choline chloride + cyanocobalamin + ergocalciferol + vitamin a: clinical use

Prescribing considerations

• Confirm supplementation is required because of a metabolic condition or restricted diet.
• Reconcile prescribed, over-the-counter and dietary supplements to avoid duplicate vitamins A and D.
• The liquid is used with Ketovite Tablets when complete vitamin supplementation is required.
• Consider reduced absorption with fat malabsorption or listed interacting medicines.
• Use particular caution in pregnancy because excessive vitamin A is teratogenic.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient.
• Hypercalcaemia.

Monitoring

• Review nutritional intake and ongoing need as the specialist diet changes.
• Assess calcium and phosphate when toxicity is suspected; consider calcium monitoring where clinically relevant.
• Investigate persistent nausea, thirst, frequent urination, weakness or bone pain as possible excess vitamin exposure.
• Interpret serum B12 results in the context of oral-contraceptive use and absorption-reducing medicines.

Clinical pharmacology

Supplies fat-soluble vitamins A and D2, cyanocobalamin and choline. Component pharmacokinetics are expected to resemble those of the same nutrients obtained from food; choline supplies substrates for phospholipids, acetylcholine and methyl-group metabolism.

Formulation and product differences

• The selected product is a sugar-free, pale pink to yellow oral liquid.
• It contains methyl parahydroxybenzoate and should be stored refrigerated.
• It is not a complete stand-alone multivitamin preparation; the associated tablet product supplies complementary vitamins.