Cardivit400 mg+400 IU+2 mg

Indications

Cardivit is a fixed-dose combination nutritional supplement. Its use is classified as follows:

• Established/guideline-supported use: Dietary supplementation to prevent or correctdeficiency of vitamin C, vitamin D, and folate in individuals with inadequate dietary intake, increasedrequirements, or malabsorption.
• Guideline-supported use (women of childbearing age): Folic acid supplementationbefore conception and during early pregnancy is recommended by public health bodies (e.g. CDC, WHO) tohelp reduce the risk of neural tube defects; Cardivit may be used for this purpose when a combinedvitamin C/D3/folic acid product is appropriate, as directed by a physician.
• General supportive use: Support of general immune function (vitamin C, vitamin D),bone and calcium metabolism (vitamin D3), and red blood cell/DNA synthesis (folic acid) in individualsat risk of suboptimal intake, including the elderly, restricted diets, or chronic illness.
• Adjunct use: As an adjunct to a balanced diet; Cardivit is not a substitute for avaried diet and is not intended to treat disease outside of documented nutrient deficiency.

Cardivit should be used according to the dose and duration advised by a physician or pharmacist, sinceindividual requirements vary with age, sex, pregnancy status, and clinical condition.

Vitamin C + Vitamin D3 + Folic acid is available as a combination product; each tablet/capsule typically contains:

• Vitamin C (ascorbic acid) — commonly 250 mg to 500 mg
• Vitamin D3 (cholecalciferol) — commonly 200 IU to 1000 IU (5 mcg to 25 mcg)
• Folic acid (vitamin B9) — commonly 350 mcg to 800 mcg

Exact strengths vary by brand and formulation; the actual composition is stated on the productlabel/packaging of the specific brand being dispensed.

Cardivit is an oral multivitamin combination that brings together three complementary micronutrients.Vitamin C is a water-soluble antioxidant vitamin that supports immune function, collagen synthesis, andenhances non-heme iron absorption. Vitamin D3 (cholecalciferol) is a fat-soluble vitamin that promotesintestinal calcium and phosphate absorption, supports bone mineralization, and contributes to immuneregulation. Folic acid is the synthetic, oxidized form of folate (vitamin B9) required for nucleotidesynthesis, DNA replication, and red blood cell formation, and is of particular importance for neuraltube development in the early weeks of pregnancy.

Cardivit is used as a nutritional supplement to help meet daily requirements for these threemicronutrients, particularly in people with increased needs or inadequate dietary intake.

Vitamin and mineral supplement — combination of vitamin C, vitamin D3, and folic acid (Cardivit)

Pharmacology

Vitamin C + Vitamin D3 + Folic acid combines three micronutrients with distinct but complementary mechanisms:

• Vitamin C (ascorbic acid): Acts as a cofactor for enzymes involved in collagen,carnitine, and neurotransmitter (norepinephrine) synthesis, and functions as a water-soluble antioxidantthat scavenges reactive oxygen species and regenerates other antioxidants (e.g. vitamin E). It alsoenhances intestinal absorption of non-heme dietary iron.
• Vitamin D3 (cholecalciferol): Is hydroxylated in the liver to25-hydroxyvitamin D, then in the kidney to the active hormone 1,25-dihydroxyvitamin D (calcitriol),which binds the vitamin D receptor to increase intestinal absorption of calcium and phosphate, regulatebone mineralization and remodeling, and modulate innate and adaptive immune responses.
• Folic acid: Is reduced to tetrahydrofolate and its derivatives, which act asone-carbon donors required for purine and thymidylate synthesis, DNA/RNA replication and repair, andmethionine regeneration from homocysteine; this supports normal erythropoiesis (red blood cellformation) and rapidly dividing tissues such as the developing neural tube.

Pharmacokinetics (brief): Vitamin C is absorbed via active intestinal transport(saturable at high doses) and excreted renally, with excess largely excreted unchanged. Vitamin D3 isabsorbed with dietary fat, stored in adipose tissue and liver, and undergoes hepatic/renal activation asabove; it has a long biological half-life. Folic acid is well absorbed from the small intestine,converted to its active reduced forms primarily in the liver, and excess is excreted in urine.

Cardivit is for oral use only. Swallow the tablet/capsule whole with a glass of water, preferably withor after a meal to aid absorption of vitamin D3 and minimize gastrointestinal discomfort. Do not chew orcrush unless the product is specifically formulated as a chewable. Take at approximately the same timeeach day for consistent nutrient intake.

Drug Interactions

• Anticonvulsants (phenytoin, phenobarbital, carbamazepine): These drugs can increasehepatic vitamin D catabolism, potentially reducing vitamin D's effectiveness; conversely, folic acid canlower serum phenytoin levels, occasionally reducing seizure control. Monitoring may be needed ifCardivit is co-administered with these agents.
• Methotrexate and other antifolate drugs: Folic acid can interfere with thetherapeutic (antifolate) action of methotrexate when used for cancer chemotherapy or severeinflammatory conditions; use of Cardivit in these patients should only occur under specialist medicalguidance.
• Thiazide diuretics: Concurrent use with the vitamin D3 component of Cardivit canincrease the risk of hypercalcemia in patients with hypoparathyroidism or other predisposing conditions,due to reduced renal calcium excretion.
• Calcium-containing products and other vitamin D-containing supplements: Concurrentuse increases the risk of hypercalcemia and hypervitaminosis D; total daily intake from all sourcesshould be reviewed.
• Aluminum- and magnesium-containing antacids, and orlistat/mineral oil: Chronic usecan reduce absorption of the fat-soluble vitamin D3 component of Cardivit; separate dosing where possible.
• Warfarin and other oral anticoagulants: Very high doses of vitamin C have beenreported rarely to alter anticoagulant response; standard supplement doses of Cardivit are unlikely to beclinically significant, but monitoring is reasonable in patients on anticoagulant therapy.

