamins are involved in the formation of various enzymes that regulate metabolism in the body.

Vitamin C is involved in the oxidation of a number of biologically active substances, regulation of metabolism in connective tissue, carbohydrate metabolism, blood clotting and tissue regeneration, stimulates the formation of steroid hormones, and normalizes capillary permeability. Vitamin C increases the body's resistance to infections and reduces inflammatory reactions.

Folic acid stimulates erythropoiesis.

Calcium is involved in the formation of bone tissue, blood clotting, transmission of nerve impulses, and contraction of skeletal and smooth muscles.

Phosphorus, along with calcium, is involved in the formation of bones and teeth, and is also involved in energy metabolism processes.

Pikovit emulsion for oral administration 150ml No. 1

Name

Pikovit emulsion 150ml

Description

Thick, viscous liquid from light yellow to brownish-orange. The emulsion has a pleasant smell and sour taste. The emulsion can be separated into two layers, which disappears after shaking the bottle.

Main active ingredient

5 ml (1 scoop) of emulsion for oral administration contains: Active components: Retinolum (retinol palmitate 1.7 million IU/g, vitamin A, 900 IU riboflavin) Cholecalciferolum (cholecalciferol 1 million IU/g, vitamin D3) – 100 IU Riboflavinum (sodium riboflavin phosphate, vitamin B2) – 1 mg Pyridoxini hydrochloridum (pyridoxine hydrochloride, vitamin B6) – 0.6 mg Thiamini hydrochloridum (thiamin hydrochloride, vitamin B1) – 1 mg Cyanocobalaminum (cyanocobalamin, vitamin B12) – 1 mcg Acidum ascorbinicum (ascorbic acid, vitamin C) – 50 mg Nicotinamidum (nicotinamide, vitamin PP) – 5 mg D-Panthenol (dexpanthenol, D-panthenol) – 2 mg

Release form

Dark glass bottles of 150 ml of emulsion for oral administration. 1 bottle with a polyethylene cap with a polyethylene protective ring of the first opening, complete with a 5 ml measuring spoon and a leaflet in a cardboard box.

Dosage

The usual dose for children from 1 to 3 years is 1 scoop (5 ml) of emulsion twice a day. For children from 4 to 6 years old, 1 scoop (5 ml) of emulsion three times a day. For children from 7 to 14 years old, 1 scoop (5 ml) of emulsion 3 times, maximum 4 times a day.

special instructions

If you suffer from diabetes, Pikovit emulsion is not recommended, since 5 ml of emulsion (1 measuring spoon) contains 3 g of sugar, a daily dose (from 10 ml to 20 ml) contains from 6 to 12 g of sugar. High doses of some components, especially vitamin A and vitamin D, can be hazardous to health. Use with other vitamin preparations is not recommended to avoid overdose and side effects. It is recommended to prescribe with caution to patients with liver damage, acute nephritis, cardiac decompensation, allergic diseases, idiosyncrasy, a history of peptic ulcers of the stomach and duodenum, cholelithiasis, chronic pancreatitis, patients with neoplasms, a history of kidney disease, a tendency to thrombosis and bleeding (hemophilia, thrombocytopenia, thrombocytopathy). The absorption of ascorbic acid may be impaired by intestinal dyskinesias, enteritis and achylia. Because ascorbic acid increases iron absorption, its use in high doses may be harmful to patients with hemochromatosis, thalassemia, polycythemia, leukemia and sideroblastic anemia. Ascorbic acid, as a reducing agent, can affect the results of laboratory tests, for example, when determining the content of glucose, bilirubin, transaminase activity, lactate dehydrogenase. It is possible that the urine may turn yellow, which is a completely harmless factor and is explained by the presence of riboflavin in the drug. If you develop a hypersensitivity reaction, you should stop taking the medicine. Children in the first year of life can take the drug only as directed or under the supervision of a doctor. Before taking other vitamins or vitamin-mineral preparations at the same time, consult your doctor or pharmacist.

