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Focus
on
vitamins, Immune
Boosters & the Flu
Vaccine
Joy Zuccaroli (B. Pharm)
Amayeza Info Services
Winter is just around the corner and now is
a great time to focus on our health and protect
ourselves from colds and flu.
FOCUS ON VITAMINS
Our food contains fewer nutrients today
than even 20 years ago. This is because
soils have become depleted and the
necessary soil nutrients have not been
replaced. As a result, even people who
are eating the recommended amount of
fruit and vegetables a day (i.e. 8 to 10
servings), are quite possibly not getting
the essential nutrients required for the
optimal functioning of the body.
Furthermore, stress - whether physical
as in sportsmen or mental as in work
pressures - leads to increased requirements for vitamins and minerals. Since
the body does not make vitamins and
minerals, they must either form part of
the diet or be taken in as supplements
to the diet.
SA Pharmacist’s Assistant [ Mar / Apr 2006 ]
Antioxidant vitamins include vitamins
A, C and E and are thought to protect
the body by stabilising the free radicals
that enter the body. Free radicals cause
damage to the body and may be found
in the food we eat, the water we drink
and the air we breathe and are also the
end-result of certain metabolic processes
in the body.
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Historically, vitamin and mineral supplements were only recommended to
people with increased nutritional requirements, such as pregnant women,
endurance athletes or stressed students
writing exams. However, most people
can benefit from taking a vitamin and
mineral supplement.
Before discussing some of the multivitamin and mineral supplements
available, it would be wise to discuss
Recommended Daily Allowances (RDA’s).
The Recommended Daily Allowances
of vitamins are the amounts of vitamins
(and minerals) required each day
to prevent deficiency, i.e. the RDA for
vitamin C is the amount needed to prevent scurvy. We know that much higher
doses of certain vitamins can be used
in the short-term. However, always
consult with a pharmacist should you
want to give a large dose of any vitamin
to a patient as these products are not
always safe for certain groups of
patients, i.e. those taking certain other
medications or those with concomitant
medical conditions. Pregnant women
are also safest taking supplements
recommended by the doctor or
pharmacist. If you are unsure, it is
recommended to stick to products that
contain no more than 50 to 60% of the
RDA for each ingredient.
Below is a list of some multivitamin and
mineral supplements, as well as some
antioxidants. Unless otherwise stated,
all products below are taken as 1 tablet /
capsule daily, taken after a meal as they
can cause nausea if taken on an empty
stomach.
Allvit and M® (Georen Pharmaceuticals)
This supplement combines Korean
ginseng root with a general multivitamin and mineral supplement. The
recommended dose is 1 capsule daily,
in the morning as ginseng is a natural
stimulant and therefore would keep a
patient awake if taken at night.
Berocca® (Bayer)
Berocca combines the B vitamins
and minerals and is available as an
effervescent tablet and a film-coated
tablet.
Centrum® (Wyeth)
A vitamin and mineral supplement for
the under 50’s and then an altered
supplement to suit the over 50’s (the
latter contains a higher dosage of certain
vitamins and minerals).
Dynamisan® (Novartis)
Dynamisan includes amino acids (the
building blocks of protein) in its formulation of a multivitamin and mineral
supplement. It may be used by sportsmen and is safe for diabetics as the
formulation contains no sugar.
Emvit M® (Altana Madaus)
Emvit M is a multivitamin and mineral
supplement for adults and may be used
during pregnancy.
Foodstate Multivitamin and Mineral
Formula (Regal Nutrients)
This multivitamin and mineral supplement attaches proteins to the vitamins
and minerals to increase their absorption
and availability to the body.
Pharmaton® (Ingelheim)
This multivitamin and mineral supplement also contains panax ginseng root
for stamina and should therefore be
taken once daily in the morning.
Minamino® capsules and syrup
(Pharmacare)
Minamino combines vitamins and
minerals with amino acids. The capsules
are for adults and the syrup contains
mainly vitamin B with minerals and
amino acids and is recommended for
children.
Supradyn Recharge® (Bayer) is specifically formulated to replenish those
nutrients lost during physically demanding activities. A unique combination
of vitamins, minerals and trace elements
to sustain energy levels during busy,
hectic times are the main benefits of
using this product.
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Supradyn® Complete is a comprehensive multivitamin that provides most
of the essential nutrients required by
the body at 100% RDA.
or duration of the illness. At this point it
is important to stress that rest, a healthy
diet and plenty of fluids are also important
for the body to heal itself.
Supradyn® 50+ is specifically formulated, with ginseng, to meet the changing
vitamin and mineral requirements of the
over 50’s age group.
Below is a list of some commonly used
immune boosters.
