Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6 Pharmacology

Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6

About Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Mechanism of Action of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Pharmacokinets of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Onset of Action for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Duration of Action for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Half Life of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Side Effects of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Contra-indications of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Special Precautions while taking Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Pregnancy Related Information
Use with caution
Old Age Related Information
N/A
Breast Feeding Related Information
Use with caution
Children Related Information
N/A
Indications for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
1.Antioxidant
2.Vitamin deficiency
Interactions for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
N/A
Typical Dosage for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
1 capsule / day
Schedule of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Storage Requirements for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Effects of Missed Dosage of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Effects of Overdose of Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6
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Beta Carotene

About Beta Carotene
A natural precursor to Vitamin A.
Mechanism of Action of Beta Carotene
Beta-carotene acts as the precursor of Vitamin A and in the body it is converted in to Vitamin A. Vitamin A is required for a variety of physiological functions in the body such as: - 1).Proper functioning of retina and formation of pigment Rhodopsin during dark adaptation. 2).promotes differentiation and maintains structural integrity of epithelia over the body and also retard the malignancies of epithelial structures.3).Promotes mucous secretion. 4).Inhibits keratinization, 5). Maintains proper bone growth, 6).Maintenance of spermatogenesis, 7).Supports foetal development, 8).Improves resistance to infection. It is required for proper antibody response, normal lymphocyte proliferation and killer cell function.
Pharmacokinets of Beta Carotene
Absorption: Completely absorbed normally. Steatorrhoea, bile deficiency, and protein poor diet adversely affects the absorption and absorption requires bile salts, pancreatic lipase, and dietary fat.
Distribution: Stored primarily as palmitate in kupffer`s cells in liver. Circulates in the form of specific alpha-1 protein; retinol binding protein and transported to cellular retinol binding protein of target cells.
Metabolism: Metabolized in the liver.
Excretion: Excreted mainly through bile and a small amount is excreted through urine.
Onset of Action for Beta Carotene
N/A
Duration of Action for Beta Carotene
N/A
Half Life of Beta Carotene
N/A
Side Effects of Beta Carotene
Adverse effects occurs only with higher doses and toxicity
1. Nausea
2. Vomiting
3. Itching
4. Dermatitis
5. Exfoliation
6. Alopecia
7. Bone and joint pain
8. Anorexia
9. Irritability
10. Increased intracranial pressure
11. Hepatic impairment
12. Anaphylactic shock
Contra-indications of Beta Carotene
1. Hypervitaminosis A
2. Hypersensitivity to Beta Carotene
Special Precautions while taking Beta Carotene
1. Oral form should not use in patients with malabsorption syndrome.
2. In inadequate bile secretion oral route may be used with concurrent administration of bile salts.
3. I. V. route is contraindicated except for special water miscible forms intended for infusion with large parenteral volumes and should not use I. V. push of vitamin A of any type.
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
Indications for Beta Carotene
1. Vitamin A deficiency
2. Xerophthalmia
3. Acne
4. Ichthyosis
5. Bitot`s spots
6. Night blindness
Interactions for Beta Carotene
Cholestyramine: Absorption of Vitamin A is reduced due to reduced availability of fat stabilizing bile salts.
Mineral oil: Interferes with intestinal absorption of Vitamin A.
Oral Contraceptives: Plasma Vitamin A levels are significantly increased.
Typical Dosage for Beta Carotene
Severe vitamin A deficiency with xerophthalmia: 500000 IU daily for 3 days followed by 50000 IU daily for 14 days. Then maintenance dosage of 10000 to 20000 IU for 2months followed by adequate dietary nutrition and RDA vitamin A supplements.
Severe vitamin A deficiency: 100000 IU daily for 3 days followed by 50000 IU daily for 14 days. Then maintenance dosage of 10000 to 20000 IU for 2months followed by adequate dietary nutrition and RDA vitamin A supplements.
Children: 5000 to 10000 IU daily for 14 days.
Schedule of Beta Carotene
C1 (Oral)
C (Parenteral)
Storage Requirements for Beta Carotene
Store in a well closed, airtight container in a cool dry place.
Effects of Missed Dosage of Beta Carotene
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Beta Carotene
Discontinue the vitamin A if hypercalcaemia persists and administer I.V. saline, prednisolone, and calcitonin if required. Monitor hepatic function tests to detect liver damage.

