Preparations of B vitamins: review of drugs, application in neurology

Cyanocobalamin (B12)

This vitamin is essential for the production of red blood cells and affects the growth and proper functioning of the nervous system. Responsible for blood clotting, reduces cholesterol, strengthens the immune system. B12 comes exclusively from animal products, so vegans need to take extra.

If you suspect a lack of B vitamins, you should consult a doctor and get tested, based on the results of which a specialist will prescribe additional intake of the necessary vitamins.

You can purchase vitamin complexes at Stolichki pharmacies.

B vitamins in neurological practice

I.S. LUTSKY, L.V. LYUTIKOVA, E.I. LUTSKY, Donetsk National Medical University. M. Gorky, Road Clinical Hospital of Donetsk Station

Summary

The biological significance of vitamin preparations and the causes of the development of hypo- and vitamin deficiencies are considered. The most significant B vitamins - thiamine, pyridoxine, cyanocobalamin - are presented in detail.

Keywords

vitamins, thiamine, pyridoxine, cyanocobalamin, Neuromultivit

One of the most successfully and dynamically developing sectors of the world economy is the pharmaceutical industry. Every year, huge amounts of money are invested in the development, production and testing of new drugs. However, increasingly, the attention of pharmaceutical manufacturers is turning to substances created by nature itself, which evolutionarily play an invaluable role in the life of the body. The most prominent representatives of such substances are vitamins, which are a group of organic low-molecular compounds of a non-protein nature that are not synthesized in the human body (or are synthesized in small quantities), play an important role in supporting vital processes and exhibit their activity in low concentrations. Vitamins are irreplaceable (essential) nutrients, they are active as coenzymes of various enzymes, participate in the regulation of carbohydrate, protein, fat and mineral metabolism, as well as in the preservation of cellular structures [1-3].

Today, more than 13 groups of compounds classified as vitamins are known, which are traditionally divided into fat-soluble and water-soluble. The main sources of vitamins in the human body are food products [1, 2, 4]. The action of vitamins occurs at the molecular level. Most of them are converted in tissues into various coenzymes and are part of the non-protein part of enzymes. Currently, more than two hundred enzyme systems are known, the coenzymes of which are vitamins [1, 2, 4].

Insufficient intake of vitamins into the body, more or less prolonged over time, can lead to the development of hypo- or avitaminosis. The reasons for this may be exogenous or endogenous factors. Exogenous factors include a lack or complete absence of vitamins in food (improper storage, processing or preparation), refusal to eat certain types of foods (vegetarianism - vitamin B12 deficiency), a decrease in the amount of food consumed (fasting, desire to lose weight, etc.). d.) [5]. Endogenous causes are divided into physiological and pathological. Physiological conditions include conditions accompanied by an increased need for vitamins: pregnancy, lactation, intense muscle load, old age, etc. The most common pathological causes are intestinal diseases with decreased absorption of vitamins (malabsorption syndrome, dysbacteriosis, chronic inflammatory diseases of the digestive tract, operated stomach etc.), pathology of the liver and pancreas with impaired fat metabolism, which reduces the absorption of fat-soluble vitamins, diseases of the thyroid gland, leading to an acceleration of metabolic processes. The cause of vitamin deficiency may be genetic defects that lead to impaired absorption, transportation and formation of coenzyme forms of vitamins.

Vitamin preparations have long been used in medical practice. They are especially widely used in neurological diseases. This is largely due to the high sensitivity of nerve formations to various kinds of metabolic disorders and hypoxic conditions. At the same time, the most in demand in clinical practice are B vitamins, in particular B1, B6 and B12.

Vitamin B1 (thiamine) is the most important water-soluble vitamin. It plays an invaluable role in energy metabolism, participates in the organization of excitation in nerve structures, performing a neurophysiological function due to the activation of chloride ion channels in the membranes of nerve cells [6]. In addition, the structural role of thiamine directly in the construction of nerve cell membranes has been established [7]. A lack of vitamin B1 leads primarily to a deficiency in energy production due to impaired carbohydrate combustion. As a consequence, insufficient biosynthesis of fat-soluble acids, cholesterol, a number of hormones, amino acids and nucleic acids occurs [8].

One of the first to react to a lack of thiamine in the body is the nervous system. It is based on impaired conduction through nerve structures, the death of neurons with the development of gliosis and vascular damage [9].