pharmachologic effect

Multivitamins

Pharmacodynamics

A combined preparation containing a complex of vitamins and minerals, which are important factors in metabolic processes. Vitamin A is involved in the synthesis of various substances (proteins, lipids, mucopolysaccharides) and ensures the normal function of the skin, mucous membranes, and the organ of vision. Vitamin D3 plays an important role in maintaining the balance of calcium and phosphorus in the body. Vitamin B1 normalizes the activity of the heart and contributes to the normal functioning of the nervous system. Vitamin B2 promotes tissue regeneration processes, incl. skin cells. Vitamin B6 helps maintain the structure and function of bones, teeth, and gums; influences erythropoiesis and promotes the normal functioning of the nervous system. Vitamin B12 is involved in erythropoiesis and contributes to the normal functioning of the nervous system. Vitamin B5 (calcium pantothenate) is part of coenzyme A, which plays an important role in the processes of acetylation and oxidation. Activates metabolic processes in tissues. B vitamins are involved in the formation of various enzymes that regulate metabolism in the body. Vitamin C is involved in the oxidation of a number of biologically active substances, regulation of metabolism in connective tissue, carbohydrate metabolism, blood clotting and tissue regeneration, stimulates the formation of steroid hormones, and normalizes capillary permeability. Vitamin C increases the body's resistance to infections and reduces inflammatory reactions. Vitamin PP (nicotinamide) is a coenzyme involved in protein metabolism, the synthesis of fatty acids and cholesterol, and energy production; necessary for the normal functioning of the central nervous system. Folic acid stimulates erythropoiesis. Calcium is involved in the formation of bone tissue, blood clotting, transmission of nerve impulses, and contraction of skeletal and smooth muscles. Phosphorus, along with calcium, is involved in the formation of bones and teeth, as well as in energy metabolism processes.

Indications for use

Pikovit emulsion for oral administration contains 9 of the most important vitamins that are involved in the regulation of biochemical processes in the body. Vitamins are important factors in metabolic processes in the body, necessary for normal growth and development, to maintain and improve health. B vitamins (B1, B2, B6, pantothenic acid and nicotinamide) take part in the metabolism of carbohydrates, proteins and fats and contribute to the normal functioning of the nervous system. Vitamin A is necessary for the development of epithelial cells and the synthesis of visual pigment. Vitamin D plays an important role in maintaining the balance of calcium and phosphorus in the body and promotes the mineralization of bones and teeth. Vitamin C promotes the absorption of iron and takes part in many redox processes in the body. The metabolic pathway of individual vitamins in the body is known and described in the literature. Water-soluble vitamins (B vitamins, vitamin C and biotin) are well absorbed in doses within the recommended daily dose. Excess amounts are excreted in urine and, to a lesser extent, in feces. These vitamins are stored in the body in limited quantities, so they must be constantly supplied with food to achieve the appropriate tissue concentration. In the presence of fats, vitamins A and D are well absorbed in the small intestine. Pikovit emulsion for oral administration is intended for the treatment of hypo- and avitaminosis in children caused by insufficient intake or increased need for vitamins. Pikovit emulsion is not a substitute for a balanced and varied diet. Therefore, it is important that your child’s diet is balanced and varied even while using Pikovit emulsion.

Directions for use and doses

Always take Pikovit as prescribed by your doctor. If you are unsure, contact your doctor. The usual dose for children from 1 to 3 years is 1 scoop (5 ml) of emulsion twice a day. For children from 4 to 6 years old, 1 scoop (5 ml) of emulsion three times a day. For children from 7 to 14 years old, 1 scoop (5 ml) of emulsion 3 times, maximum 4 times a day. Take the emulsion orally after meals. The emulsion can be given from a measuring spoon or mixed with tea, juice or fruit puree. The duration of treatment is determined by the doctor.

Use during pregnancy and lactation

Consult your doctor before using any medications. Pregnant women and nursing mothers should take vitamins and minerals as recommended by their doctor. Doses of vitamins Pikovit emulsion for oral administration are adapted for children. You should not plan a pregnancy earlier than 6–12 months after treatment with retinol in high doses (more than 10,000 IU) due to the fact that at this time there is a risk of embryonic disorders due to the high content of vitamin A in the body.

Precautionary measures

Do not take the drug if you are allergic (hypersensitive) to the active substances or any other ingredients of Pikovit emulsion. if you have hypervitaminosis A or D, hypercalcemia. if you have one of the following diseases: nephrolithiasis, renal failure, gout, hyperuricemia, erythremia, erythrocytosis, thromboembolism, thrombophlebitis, fructose intolerance, glucose-galactose malabsorption syndrome, sucrase-isomaltase deficiency, impaired iron and copper metabolism, hypercalcemia, hypercalciuria, thyrotoxicosis, chronic glomerulonephritis, chronic heart failure, sarcoidosis, a history of active gastric and duodenal ulcers (due to a possible increase in the acidity of gastric juice), an active form of pulmonary tuberculosis, simultaneous use of retinoids.