Vitamin C

About Vitamin C
Water soluble vitamin, antioxidant.
Mechanism of Action of Vitamin C
Vitamin C exerts it`s action by influencing the biologic oxidations and reductions used in cellular respirations. It directly stimulates collagen synthesis and maintains intracellular connective tissue. It involves in various metabolic reactions such as 1).Hydroxylation of praline and lysine residues of protocollagen which is essential for formation and stabilization of collagen triple helix, 2).hydroxylation of carnitine, 3).Conversion of folic acid to folinic acid, 4).biosynthesis of adrenal steroids, catecholamines, oxytocin, and ADH, 5).Metabolism of cyclic nucleotides and prostaglandins. Vitamin C is important in resistance to infections.
Pharmacokinets of Vitamin C
Absorption: Well absorbed orally.
Distribution: Widely distributed both extracellularly and intracellularly, It crosses the placenta and also distributed in to the breast milk.
Metabolism: Metabolized in the liver; partly oxidized in to active dehydroascorbic acid and inactive metabolites.
Excretion: Inactive metabolites and extra drug is excreted through urine.
Onset of Action for Vitamin C
N/A
Duration of Action for Vitamin C
N/A
Half Life of Vitamin C
N/A
Side Effects of Vitamin C
1. Discomfort at injection site
2. Acid urine
3. Renal calculi
4. Oxaluria
Contra-indications of Vitamin C
No known contraindications
Special Precautions while taking Vitamin C
1. Renal impairment
2. Ingestion of large doses during pregnancy has resulted in scurvy in neonates
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
May be used
Indications for Vitamin C
1. Scurvy
2. Prophylaxis and treatment of vitamin C deficiency
3. As an antioxidant to maintain natural colour and flavour of food items
4. For acidification of urine
5. Capillary fragility
6. Dental caries

Interactions for Vitamin C
Oral contraceptives and estrogens: Vitamin C increases serum levels of oestrogen resulting in adverse reactions .
Warfarin: The anticoagulant effects of warfarin is reduced.
Lab Tests: Large doses (>500 mg) of vitamin C may cause false negative urine glucose determinations. May result in false negative amine dependent stool occult blood tests.
Typical Dosage for Vitamin C
Oral:
Adults: 50 to 1000mg/day depending up on the requirement.
Pregnancy and lactation: 100 to 150mg/day
Children: 30 to 100mg/day.
Scurvy:
Oral:
Adults: 1000mg twice daily to thrice daily.
Children: 300mg to 1000mg daily.
Sub clinical scurvy:
Oral, S.C., I.M., or I.V.: 100 to 250mg once daily or twice daily depending up on the severity of the condition. Then give a maintenance dosage of 50mg/day.
Children: 100 to 300mg depending up on the severity. Then give a maintenance dose of 35mg/day.

Schedule of Vitamin C
C1 (Oral)
C (Parenteral)
Storage Requirements for Vitamin C
Store in a cool dry area in a well closed container. Protects from moisture, light and direct heat.
Effects of Missed Dosage of Vitamin C
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Vitamin C
Discontinue the therapy and provide symptomatic and supportive measures.

Vitamin E

About Vitamin E
N/A
Mechanism of Action of Vitamin E
Vitamin E acts as an antioxidant and protecting unsaturated lipids in the cell membrane, coenzyme Q, vitamin A, vitamin C etc. from free radical oxidation damage and generation of toxic peroxidation products. It also decreases platelet aggregation.
Pharmacokinets of Vitamin E
Absorption: Absorbed through lymph with the help of bile. Only 20 to 60% of vitamin from dietary sources is absorbed. As dose increases the fraction absorbed decreases.
Distribution: Widely distributed in a protein bound form and stored in adipose tissue.
Metabolism: Metabolized in liver by glucuronide conjugation.
Excretion: Excreted mainly through bile and also excreted through urine.
Onset of Action for Vitamin E
N/A
Duration of Action for Vitamin E
N/A
Half Life of Vitamin E
N/A
Side Effects of Vitamin E
1. Fatigue
2. Weakness
3. Headache
4. Nausea
5. Diarrhoea
6. Blurred vision
7. Flatulence


Contra-indications of Vitamin E
1. Hypersensitivity to the drug
2. Should not administer intravenously
Special Precautions while taking Vitamin E
1. Hepatic impairment
2. Gall bladder disease
3. Along with estrogens
Pregnancy Related Information
May be used
Old Age Related Information
N/A
Breast Feeding Related Information
May be used
Children Related Information
N/A
Indications for Vitamin E
1. Vitamin E deficiency
2. Intermittent claudication
3. Nocturnal muscle cramps
4. Coronary artery disease
5. Fibrocystic breast disease
6. Cystic fibrosis
7. In premature infants exposed to high concentration of oxygen
8. As antioxidant


Interactions for Vitamin E
Oral anticoagulants : Hypoprothrombinemic effect may be increased with possibility of bleeding.