A frequent clinical manifestation of hypovitaminosis B1 is a violation of human cognitive functions. The consequence is the formation of Korsakoff-Wernicke syndrome (the most common manifestation of thiamine deficiency noted in Western European countries) [10, 11]. An animal experiment found that thiamine deficiency is accompanied by a decrease in acetylcholine content in the hippocampus of rats with the development of behavioral disorders characteristic of Korsakoff syndrome [12]. The effect of thiamine on cholinergic processes in the central nervous system (CNS) is one of the causes of cortical failure in patients with Alzheimer's disease [13, 14]. One of the mechanisms for the participation of vitamin B1 in this process is considered to be the disruption of glucose oxidation processes caused by its deficiency with the activation of oxidative stress phenomena [15].

Insufficient intake or absorption of thiamine serves as a trigger for the formation of polyneuropathies [16] and, as a consequence, failure of energy processes in nerve structures, as well as disruption of the processes of excitation along nerve fibers. Various mechanisms of occurrence of deficiency polyneuropathies and polyneuropathies due to alcohol abuse are emphasized [17]. An additional mechanism of nerve damage in alcoholic neuropathy is the alternating effect of acetaldehyde.

Insufficient vitamin B1 content in food products can cause neurological pathology in newborns. Cases of beriberi with symptoms of nervous system damage in infants in India have been described [18]. Confirmation is the case of the development of Wernicke syndrome in 9 infants in Israel due to a lack of thiamine in the milk formula (violation of storage conditions). The clinical picture was accompanied by the development of ophthalmoparesis, vertical nystagmus, apathy, and vomiting. Moreover, in two cases the disease led to death [19].

Vitamin B6 (pyridoxine) is the group name of three pyrimidine derivatives: pyridoxine, pyridoxal and pyridoxamine. The active form of vitamin B6 is pyridoxal-5-phosphate (PLP) - the most important prostatic group in the metabolism of amino acids, which acts as a coenzyme in more than 100 enzymatic reactions [20], is involved in the processes of protein synthesis and energy metabolism, plays an important role in the synthesis and destruction of catecholamines, histamine, dopamine, gamma-aminobutyric acid, serotonin, participates in the synthesis and transport of amino acids, lipid metabolism, formation of mediators of the central nervous system and peripheral nervous system (PNS) [1, 21].

Currently, clinical manifestations of vitamin B6 deficiency are quite rare and can be associated with both physiological and pathological processes in the body. Of these, the most common cause is impaired absorption of pyridoxine, especially in older people [22]. One of the clinical manifestations of B6 deficiency is the formation of multiple lesions of peripheral nerves. K. Scott et al. [23] analyzed various forms of polyneuropathies and came to the conclusion that the possibility of pyridoxine deficiency should be taken into account in the differential diagnosis of any sensory or sensorimotor form of polyneuropathies.

Hypovitaminosis B6 may be one of the causes of depressive disorders in older people. Studies conducted with the participation of 618 Caribbean Spaniards and 251 white Americans using special scales for diagnosing depression and tests for memory and attention revealed an association between the development of depressive disorders and low levels of the vitamin in the blood plasma (< 20 nmol/l pyridoxal-5-phosphate) [24]. One of the reasons for such conditions may be a violation of energy processes due to pyridoxine deficiency, which has been proven in experimental studies on animals [25].

One of the forms of paroxysmal disorders in children is pyridoxine-dependent epilepsy. To diagnose this form of the disease, a method was used to limit the intake of vitamin B6 from food, which caused an increase in attacks. Currently, the mechanisms of impaired pyridoxine metabolism in this form of epilepsy have been established: deficiency of alpha-aminoadipic semialdehyde (α-AASA) and the presence of 2 different mutations of the ALDH7A1 gene, which entails the possibility of biochemical and genetic diagnosis of pyridoxine-dependent form of epilepsy [26].

Vitamin B12 (cyanocobalamin) is a complex compound based on the corrin cycle and containing a coordinated cobalt ion. It is synthesized only by microorganisms and is completely absent from plant foods. Cyanocobalamin has homopoietic, erythropoietic, antianemic, metabolic effects, participates in carbohydrate, protein, lipid metabolism, increases tissue regeneration, normalizes the hematopoietic function of the liver, the functioning of the nervous system, regulates the blood coagulation system, lowers the content of cholesterol and homocysteine ​​in the blood [1, 27-30 ].

Symptoms of vitamin B12 deficiency are varied, affecting various organs and systems of the body [30] and include hematological, neurological (paresthesia, peripheral neuropathy, combined systemic disease), psychiatric, and cardiovascular.

Neurological disorders associated with cyanocobalamin deficiency can occur in early childhood. They include delayed psychomotor development, regression of mental functions, apathy, irritability, and anorexia. Clinical manifestations are based on delayed myelination or demyelination of nerve fibers, increased concentrations of neurotoxic cytokines in the cerebrospinal fluid, and accumulation of lactate in brain neurons [32]. It should be borne in mind that in some cases, symptoms of damage to the nervous system may occur before hematological disorders. In these cases, a reliable diagnostic criterion is the determination of increased serological levels of methylmalonic acid and homocysteine ​​[33].