Interaction with other drugs

Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Due to the possibility of developing hypervitaminosis A, simultaneous use of Pikovit emulsion with other drugs containing vitamin A or oral retinoids is not recommended. Vitamin A is not recommended to be given with oral retinoids as the combination may be toxic. Retinol may reduce the anti-inflammatory effects of glucocorticoids. It should not be taken simultaneously with nitrates and cholestyramine, because they interfere with the absorption of retinol. During therapy with sulfonamides, large doses of vitamin C should be avoided to prevent crystalluria. Vitamin C increases the absorption of iron, but slows down the absorption of beta-blockers and indirect anticoagulants. The simultaneous use of vitamin C and deferoxamine increases tissue toxicity of iron, especially in the heart muscle, which can lead to decompensation of the circulatory system. Vitamin C can be used only 2 hours after the injection of deferoxamine. Calcium chloride, salicylates, and corticosteroids with long-term use reduce the reserves of ascorbic acid in the body. Absorption of ascorbic acid is reduced with simultaneous consumption of fruit or vegetable juices and alkaline drinks. Vitamin B6 weakens the effect of levodopa if the patient takes only levodopa. Prevents or reduces toxic manifestations that are observed with the use of isoniazid and other anti-tuberculosis drugs. Thiamine may weaken the curare-like effect. PAS, cimetidine, potassium supplements, alcohol reduce the absorption of vitamin B12. Riboflavin is incompatible with streptomycin and reduces the effectiveness of antibacterial drugs (oxytetracycline, doxycycline, erythrocycline, tetracycline and lincomycin). It should be taken at least 3 hours before or 3 hours after the antibiotic dose. Tricyclic antidepressants, imipramine and amitriptyline inhibit the metabolism of riboflavin, especially in cardiac tissue. When used simultaneously with quinine, hemorrhages may increase. With the simultaneous use of vitamin D3 and diuretics, the risk of hypercalcemia increases. Ion exchange resins such as cholestyramine and laxatives (paraffin oil) may reduce the absorption of vitamin D3. The effectiveness of vitamin D3 may be reduced when used concomitantly with phenytoin or barbiturates. In this regard, it is recommended to take the drug before or 2 hours after taking other medications. Since concomitant oral use of calcium and vitamin D3 supplements enhances the effect of cardiac glycosides, medical supervision and ECG monitoring are necessary during their simultaneous use.

Contraindications

Hypervitaminosis A and D; hypersensitivity to the components of the drug.

Compound

5 ml (1 scoop) of emulsion for oral administration contains: Active components: Retinolum (retinol palmitate 1.7 million IU/g, vitamin A, 900 IU riboflavin) Cholecalciferolum (cholecalciferol 1 million IU/g, vitamin D3) – 100 IU Riboflavinum (sodium riboflavin phosphate, vitamin B2) – 1 mg Pyridoxini hydrochloridum (pyridoxine hydrochloride, vitamin B6) – 0.6 mg Thiamini hydrochloridum (thiamin hydrochloride, vitamin B1) – 1 mg Cyanocobalaminum (cyanocobalamin, vitamin B12) – 1 mcg Acidum ascorbinicum (ascorbic acid, vitamin C) – 50 mg Nicotinamidum (nicotinamide, vitamin PP) – 5 mg D-Panthenol (dexpanthenol, D-panthenol) – 2 mg Excipients: agar, tragacanth, sucrose, liquid glucose, orange oil flavoring, orange flavor concentrate, grapefruit flavor concentrate, polysorbate 80, citric acid monohydrate, crimson dye 4R (E124), sodium benzoate, purified water.

Overdose

When taking recommended doses, the likelihood of overdose is minimal. In case of overdose, the likelihood of these adverse reactions increases, and bloating (flatulence) may occur. Long-term use of high doses can cause hypervitaminosis A and D3, although an overdose of Pikovit emulsion is unlikely. An overdose of vitamin D3 causes weakness, anorexia, nausea, vomiting, diarrhea, weight loss, fever, convulsions, and disorders of the cardiovascular system and kidneys. Hypercalcemia may develop due to hypersensitivity to vitamin D3. Symptoms of hypercalcemia are anorexia, polyuria, nausea, vomiting, general weakness, headache, apathy, thirst. An overdose of vitamin A can lead to headaches, dizziness, sleep disturbances, nausea, vomiting, drowsiness, photophobia and seizures. If the above symptoms appear, you should stop taking the drug and consult a doctor immediately. With long-term use of ascorbic acid in high doses, inhibition of the function of the insular apparatus of the pancreas is possible, so it is necessary to monitor its functional state. Overdose may lead to changes in the renal excretion of ascorbic and uric acids by acetylation of urine with a risk of oxalate stone formation. The use of large doses of ascorbic acid can lead to heartburn. If the recommended doses are significantly exceeded (if the dose of vitamin C exceeds 1 g per day, which corresponds to 100 ml of Pikovit emulsion), renal failure, sleep disturbances, a feeling of heat, increased fatigue, impaired zinc and copper metabolism, increased excitability, erythrocytopenia, neutrophilic leukocytosis may occur. . If signs of overdose appear, the drug should be discontinued. If possible, you should: induce vomiting and hydrate the body. If hypercalcemia is detected, a diet with limited amounts of calcium and vitamin D3 should be followed. Further treatment is symptomatic.

