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Haematopoietic agents, Vitamins & Antioxidants
Dr. Rishi Pal
Assistant Professor
Department of Pharmacology
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Haematopoietic system
Erythrocytes Leukocytes Thrombocytes
Exogenous nutrients Endogenous nutrients
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Types of anaemia
Microcytic hypochromic anaemia Megaloblastic anaemia Pernicious anaemia Haemolytic anaemia Aplastic anaemia Sickle cell anaemia Sideroblastic anaemia
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Iron deficiency anaemia
Pallor Fatigue Dizziness Exertional dyspnoea Iron deficiency Dietary deficiency Faulty absorption, transport and storage Excessive blood loss Worm infestation
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Max iron absorption: duodenum & jejunum Haem iron & non haem iron (Fe+++) Ascorbic acid, SH, Succinic acid facilitate
conversion of Fe+++ to Fe++ form
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Body requirement of iron Hb has 33% of iron (50 mg in 100 ml of
blood) Daily requirement
Male: 0.5-1 mg
Female: 1-2 mg
Children: 25 mg
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Pharmacokinetics of iron
Iron absorbs by active transport across intestinal mucosa.
Converted Fe2+ to Fe3+
Apoprotein-iron complex (ferritin) Release on demand Absorption depends on apoprotein to ferritin ratio. Transferrin binds with free Fe2+ or Fe3+ from ferritin
and carries to bone marrow
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Haemosiderin granules seen with iron overload & gives rise to haemosiderosis or bronze diabetes.
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Treatment of iron defeciency anaemia
Oral iron therapy: ferrous salts of sulfate,fumerate,gluconate, lactate, succinate and
glycine sulfate etc.
Ferric salts: ferric ammonium citrate, iron polysaccharide and ferric hydroxide polymaltose complex.
Ferrous salts better absorbed than ferric salts.
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Ferrous salts: 100mg provides 20% of elemental iron Ferrous fumerate: 33% Ferrous sulfate:19% Ferrous succinate: 12% Adult: 200mg of elemental iron administered in 2-3
divided doses after meal Children:3-5mg/kg in 3 divided doses 325mg tablets of ferrous sulfate, thrice a day
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Ferrous sulfate: FERSOLATE 200mg tab Ferrous fumerate: NORI-A 200mg tab Ferrous gluconate:FERRONICUM 300mg tab Collodial ferric hydroxide: NEOFERRUM 200
mg tab. 400mg/5ml syrup
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Parenteral iron therapy
For those who are not able to absorb oral iron preparations.
Not able to maintained iron content because of acute/chronic blood loss or GITdisorders like sprue or inflammatory bowel disease.
Iron-dextran: iv or im (50mg/ml) Iron sucrose complex: iv or im Iron-sodium gluconate: iv or im Iron-sorbitol-citrate: only im
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Vitamin B12
Cyanocobalamine Hydroxycobalamine Methylcobalamine 5’ deoxyadenosyl cobalamine
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Pharmacokinetics of cobalamine Intrinsic factor (IF) Transcobalamine-II Metabolic functions Therapeutic uses Daily requirement: 2-3 ug/day Therapeutic dose: 100-1000ug/day i.m
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Cyanocobalamine REDISOL, MACRABIN 100µg, 500µg/day Hydroxocobalamine REDISOL-H, MACRABIN-H 500µg, 1000µg
per vial inj. Methylcobalamine METHYLCOBAL 500µg tab, NEUROKIND-
OD 1500µg tab., 500µg/ml inj.
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Folic acid
Pteroylglutamic acid Pharmacokinetics Metabolic functions Deficiency Therapeutic uses Daily requirement: 50µg Therapeutic doses: 1-5mg/day
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Folic acid
FOLVITE, FOLITAB 5mg tab Folinic acid
RECOVORIN 15 mg tab., 75mg/ml, 10mg/ml inj.
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Haematopoietic growth factors
Erythropoietin: epoietin 100 IU/kg s.c or i.v 3 times a week, darbepoetin.