Typical Dosage for Vitamin E
Oral:
Vitamin E deficiency:
Adults: 40 to 50mg/day or 60 to 75i.u. daily based on the severity of deficiency.
Children: 1 unit/kg/day.
Premature neonates: 5units daily.
Full term neonates: 5 units per liter of formula.
Intermittent claudication: 400mg/day for 12 to 18 weeks.
Nocturnal muscle cramps: 400mg/day for 8 to 12 weeks.
Coronary artery disease: 100 to 200mg/day for at least 2 years.
Fibrocystic breast disease: 600mg/day for at least 2years.
Cystic fibrosis: 100 to 200mg/day.
Children above 1 year: 100mg/day.
Children below 1year: 50mg/day.



Schedule of Vitamin E
C1
Storage Requirements for Vitamin E
Store in a well closed container in a cool dry place. Protect from light.
Effects of Missed Dosage of Vitamin E
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Vitamin E
Provide supportive measures and symptomatic treatment.

Selenium

About Selenium
A vital antioxidant, selenium acts with vitamin E to protect the immune system and maintain healthy heart function. It is needed for pancreatic function and tissue elasticity and has been shown to protect against radiation and toxic minerals. High levels of heart disease are associated with selenium-deficient soil in Finland and a tendency to fibrotic heart lesions is associated with selenium deficiency in parts of China. Best sources are butter, Brazil nuts, seafood and grains grown in selenium-rich soil.
Mechanism of Action of Selenium
N/A
Pharmacokinets of Selenium
N/A
Onset of Action for Selenium
N/A
Duration of Action for Selenium
N/A
Half Life of Selenium
N/A
Side Effects of Selenium
N/A
Contra-indications of Selenium
N/A
Special Precautions while taking Selenium
N/A
Pregnancy Related Information
N/A
Old Age Related Information
N/A
Breast Feeding Related Information
N/A
Children Related Information
N/A
Indications for Selenium
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Interactions for Selenium
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Typical Dosage for Selenium
N/A
Schedule of Selenium
N/A
Storage Requirements for Selenium
N/A
Effects of Missed Dosage of Selenium
N/A
Effects of Overdose of Selenium
N/A

Folic Acid

About Folic Acid
Dietary supplement, Folate derivative( B9 ), Water Soluble Vitamin.
Mechanism of Action of Folic Acid
Folic acid reduced by enzymes folate reductase and dihydrofolate reductase and forms dihydrofolic acid tetrahydrofolic acid respectively. Tetrahydrofolic acid acts as a coenzyme which mediates a number of one carbon transfer reactions by carrying a methyl group as an adduct. It involves a number of reactions such as 1).conversion of homocysteine to methionine. 2).synthesis of thymidylate which is an essential constituent of DNA from methylene-tetrahydrofolic acid. 3). Conversion of serine to glycine by tetrahydrofolic acid and forms methylene-tetrahydrofolic acid. 4).to introduce carbon units at position 2 and 8 during de novo purine synthesis requires formyl-tetrahydrofolic acid and methenyl-tetrahydrofolic acid.5).generation and utilization of "formate pool". 6).For mediating formino group transfer in histidine metabolism. Folic acid is required to maintain normal erythropoiesis and nucleoprotein synthesis.
Pharmacokinets of Folic Acid
Absorption: Well absorbed orally
Distribution: Widely distributed in the body and highest concentration is seen in liver. It appears in the CSF and breast milk
Metabolism: Metabolized in to N-methyl tetrahydrofolic acid in liver
Excretion: Extra drug is excreted unchanged in urine. A small portion of folate is lost by a combination of urinary and fecal excretion and oxidative cleavage of molecule.
Onset of Action for Folic Acid
Oral: 20 to 30minutes
I.V.: 5 minutes
I.M.:10 to 20minutes
Duration of Action for Folic Acid
Oral: 3 to 6 hours
I.V.:3 to 6minutes
I.M.:3 to 6hours
Half Life of Folic Acid
N/A
Side Effects of Folic Acid
N/A
Contra-indications of Folic Acid
N/A
Special Precautions while taking Folic Acid
1. In patients with undiagnosed anaemia; because it may mask pernicious anaemia
2. In pernicious anaemia and other megaloblastic where vitamin B12 is deficient
Pregnancy Related Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
May be used
Children Related Information
May be used
Indications for Folic Acid
1. Megaloblastic anaemia
2. Folic acid deficiency
3. Anaemias of pregnancy
4. Nutritional anaemia
5. Alcoholism
6. Tropical sprue
7. Non tropical sprue
Interactions for Folic Acid
1. Hypersensitivity reactions with injection form
2. Bronchospasm
Typical Dosage for Folic Acid
Oral: 5mg 1 to 4 times daily; depending up on the severity of deficiency.
Maintenance dosage: Half of the therapeutic dosage.
Children: 2.5 to 5mg 1 to 2 times daily.
Schedule of Folic Acid
C1 (Oral)
C (Parenteral)
Storage Requirements for Folic Acid
Store at controlled room temperature at a range of 15 to 25 degree C in a well closed container. Protect from excess heat, light and moisture.
Effects of Missed Dosage of Folic Acid
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Folic Acid
Relatively non toxic. Provide symptomatic treatment and supportive measures.