Side effect

Recommended doses are well tolerated. The following adverse reactions may very rarely occur in some individuals: From the immune system: in individuals with hypersensitivity, allergic reactions are possible, including anaphylactic shock, angioedema, bronchospasm. From the skin and subcutaneous tissue: rash, urticaria, itching, redness of the skin, eczema. Metabolism and nutrition: hypercalcemia, calcification. From the gastrointestinal tract: dyspepsia, nausea, vomiting, belching, stomach pain, constipation, diarrhea. Increased secretion of gastric juice, heartburn. From the nervous system: headache, dizziness, drowsiness, increased excitability. From the organ of vision: visual impairment. From the kidneys and bladder: change in urine color, hypercalciuria, damage to the glomerular apparatus of the kidneys. Others: hyperthermia, increased sweating. With long-term use in high doses, the following side effects may occur. Metabolism and nutrition: hyperuricemia, decreased glucose tolerance, hyperglycemia, impaired glycogen synthesis. From the nervous system: paresthesia. Cardiac disorders: arrhythmia, arterial hypertension, myocardial dystrophy. Blood disorders: thrombocytosis, hyperprothrombinemia, thrombus formation. The use of ascorbic acid at a dose of 1 g per day (which is more than 100 ml of Pikovit emulsion) in patients with glucose-6-phosphate dehydrogenase deficiency can cause hemolysis of red blood cells (hemolytic anemia). From the gastrointestinal tract: irritation of the mucous membrane of the digestive tract. From the skin of the subcutaneous tissue: dryness and cracks on the palms and soles, hair loss, seborrheic rash. From the kidneys and bladder: renal failure, crystalluria, formation of urate, cystine and/or oxalate stones. Laboratory and instrumental data: transient increase in the activity of aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase, increased calcium levels in the blood and urine, glycosuria. If hypersensitivity reactions develop, the drug should be discontinued.

Storage conditions

Store at a temperature not exceeding 25 °C in a place protected from light. Keep out of the reach of children.

Interaction

The drug contains calcium and therefore delays the absorption in the intestine of antibiotics from the tetracycline group, as well as antimicrobial agents - fluoroquinolone derivatives (it is necessary that there is an interval of at least 2 hours between doses of the drugs).

Vitamin C enhances the effect and side effects of antimicrobial agents from the sulfonamide group (including the appearance of crystals in the urine).

With the simultaneous administration of diuretics from the thiazides group, the likelihood of hypercalcemia increases.

Indications of the drug Pikovit®

Pikovit® syrup for children is used as a prophylactic agent for conditions accompanied by an increased need for vitamins:

overwork in school-age children;

increased physical and neuropsychic stress;

lack of appetite and irregular, inadequate or monotonous diet;

recovery period after illnesses;

increasing the body's resistance to infectious and colds;

complex therapy when using chemotherapeutic agents.

special instructions

It is possible that the urine may turn yellow - this is completely harmless and is explained by the presence of riboflavin in the drug.

It is not recommended to take Pikovit® together with other medications containing vitamins and minerals.

High doses of glycerol can cause headaches and gastrointestinal disorders (diarrhea).

Pikovit® contains azo dyes E124 and E110, which can cause a hypersensitivity reaction with an asthmatic component. Such reactions are more often observed in patients with hypersensitivity to acetylsalicylic acid.

The drug contains 192 mg of lactose, 611 mg of sucrose, 160 mg of glucose and 134 mg of sorbitol, therefore the drug is not recommended for children with congenital intolerance to glucose and fructose, with glucose/galactose malabsorption syndromes and sucrose/isomaltose deficiency.