FOCUS ON IMMUNE BOOSTERS
The immune system is the body’s defence
system against any foreign particle that
enters the body, be it a virus, a bacterium
or, in allergic people, dust or pollen.
Our bodies are bombarded by foreign
particles all the time and people who
seem to get one illness after the next
could benefit from taking a short course
of an immune booster, provided their
doctor is confident that there is no
underlying cause for the recurrent minor
illnesses. The other, more common use,
for immune boosters is when someone
feels a minor illness such as a cold starting
and they want to decrease the severity
Echinaforce (A. Vogel)
This homoeopathic preparation contains
part of the echinacea plant. It is thought
to increase the body’s natural resistance
to viral and bacterial infections. The
dosage is 10-20 drops 3 times daily, but
it should not be used for longer than 6
weeks.
Foodstate Antioxidant and Immunity
Formula
This formulation combines a range of
antioxidants, such as vitamin C and E
plus selenium, with sterols for improved
immune function and building resistance
to disease.
ImmunoChoice ® (PharmaChoice)
ImmunoChoice combines antioxidants
with vitamins and immune boosting
nutrients. Children over 5 years old and
adults take 1 capsule twice a day.
Vitamin C
A vitamin C supplement can be taken
at doses of 2-3g daily for 3-5 days at the
onset of illness and this is thought to
decrease the severity and duration of
the common cold.
ViralChoice® (PharmaChoice)
ViralChoice combines echinacea, garlic
and vitamin C with antioxidants and
sterols and sterolins, all of which work
to increase resistance to infections and
to boost the immune system. The recommended dosage is 1-2 capsules per
day during high-risk periods (no longer
than 6 weeks) or 1 capsule 3 times a
day for 10 days at the first sign of a cold
or flu. A syrup formulation is also available for children.
FOCUS ON THE FLU VACCINE
The flu vaccine is used in the prevention
of flu and must be administered every
Continued on p10
The influenza vaccine for 2006 is now available in South Africa. The following strains have been recommended by the World
Health Organization for the 2006 Southern Hemisphere influenza season:
- A/New Caledonia/20/99 (H1N1) - like virus
- A/California/7/2004 (H3N2) - like virus
- B/Malaysia/2506/2004 - like virus
Indications for influenza vaccine use in South Africa for 2006 include:
In addition to the above it is recommended that individuals in the agricultural, veterinary and laboratory sectors who are
conducting surveillance and/or research into avian influenza are also vaccinated. This recommendation is based on the
following considerations:
• There is a theoretical risk of genetic reassortment in individuals co-infected with avian and human strains of influenza.
• Individuals working with avian influenza may present with signs and symptoms that would potentially prompt investigation
of such cases for infection with an avian influenza virus. It would be useful to immunise individuals against human
influenza thereby reducing the number of flu-like illnesses that occur and thus reduce unnecessary investigation and
diagnostic confusion.
The seasonal influenza vaccine will however NOT protect against infection with avian influenza and strict adherence to
recommendations for use of personal protective equipment (PPE) and laboratory bio-safety is advised.
[ Mar / Apr 2006 ] SA Pharmacist’s Assistant
• Persons (adults or children) who are at high risk for influenza and its complications because of underlying medical
conditions and who are receiving regular medical care for conditions such as chronic lung and heart disease, chronic
kidney diseases, diabetes mellitus and similar metabolic disorders, and individuals who are immunosuppressed (including
HIV infected persons with CD4 counts above 200/ml).
• Children over the age of 6 months can be vaccinated against influenza.
• Residents of old-age homes, chronic care and rehabilitation institutions.
• Children on long-term aspirin therapy.
• Medical and nursing staff responsible for the care of high-risk cases.
• Adults and children who are family contacts of high-risk cases.
• All persons over the age of 65 years.
• Women who would be in the second or third trimester of pregnancy during the influenza season. Pregnant women with
medical conditions placing them at risk for influenza complications should be immunized at any stage of pregnancy.
• Any persons wishing to protect themselves from the risk of contracting influenza, especially in industrial settings, where
large-scale absenteeism could cause significant economic losses.
Reprinted with permission from: Communicable Diseases Communique March 2006;5(3)
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Focus
on
vitamins, Immune
Boosters & the Flu
Vaccine
Continued from p7
year as the particular strains of flu vary
from winter to winter. The WHO identifies the most active viruses before the
flu season and these are then included
in the new vaccines.
Although some symptoms of colds
and flu may be the same, flu is more
dangerous than a common cold
and can lead to life-threatening complications, especially in the elderly.
However, the flu vaccine does not protect against a common cold and so
people may mistake a cold for flu
and then claim that the flu injection
does not work. This is obviously not
the case.