Side Effects

Cardivit is generally well tolerated at recommended supplement doses. Reported side effects include:

• Common (mild, dose-related): Nausea, mild stomach upset, heartburn, or diarrhea,particularly with the vitamin C component at higher doses.
• Uncommon: Headache, mild allergic skin reactions (rash, itching).
• Rare, with chronic excessive intake: Symptoms of hypercalcemia related to thevitamin D3 component — nausea, vomiting, constipation, weakness, confusion, increased thirst andurination, and kidney stones; high-dose vitamin C can rarely contribute to oxalate kidney stoneformation in predisposed individuals.

Patients should seek medical advice if persistent or severe symptoms occur while takingCardivit.

Pregnancy and Lactation

Folic acid supplementation, such as that provided by Cardivit, is commonly recommended by physiciansbefore conception and during early pregnancy to help reduce the risk of neural tube defects, andvitamin C and vitamin D3 requirements are also modestly increased during pregnancy and lactation.However, Cardivit should be used only in the dose and duration advised by a physician, since individualrequirements vary and excessive intake of vitamin D3 in particular is not recommended in pregnancy.Potential benefit should be weighed against potential risk, and a physician should be consulted beforeuse.

During breastfeeding, Cardivit may be used under medical guidance to support maternal nutrient status;avoid exceeding the recommended dose, and consult a physician regarding the appropriate strength forlactating women.

Precautions and Warnings

• Hypervitaminosis D / hypercalcemia risk: Prolonged intake of vitamin D3 above thetolerable upper intake level can cause hypercalcemia and its complications (see Contraindications andSide Effects); do not exceed the recommended dose of Cardivit without medical supervision, and avoidcombining with other vitamin D or high-dose calcium products without medical advice.
• Masking of vitamin B12 deficiency: The folic acid component of Cardivit can correctthe megaloblastic anemia of vitamin B12 deficiency without correcting the associated neurologicaldamage; anemia should be properly evaluated (including B12 status) before starting Cardivit where B12deficiency is possible.
• Renal impairment, sarcoidosis, and other granulomatous disease: Patients with theseconditions are at increased risk of vitamin D-related hypercalcemia and should use Cardivit only undermedical supervision.
• Oxalate/kidney stone history: Use high-dose vitamin C components of Cardivitcautiously in patients with a history of oxalate kidney stones.
• Glucose-6-phosphate dehydrogenase (G6PD) deficiency: Very high doses of vitamin Chave rarely been associated with hemolysis in G6PD-deficient individuals; use standard supplement dosesof Cardivit with awareness of this history.

Overdose

Acute overdose of Cardivit is uncommon at typical supplement strengths but chronic excessive intake,particularly of the vitamin D3 component, can cause hypercalcemia with symptoms such as nausea,vomiting, constipation, confusion, muscle weakness, excessive thirst, and kidney injury. High-dosevitamin C can cause gastrointestinal upset and, rarely, kidney stones. There is no widely-used specificantidote. If overdose of Cardivit is suspected, stop the product and seek immediate medical attention orcontact a poison control center/emergency services; management is supportive and directed atcorrecting hypercalcemia and other symptoms under medical supervision.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Use in Special Populations

• Pregnant women: See Pregnancy and Lactation; use of Cardivit only as advised by aphysician.
• Breastfeeding women: See Pregnancy and Lactation.
• Elderly: May have increased requirement for vitamin D3 due to reduced cutaneoussynthesis and dietary intake; monitor total vitamin D intake from all sources.
• Renal impairment: Increased risk of vitamin D-related hypercalcemia; use Cardivitunder medical supervision (see Precautions and Warnings).
• Hepatic impairment: Vitamin D3 requires hepatic activation; significant hepaticimpairment may theoretically reduce efficacy, though clinically significant dose adjustment forCardivit is not well established.
• Children: Safety and efficacy of this specific fixed-dose combination have notbeen established in infants and young children; see Pediatric Uses.

Duration of Cardivit use depends on the indication: general nutritional supplementation may be takenlong-term as advised by a physician, while use for pre-conception/early-pregnancy folate supplementationis typically continued from before conception through at least the first trimester. Vitamin D3supplementation duration should be periodically reviewed, particularly with long-term use, to avoidcumulative excess. Cardivit should not be continued indefinitely without medical review of ongoing needand dose.

Vitamins and micronutrient supplements; water-soluble vitamin (vitamin C) + fat-soluble vitamin (vitamin D3) + B-complex vitamin (folic acid) combination

Vitamin C + Vitamin D3 + Folic acid acts through the combined, complementary actions of its three components: vitamin C as awater-soluble antioxidant and cofactor for collagen and neurotransmitter synthesis; vitamin D3, afterhepatic and renal activation to calcitriol, as a regulator of intestinal calcium/phosphate absorption,bone mineralization, and immune modulation via the vitamin D receptor; and folic acid, after conversionto tetrahydrofolate, as a one-carbon donor essential for DNA/RNA synthesis and normal red blood cellproduction.

Pediatric Uses

Cardivit as a fixed-dose adult-strength combination is generally not recommended for infants and youngchildren; safety and efficacy of this specific combination and strength have not been established inthe pediatric population. Where a child has a documented need for vitamin C, vitamin D, or folic acidsupplementation, age-appropriate, weight-based pediatric formulations should be used instead, under theguidance of a pediatrician. Adolescents may use Cardivit at adult dosing only on a physician's advice.