Results of using Pikovit multivitamin complexes in the neuropsychiatric department

Etiology of vitamin deficiency The causes of vitamin deficiency conditions are traditionally considered as part of four main categories, which are presented in order of their importance. Nutritional deficiency This category of causes of vitamin deficiency can arise as a result of various factors listed below: 1) low content of vitamins in the diet (not fortified or deficient diets); 2) destruction of vitamins due to technological processing of food products, their long-term and improper storage and irrational culinary processing; 3) the effect of the so-called “antivitamin factors” contained in food products; 4) the presence of vitamins in products in a poorly digestible form; 5) imbalance in the chemical composition of diets and optimal relationships between vitamins and other nutrients, as well as between individual vitamins; 6) various food perversions and religious prohibitions imposed on the use of a number of products; 7) anorexia (of various origins). Inhibition of normal intestinal microflora that produces a number of vitamins. It can occur in the following two clinical situations: 1) diseases of the gastrointestinal tract, 2) chemotherapy, especially irrational. Violations of vitamin assimilation This category of causes of vitamin deficiency is represented by relatively numerous phenomena: 1) impaired absorption of vitamins in the gastrointestinal tract (diseases of the stomach and intestines, damage to the hepatobiliary system, competitive relationships with the absorption of other vitamins and nutrients, congenital defects of transport and enzymatic mechanisms of vitamin absorption ); 2) utilization of vitamins supplied with food by intestinal parasites and pathogenic intestinal microflora; 3) disruption of the normal metabolism of vitamins and the formation of their biologically active forms: due to hereditary anomalies, certain acquired diseases or exposure to toxic and infectious agents; 4) disturbances in the formation of transport forms of vitamins (hereditary or acquired); 5) permanent or transient antivitamin effect of certain medications, xenobiotics, etc. Increased need for vitamins The need for vitamins can increase significantly as a result of a number of reasons listed below. These include: 1) Special physiological states of the body (for example, intensive growth during certain periods of development, etc.), 2) specific climatic and climatic-geographical conditions (mostly unfavorable), 3) winter-spring season, 4) intensive energy expenditure (or physical activity) - episodic or chronic, 5) increased neuropsychic stress, exposure to stressful conditions (of various origins and severity), 6) infectious diseases and intoxications (acute and chronic), 7) exposure to harmful environmental factors, diseases internal organs and endocrine glands (including neuroendocrine pathology), 9) increased excretion of vitamins [1,5]. It is quite natural that in some cases there may be a combination of etiological causes of vitamin deficiency, leading to isolated and combined vitamin deficiency. Principles of dietary correction of vitamin deficiency and vitamin therapy As mentioned above, the possibilities of diet therapy are traditionally used to correct vitamin deficiency states of varying severity. At the same time, at first glance, providing children with the necessary vitamins through appropriately selected food products in the daily diet appears to be the most physiological, minimally invasive and aesthetically acceptable [6]. However, it must be remembered that the content of various vitamins in food can vary significantly (even within the same food group). It should also be remembered that no natural product contains all vitamins at a level sufficient to meet the physiological needs of children or adults for these essential nutrients [7]. The diet should include not only sufficient amounts of vitamins and macronutrients, but also minerals, some of which can interact with vitamins, promoting or, conversely, preventing their absorption [1]. Therefore, diet plays an important, but purely secondary role in the prevention and correction of vitamin deficiency. Currently, there is evidence that even if the diet is balanced and varied, representatives of all age categories may experience deficiency in the absolute majority of vitamins, reaching a deficiency of 20–30% [8,9]. In this regard, an absolutely necessary measure is the prescription of vitamin preparations. Ideally, vitamin preparations for children should precisely meet the needs of a growing organism in a particular period of life, be offered in a form convenient for administration and absorption, not interfere with the absorption of other components of the diet (nutrients), and be easily and accurately dosed (in accordance with age-related needs and manufacturers' recommendations). It is also extremely important to ensure that your child takes vitamins for an adequate period of time. The purpose of multivitamin preparations is not only prevention, but also the correction of existing vitamin deficiency conditions. Multivitamin preparations are used not only for the prevention and treatment