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OTC Products 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. 6 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. OTC Products 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) 7 OTC Products 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. 10 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.