Preparations available EPOX, ZYROP,EPREX 2000IU, 4000IU/ml
inj. Colony stimulating factor (CSF) G-CSF & GM-CSF Filgrastim & pegfilgrastim 300µg/inj.
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Megakaryocyte growth factors Interleukin-11
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Vitamins
Fat soluble vitamins: A, D, E and K Water soluble vitamins B-complex group: B1,B2,B3,B5,B6 and Biotin
Haematopoietic B-complex vitamins
Folic acid and cyanocobalamin
Non B-complex group: Ascorbic acid (vitamin-C)
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Vitamin A (Retinol)
Dietary sources Physiological role a) Proper vision in dim light b) Structural integrity of epithelial cells Deficiency a) Night blindness b) Keratomalacia c) Xerophthalmia
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Vitamin A analogs
Beta-Carotene: 30-300µg/day
Tritinoin
Isotritinoin:500µg/kg in 2 divided doses for 3-4 months
Etretinate: For refractory Psoriasis
Tazarotene and Bexarotene
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Daily requirements
Adult doses: 4000IU/day Therapeutic doses
50,000IU-1 lac IU orally for 3 days Hypervitaminosis Preparations available AROVIT 50,000IU tab., 1 lacIU/2 ml inj AQUQSOL-A 50,000IU cap
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Vitamin E(Tocoferol)
Dietary sources Phyiological role Deficiency symptoms: Peripheral
neuropathy,Sterility in males and Recurrent abortion in females
Therapeutic doses:400mg/day Nocturnal muscle cramps:400mg/day for 6-12
weeks
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Vitamin E contd.
Fibrocystic breast disease:600mg/day for 3-6 months
Intermittent claudication:400mg/day for 12-15 weeks
Acanthocytosis:100mg/week i.m inj
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Thiamine (Vitamin B1)
Dietary sources Physiological role Deficiency symptoms Dry Beri-Beri,Wet Beri-Beri Therapeutic doses:100mg/day i.m or iv then
5-10mg/day orally as maintenance dose Preparations available:BERIN 50mg-100mg
tab,100mg/ml inj,BENALGIS 75mg tab
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Riboflavin (Vitamin B2)
Dietary sources Physiological role Deficiency symptoms:
Glossitis,Cheilosis,Cataract formation Therapeutic doses:5-20mg/day Preparations available:RIBOFLAVIN10mg
tab,10mg/ml inj.
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Niacin (Vitamin B3)
Dietary sources Physiological role Deficiency symptomsPellagra(Dermatitis,Dementia,Insomnia,Diarrhoea,Deat
h) Prophylactic doses:15-20mg/day Therapeutic doses:200-500mg/day oral Preparations available:NEASION-SR,NIALIP
375mg,500mg tab
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Pantothenic acid (Vitamin B5)
Dietary sources Physiological role Deficiency symptoms:Intermittent diarrhoea,
Leg cramps,Paraesthesia,Insomnia Therapeutic doses:50-100mg/day
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Pyridoxine (Vitamin B6)
Dietary sources Physiological role Deficiency symptoms
Peripheral neuropathy,Stomatitis,Precipitation of epilepsy and growth retardation.
Prophylactic doses:2-5mg/day Therapeutic doses:50-200mg/day Preparations
available:PYRIDOX,BENADON50mg tab
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Ascorbic acid (Vitamin C)
Dietary sources Physiological role Deficiency symptoms: Scurvy (defect in collegen
formation) Prophylactic doses:50-500mg/day Therapeutic doses:1-1.5g/day As antioxidant:100mg/day Haematinic formulations 150mg/day Preparations
available:CELIN,CHEWCEE,REDOXON 500mg tab
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Antioxidants
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Erythropoietin
Cytokine produced in juxtatubular cells in the kidney and also in macrophages.
Produced by recombinant technology. Available as epoeitin α and β. 25-100 IU/kg, s.c. or i.v. 3 times a week.
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Uses of Erythropoietin
Anaemia due to: Chronic renal failure. Cancer chemotherapy. AIDS. Premature infants. Blood transfusion Adverse effects: flu-like symptoms, mild
hypertension, encephalopathy, occasionally convulsions, risk of thrombosis due to hematocrit rises.