of hypovitaminosis and vitamin deficiency, but also in the complex treatment of nutritional disorders such as malnutrition or paratrophy [10]. Children of any age need regular intake of vitamins, preferably in the form of complex multivitamin preparations. At the same time, it is known that less than 50% of children in the Russian Federation receive multivitamin complexes with any regularity [8]. While there are over 150 multivitamin preparations of domestic and foreign production available in the pharmacy network of the Russian Federation, not all of them can be prescribed to children [11,12,13,14]. In this regard, vitamin preparations, the clinical effectiveness and safety of which have been proven during clinical testing, are of particular importance for pediatric practice. In the past, pediatric clinical psychoneurology has repeatedly demonstrated the effectiveness of prescribing vitamin preparations for various types of pathology, in particular, for attention deficit hyperactivity disorder, learning skills disorders, early childhood autism (EDA), and even for certain forms of schizophrenia [1,2] . Instead of the outdated and poorly substantiated “orthomolecular” approach to vitamin therapy (so-called “megadoses”), regular and long-term administration of multivitamin preparations is now predominantly used [1]. Over the past decade, employees of the Department of Psychoneurology of the Research Institute of Pediatrics of the State Scientific Center for Children of the Russian Academy of Medical Sciences (Director - Academician of the Russian Academy of Medical Sciences, Prof. Baranov A.A.) over the past decade have repeatedly tested and used various dosage forms of domestic and foreign multivitamin preparations, assessing their preventive and therapeutic effectiveness for various types of psychoneurological pathology [2,3,4,15]. One of these studies was the clinical testing of multivitamin preparations Pikovit D (indications for children over 4 years of age) and Pikovit Forte (for children over 7 years of age) in the form of lozenges. Results of clinical testing of two forms of the multivitamin preparation Pikovit During the period from February to April 2004, in the department of psychoneurology of the Research Institute of Pediatrics of the State Scientific Center for Children of the Russian Academy of Medical Sciences, clinical testing of two forms of the multivitamin preparation Pikovit (pharmaceutical, Slovenia) was carried out: • Pikovit forte • Pikovit D (in lozenges). The following criteria for inclusion in the observation group were used: • age >4 years (for the drug Pikovit D), • age >7 years (for the drug Pikovit forte), • the presence of one of the following conditions: 1) attention deficit hyperactivity disorder (ADHD) ), 2) minimal brain dysfunction (MMD), 3) tic disorders, 4) neurotic reactions, 5) epilepsy, 6) hypovitaminosis (specific or clinically manifest), • absence of mental retardation (MR), • absence of acute respiratory diseases (ARI) ) and somatic diseases in the period of exacerbation, • refusal to take other multivitamin preparations during the treatment period. In accordance with the manufacturers' recommendations, Pikovit Forte was prescribed to children aged 7 years and older, 1 lozenge 1 time per day, and Pikovit D was prescribed to patients aged 4 to 6 years, 1 lozenge 4-5 times per day. In total, 50 children (among them 33 boys and 17 girls, ages from 4 to 16 years) who were being treated in the clinic with various types of nervous system pathologies received these multivitamin preparations. Pikovit D was prescribed to 25 patients, and Pikovit forte was also prescribed to 25 children. The main diagnoses among the patients we observed included the following types of psychoneurological disorders: • migraine • epilepsy • attention deficit hyperactivity disorder • tic disorders • minimal cerebral dysfunction • asthenoneurotic reactions • primary nocturnal enuresis • hydrocephalus • cerebral palsy • multiple sclerosis (MS), etc. There were no clinically manifest isolated forms of hypovitaminosis among the observed children, but 5 patients (10%) had symptoms regarded as probable manifestations of (seasonal) multivitamin deficiency, such as: increased fatigue and irritability, decreased appetite, sleep disturbances, etc. Protocol examination of patients included the following main studies: 1) physical and neurological examination, 2) electroencephalographic (EEG) study, 3) examination on test computer systems (TCS), as well as the Lusher color test (Lusher test) - selectively, 4) defectological examination of children (carried out selectively), 5) routine clinical blood and urine tests. Cognitive functions using TCS were assessed selectively due to existing age restrictions (22 studies were performed in children over 6 years of age). All medications taken by patients during treatment with Pikovit (its two forms) were taken into account. Isolated administration of the drug Pikovit was not practiced; a multivitamin complex was used as part of combination therapy. Compliance with taking the drug Pikovit (so-called “compliance”) was recorded. Due to refusal or irregular use of the study multivitamin