Flu is very contagious and is easily
transmitted via droplets in the air. A
person can be vaccinated at any time,
but preferably before the flu season
begins in March to April. The only time
a person shouldn’t be vaccinated is
during an acute illness, particularly if a
fever is present or if the person has an
allergy to egg.
Relenza® is an antiviral agent (Schedule
4) that is often prescribed for an at-risk
group of patients in the early stages of
the disease. It has been shown to reduce
the duration of symptoms by around
one day and reduce the absolute rate
of complications requiring antibiotics
by 6%. Relenza® is administered through
an inhaler device and is indicated for
the treatment of influenza A and B in
adults and adolescents (>12 years)
showing symptoms typical of influenza
when influenza is circulating in the
community. Patients with asthma or
COPD may experience bronchospasm,
immediately after using the product, and
may therefore need fast acting
bronchodilators. The use of zanamivir
is not recommended during pregnancy
or in mothers who are breast-feeding.
It should be prescribed for at-risk adults
who present within 36 hours of the start
of influenza-like symptoms and are able
to begin treatment within 48 hours. Generally, the at-risk groups are defined as:
• Age 65 years or over
• Chronic respiratory disease that requires regular medication
• Significant cardiovascular disease (not
just hypertension)
• Immuno-compromised due to treatment or disease
• Diabetes mellitus
Conclusion
Weather forecasters foresee an
exceptionally cold winter for 2006. This
article will hopefully provide a useful
guide to the assistant to advise those
who want to prevent serious illness like
flu (influenza) and to “immuno-boost”
against the common cold. It is important
to recommend the flu vaccine to all your
customers and to explain that influenza
usually causes absenteeism from work
and may have dire complications. South
Africa had alarming vaccination figures
the past 2 years - only 800 000 people
got flu vaccinations in 2005, compared
to over 2million in 2004. Pharmacist’s
assistants play a vital role in reminding
the public to vaccinate and thereby to
sapa
prevent serious disease.
References available upon request.
Keep your body balanced these holidays with Inteflora 250
SA Pharmacist’s Assistant [ Mar / Apr 2006 ]
Probiotics have become widely recognized as the ‘musthave’ supplement to help keep the body in balance, by
maintaining a healthy digestive system. This is particularly
beneficial during the holiday season, when many of us
take time out to visit unfamiliar destinations where we
may be skeptical about the quality of food and water.
Yeast-based probiotics such as Saccharomyces boulardii
(Inteflora 250) can help prevent traveler’s diarrhoea, or
reduce the severity of this viral infection.
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While most of us prefer not to contemplate the down-side
of traveling, diarrhoea is a very real threat to travelers. It
is usually caused by bacterial infections picked up from
contaminated food and water, including ice cubes and
inadequately cooked food. Infection can also be passed
on by unhygienic handling of food and flies. However,
infection is not always the cause – especially during the
holiday season when too much sun, fruit and alcohol can
also cause diarrhoea. Special care is therefore advisable
when visiting remote or exotic holiday destinations or high
risk developing countries such as Africa, Latin America
and the Far East.
Yeast-based (Saccharomyces boulardii) probiotics are
particularly beneficial when traveling because they:
1. Do not require refrigeration
2. Have a simple and convenient dosage of one capsule
twice daily
3. Keep toxins out of the body’s sensitive digestive area1
4. Significantly ease the severity of acute diarrhoea in
children3
5. Rapidly stop diarrhoea in children3
6. Can be safely taken together with antibiotics
7. May be taken with other anti-diarrhoeal medication
8. Are suitable for the whole family – from infants (capsule
contents sprinkled over cereal), to grandparents
A recent clinical study conducted by Ege University in
Turkey, has shown that probiotics containing the yeast
type Saccharomyces boulardii (Inteflora 250) effectively
speeds up the recovery of children with acute diarrhoea3.
The clinical study also proves that Saccharomyces boulardii
(Inteflora 250) significantly reduces the duration of acute
diarrhoea in children after only two days of therapy,
thereby reducing their stay in hospital3.
For further detailed information regarding this
clinical study, or to simply get tips on keeping your body’s
natural flora in balance, visit www.inteflora.co.za
References:
1. Elmer GW. Probiotics:’Living Drugs’. Am J Health-Syst Pharm 2001
58(12):1101-1109.
2. Buts J-P, Bernasconi P et al. Response of Human and Rat Small
Intestinal Mucosa to Oral Administration of Sacchromyces boulardii.
Pediatric Research 1986, 20 (2): 192-196.
3. Kurugöl Z, Koturo_lu G. Effects of Saccharomyces boulardii in children
with acute diarrhoea. Acta Paediatrica, 2005; 94:44-47.