Vit B12

About Vit B12
N/A
Mechanism of Action of Vit B12
Vitamin B12 is an essential constituent for growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis. Vitamin B12 is converted in to coenzyme B12 in the tissues which is essential for conversion of methyl-malonate to succinate and synthesis of methionine from homocystine. It is also associated with fat and carbohydrate metabolism and protein synthesis. Cells characterized by rapid division such as epithelial cells, bone marrow, and myeloid cells appear to have greatest requirement of Cyanocobalamin.
Pharmacokinets of Vit B12
Absorption: Absorbed irregularly after oral administration and absorption depends on Ca and intrinsic factor. It is also administered subcutaneously and intramuscularly.
Distribution: Distributed in to liver, bone marrow, and other tissues. It crosses the placenta and appears in breast milk.
Metabolism: It is metabolized in liver.
Excretion: In normal dosage it is reabsorbed from bile and a minute portion is excreted through urine but the extra drug is excreted through urine.
Onset of Action for Vit B12
N/A
Duration of Action for Vit B12
N/A
Half Life of Vit B12
N/A
Side Effects of Vit B12
1. Anaphylaxis
2. Anaphylactoid reactions
3. Pain and burning sensation at injection site
4. Itching
5. Urticaria
6. Transient diarrhea
7. Peripheral vascular thrombosis
8. Pulmonary oedema
Contra-indications of Vit B12
1. Hypersensitivity to the drug
2. Leber`s disease
Special Precautions while taking Vit B12
1. Anemic patients with coexisting cardiac, pulmonary and hypertensive diseases.
Pregnancy Related Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
May be used
Children Related Information
Use with caution
NEONATES : Use with caution
Indications for Vit B12
1. Vitamin B12 deficiency
2. Pernicious Anaemia
3. Peripheral neuropathy (diabetic, alcoholic, and drug induced)
Interactions for Vit B12
N/A
Typical Dosage for Vit B12
I.M., S.C.:
Pernicious Anaemia: 100mcg daily for 1 week followed by the same dose given on alternate days for 7 doses and then every 3 to 4days for another 3 weeks. This regimen should be followed by 100mcg monthly for life. Concurrently administer folic acid if required.
Vitamin B12 deficiency other than pernicious Anaemia: 30mcg daily for 5 to 10days depending up on the severity of the condition.
Maintenance dosage: 100 to 200mcg once monthly.
Children: 100mcg I.M. or S.C. over the course of 2 or more weeks.
Maintenance dosage: 60mcg monthly I.M. or S.C.
Schilling test flushing dose:
Adults and Children: 1000mcg I.M. in single dose
Recommended RDA (recommended dietary allowance) for Vitamin B12:
Infants up to 6months of age: 0.3mcg.
Children age 6 months to 1 year: 0.5mcg.
Children age 1 to 3: 0.7mcg.
Children age 4 to 6: 1mcg.
Children age 7 to 10: 1.4mcg.
Children age 11 to adult: 2mcg..
Pregnant women: 2.2mcg.
Breast feeding women: 2.6mcg.
Schedule of Vit B12
C
Storage Requirements for Vit B12
Store at room temperature range of 15 to 30 degree C.in a light resistant well closed container in a dry place.
Effects of Missed Dosage of Vit B12
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Vit B12
Not applicable. Even in large doses Vitamin B12 isn`t usually toxic.