preparations, not a single child was excluded from the observation group. Clinical effectiveness was assessed using three main categories: “no effect”, “partial effect” and “significant improvement”. At the same time, possible adverse reactions from the use of Pikovit vitamin complexes were recorded, such as nausea, vomiting, abdominal pain, intestinal disorders, allergic manifestations, any (pathological) laboratory changes without clinical manifestations, as well as “other symptoms”. The tolerability of the drug by children was assessed (unsatisfactory, satisfactory, good). Taking into account the age of the patients, Pikovit D (up to 6 years of age) or Pikovit Forte (from 6 years of age) was prescribed. The duration of use of these multivitamin preparations ranged from 21 to 28 days (in 11 cases - 21 days, in 39 children - 28 days). If necessary, the drug was provided to children to complete the planned course of treatment at home. The assessment of the effectiveness of the multivitamin preparations used was based on data from a neurological and somatic examination, and was also clarified using the results of a TCS examination and other research methods. It was somewhat complicated by the fact that Pikovit D and Pikovit Forte were not used in isolation, but as part of a complex treatment for the diseases of the nervous system listed above. However, no effect was recorded in any case. In 10% of cases (5 children) a significant improvement was noted, in 90% of patients (45 children) there was a partial effect. The presence of only a partial effect in a larger number of patients is explained by the chronic nature of their existing central nervous system pathology, in which a rapid and/or complete disappearance of the existing clinical symptoms cannot be expected. In children with signs of seasonal multivitamin deficiency (5 patients), there was a complete elimination of clinical symptoms of vitamin deficiency. Special attention should be paid to the consideration of such parameters of testing cognitive functions (using TCS) in children as listed below: • tapping with the right hand (average interval - msec, frequency of reactions - number per 1 second), • memory for numbers (average response time - msec , standard deviation of the average response time - ms, number of numbers reproduced, number of correct answers), • attention to the arrangement of numbers (total search time - ms, average search time - ms, average response time - ms, total number of answers - in pieces, number of errors – in pieces), • reaction to a moving object (efficiency of psychomotor activity and accuracy of hand-eye coordination), as well as • results of the modified Luscher test (level of anxiety, autonomic coefficient, deviation from the so-called “autogenic” norm, etc. .). A comparison of the results of therapy for the observed children using vitamin complexes was carried out with a group of patients of a similar age who did not receive the multivitamin preparations Pikovit D and Pikovit Forte (as well as other forms of vitamins) as part of the treatment. In total, there were 15 patients aged 6–15 years in the comparison group. Initially, the main deficits in cognitive functions among the observed children were attention, memory and motor skills. During the first testing (on the 3rd day after admission to the clinic), the parameters of perception and processing of presented visual stimuli in children were difficult. After 20 days after starting to take both forms of the Pikovit multivitamin complex, re-testing for TCS was carried out. At the same time, the following positive dynamics were revealed on the part of the studied cognitive functions: the interval (temporary) of motor reactions decreased by an average of 5–10%; an increase in the rate and frequency of beats per 1 second was observed within almost the same limits (during the tapping test). Qualitative indicators of attention also showed positive dynamics: total search time in the group of observed patients decreased by 25–30%, average search time by 30–35%, and average response time by 15–20%. In practice, this means that the patients we observe have become better at remembering and reproducing the visual information presented to them. Data from a repeated Luscher test indicated an improvement in physical activity, vegetative support, and general well-being after a course of therapy with the described multivitamin preparations in children who had reached the age of starting school. The use of the drug Pikovit forte in a comprehensive treatment program for children with ADHD turned out to be no less effective than the use of other drugs for similar purposes. The tolerability of both tested forms of the drug Pikovit was assessed by the medical staff of the psychoneurology department, the patients themselves, as well as their parents. It was satisfactory in the vast majority of observed children (adverse reactions were noted in only 2 cases, that is, in 4% of patients, while taking Pikovit D to children aged 4.5 and 5 years, respectively). The latter included skin rashes, regarded as manifestations of exacerbation of atopic dermatitis (the connection between the appearance of rashes and taking multivitamin preparations was not reliable, since similar phenomena were periodically observed in children even before taking Pikovit D). Nausea, vomiting, abdominal pain, and intestinal disorders were not observed in the observed children. No pathological changes were recorded in general blood and urine tests, as well as during biochemical blood tests. The results obtained during the study allowed us to conclude that the vitamin complexes Pikovit D and Pikovit Forte are effective multivitamin preparations that can be used as part of the complex treatment of a number of neurological diseases, as well as for the correction of hypovitaminosis and vitamin deficiency conditions in children. It is emphasized that it is possible to use them for both preventive and therapeutic purposes. The good tolerability of these multivitamin complexes and the low frequency of adverse reactions are additional positive characteristics in relation to the tested forms of the drug Pikovit. It should be noted that the vitamin complex Pikovit D does not contain sugar, for this reason it is one of the few representatives of multivitamin preparations suitable for use during a ketogenic diet (in patients suffering from drug-resistant forms of epilepsy). The use of polyvitamin preparations, provided that their adequate and prolonged admission to the body is one of the most important directions of diet therapy along with ensuring the normal state of nutrition, the use of special (therapeutic) diets, the purpose of minerals and the use of food additives and biologically active substances (the latter are often included in The composition of vitamin complexes) [11,12,13,14]. With a number of neuropediatric problems (for example, for ADHD), for the treatment of which in the Russian Federation there are no adequate pharmacopreparations, vitamin therapy is one of the main methods of therapeutic effects. In particular, this circumstance is indicated by Gromova O.A. et al. (2003), who submitted data on the correction of vitamin status in children with ADHD, as well as our own data [2,16]. In other clinical situations, the use of polyvitamin complexes is of valuable auxiliary value, which should also not be ignored from the standpoint of the concepts of comprehensive rehabilitation of children with chronic pathology of the nervous system and neurothytiology. Literature 1. Pediatric Nutrition in Chronic Diseases and Developmental Disorders. Prevention, assessment, and treatment/Ekvall SW, Ekvall VK (eds.). – 2nd ed. - Oxford University Press. - Oxford/New York. - 2005. - 532 p. 2. The use of polyvitamin drug with lecithin in neuropediatrics (manual for doctors). - M.: Publishing House "Medical Practice - M". - 2005. - 20 p. 3. Studenikin V.M. Polyvitamin preparation with lecithin: use in children's neurology // attending physician. - 2003. - No. 6. - S. 56–57. 4. Studenikin V.M., Balkanskaya S.V., Maslova O.I. The possibilities of using a multivitamin preparation with lecithin in children's neurology // Consilium Medicum. - "Pediatrics." - 2004. - Appendix. No. 1. - S. 16-19. 5. The rule of the dietetics/Beyul E.A., Budagovskaya V.N., Vysotsky V.G. et al. - Ed. Samsonova M.A., Pokrovsky A.A. - ed. 2nd. - Refined. and additional – M.: Medicine. - 1992. - 464 p. 6. Guide to therapeutic nutrition of children/Ed. Lado K.S. – M.: Medicine. - 2000. - 384 p. 7. Organization of medical nutrition of children in hospitals/Ed. Baranova A.A., Ladodo K.S. - M.: "Evita - Prof." - 2001. - S. 80–81. 8. Studenikin V.M. Hypovitaminosis and multivitamins // Vopr. modern pediatrics. - 2002. - Volume 1. - No. 1. - S. 48–51. 9. Heinz Handbook of Nutrition/Yeung DL (ed.). - 8th ed. - HJ Heinz Co. - 1995. - 220 p. 10. Stroganova L.A., Alexandrova N.I. Chronic nutrition disorders in young children. - ST - PB. - ST - PBMAPO. - 1996. - 62 p. 11. Mashkovsky M.D. Medicines: in 2 t. - 14th ed. - Rev., fixed. and additional - M.: LLC "Publishing House of New Wave". - Publishing House S.B. Diva. - 2002. 12. Register of medicines of Russia "Encyclopedia of Medicines". - 13th issue. - Refined. and additional - M.: LLC "RLS -2006". - 1440 p. 13. Reference Vidal: Medicines in Russia: Handbook. - Publishing House 12th, re -rack., Fixed. and additional - M. - Astrafarmservice. - 2006. - 1632 p. 14. Federal guide to the use of medicines (formular system). - Issue. VII. - M.: "Echo." - 2006. - 1000 p. 15. Vitamins and minerals for children's health (textbook). - M. - Spr - OF "Healthy Child". - NCR RAMS. - 2003. - 28 p. 16. Gromova O.A., Krasny L.M., Limanova O.A., Kutuzova N.A. et al. Correction of vitamin status in the syndrome of attention deficiency and hyperactivity // Vopr. modern pediatrics. - 2003. - Volume 2. - No. 4. - S. 33–39.

Manufacturer

KRKA, d.d., Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia.

For any questions, please contact the Representative Office in the Russian Federation:

123022, Moscow, st. 2nd Zvenigorodskaya, 13, building 41.

Tel.; Fax.

When packaging and/or packaging at a Russian enterprise, the following is indicated:

LLC "KRKA-RUS", 143500, Russia, Moscow region, Istra, st. Moskovskaya, 50.

Tel.; Fax

or

CJSC "Vector-Medica", 630559, Russia, Koltsovo village, Novosibirsk region.

Tel/fax