Vit B6

About Vit B6
Physiological functions: It is involved as a coenzyme (Pyridoxal phosphate) in metabolism of tryptophan, in several metabolic transformations of amino acids including transamination, decarboxylation & racemization.
Deficiency symptoms: Peripheral neuritis, seizures, stomatitis, glossitis, anaemia, seborrhea like lesions.
Mechanism of Action of Vit B6
Vitamin B6 is a collective term for Pyridoxine, Pyridoxal, Pyridoxamine and their phosphorylated derivatives such as Pyridoxine phosphate, Pyridoxal phosphate and Pyridoxamine derivatives respectively. Vitamin B6 is essential for the metabolism of amino acid, glycogen and fatty acids, for nerve functions, for the formation of red blood cells and also helps the skin healthy. Vitamin B6 is also used for the synthesis of nucleic acid, Haemoglobin, Sphingomyelin, other Sphingolipids, Serotonin, Dopamine, Noradrenaline and GABA.
Pharmacokinets of Vit B6
Absorption: Vitamin B6 is readily absorbed after oral administration.
Distribution: It is mainly distributed in the body in protein bound form. It is stored primarily in the liver and to a lesser extent muscle and brain.
Metabolism: It is metabolised in the liver
Onset of Action for Vit B6
N/A
Duration of Action for Vit B6
N/A
Half Life of Vit B6
15-20 days
Side Effects of Vit B6
1. Neuropathy
2. Unstable gait
3. Drowsiness
4. Perioral numbness
5. Paresthesia
6. Numbness of feet
7. Somnolence
8. Sensory neuropathy
9. Ataxia
Contra-indications of Vit B6
1. Hypersensitivity to Vitamin B6
Special Precautions while taking Vit B6
N/A
Pregnancy Related Information
May be used
Old Age Related Information
May be used
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
NEONATES: Contraindicated
Indications for Vit B6
1. Vitamin B6 deficiency including inadequate diet and drug induced causes
2. Neuropathy
3. Premenstrual syndrome
4. Hyperoxaluria type 1
5. Metabolic disorder
6. Isoniazid poisoning
Interactions for Vit B6
Cycloserine, Hydralazine, Isoniazide, Oral contraceptive, Penicillamine: Increase Pyridoxine requirement.
Levodopa: Pyridoxine reverses the therapeutic effect of Levodopa.
Phenobarbital, Phenytoin: Pyridoxine decreases serum level of these anticonvulsants.
Typical Dosage for Vit B6
Adult: 10 - 20 mg / day
Dietary deficiency: 2.5 -10 mg / day for effective therapeutic response is obtained.
Maintenance dose: 2 - 5 mg / day for several weeks.
Drug induced deficiency: 100 - 200 mg / day for 3 weeks.
Maintenance dose: 25 - 100 mg / day
Neuropathy: 50 - 200 mg /day
Premenstrual syndrome: 40 - 500 mg / day
Hyperoxaluria type 1: 25 - 300 mg / day
Metabolic disorder: 100-500 mg /day.
Isoniazid poisoning: Initial dose: 1 - 4 g as IV administration, then 1 g IM every 30 minute until Pyridoxine dose is equal to the Isoniazid dose has been given.
Schedule of Vit B6
N/A
Storage Requirements for Vit B6
Store it at 15 - 30 degree C. Protect from moisture and heat.
Effects of Missed Dosage of Vit B6
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Vit B6
Give supportive measures and symptomatic treatment. The signs of Pyridoxine overdose can be resolved by discontinuation (withdrawal) of Pyridoxine.

Home Delivery for Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6 in Your City

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Beta Carotene + Vitamin C + Vitamin E + Selenium + Folic Acid + Vit B12 + Vit B6 is a generic medicine name and there are several brands available for it. Some of the brands for beta carotene + vitamin c + vitamin e + selenium + folic acid + vit b12 + vit b6 might be better known than beta carotene + vitamin c + vitamin e + selenium + folic acid + vit b12 + vit b6 itself. If the pharmacy that's willing to deliver medicines to your home doesn't have beta carotene + vitamin c + vitamin e + selenium + folic acid + vit b12 + vit b6 in stock, you can ask for one of the branded alternatives for beta carotene + vitamin c + vitamin e + selenium + folic acid + vit b12 + vit b6.