One of the reasons for the development of vitamin B12 deficiency in young children may be vegetarianism in nursing mothers [34]. Thus, cases of the development of West syndrome with typical clinical manifestations and hypsarrhythmia on the EEG have been described. The use of adrenocorticotropic hormone had no therapeutic effect, and only the administration of high doses of cyanocobalamin led to regression of neurological symptoms and normalization of the EEG [35].

There is no doubt about the participation of B vitamins, and in particular B12, in the implementation of human cognitive abilities. Thus, in Oxford (UK), cognitive functions were assessed in 1648 participants of various age groups over a period of 10 years. It was found that low levels of vitamin B12 in the blood were correlated with faster rates of cognitive decline and high levels of methylmalonic acid in the subjects' serum [36]. A similar study designed to assess the cognitive abilities of 1089 older Latinos was conducted at the University of California (USA). A relationship between cognitive abilities and blood levels of vitamin B12 has been confirmed [37].

An assessment of cognitive functions using the technique of cognitive evoked potentials of the brain in patients with megaloblastic anemia (36 patients aged 16 to 80 years) was carried out by J. Kalita and UK Misra [38]. It was found that the average level of education of the subjects corresponded to the age of 14 years. A nuclear magnetic resonance imaging (NMR) study performed on some of the subjects revealed white matter hyperintensity in T2 and T3 modes and signs of cortical atrophy. Similar changes in brain matter according to NMR imaging data were discovered by other researchers [39-41].

There is a correlation between plasma levels of vitamin B12, methylmalonic acid, the rate of brain atrophy and human cognitive abilities. In a prospective study involving 107 people aged 61-87 years, the above parameters were assessed over a time period of 5 years. Scientists have concluded that low levels of vitamin B12 in plasma are a modified cause of brain atrophy and subsequent impairment of cognitive functions [42].

Lack of vitamin B12 causes disruption in the functioning of the peripheral nervous system. A number of studies have shown that vitamin B12 deficiency is accompanied by impaired conduction along the nerve trunks and is the cause of the development of polyneuropathies [43].

One of the markers of vascular and neurodegenerative diseases of the nervous system is homocysteine ​​[44], the high content of which in the blood correlates with low concentrations of vitamins B6 and B12 [45, 46]. Homocysteine ​​is a marker indicator of B-vitaminosis. High levels of homocysteine ​​in the blood are associated with the risk of cerebrovascular and cardiac events. In addition, increased homocysteine ​​levels were found in patients with Parkinson’s disease, multiple sclerosis, and depressive disorders [45-49].

One of the mechanisms of damage to the brain substance due to vitamin B12 deficiency is an increased content in the CSF, but not in the plasma, of certain neurotoxic substances and a reduced content of neurotrophic factors [50, 51]. An experiment on rats found that vitamin B12 deficiency is accompanied by an increase in the content of tumor necrosis factor, soluble CD40, and nerve growth factor in the CSF and a decrease in the concentration of epidermal growth factor and interleukin-6. Correcting the intake of vitamin B 12 eliminates the detected disorders.

Methods for eliminating cyanocobalamin deficiency by oral administration or by intramuscular injections have led to numerous studies [52-55]. As a result, the researchers came to the conclusion that taking vitamin B12 per os is not inferior in effectiveness to intramuscular administration of the vitamin, including in the presence of pathology of the digestive tract [54] and malabsorption syndrome in old age [55].

The data on clinical and experimental studies presented in the review indicate the important role of B vitamins in the functioning of the central and peripheral nervous system. This opens up wide possibilities for their use in neurological practice. However, it should be remembered that the use of vitamin preparations must be rational and comply with certain rules [1, 2, 4, 56]. Treatment must be timely, consistent with the intended purpose and indications for use. In this case, prophylactic doses should be higher than the physiological daily requirement, and therapeutic doses should be higher than prophylactic ones. To achieve a pharmacodynamic effect, vitamin preparations should be prescribed in higher doses than for hypo- and avitaminosis [4]. For effective vitamin therapy, it is rational to use combination preparations containing several vitamin components. The most commonly used at present are combination preparations containing vitamins B1, B6 and B12.

One of the most prominent representatives of complex B vitamin preparations is Neuromultivit from the pharmaceutical company Lannacher Heilmittel (Austria). 1 tablet of the drug contains 100 mg of thiamine hydrochloride (vitamin B1), 200 mg of pyridoxine hydrochloride (vitamin B6) and 200 mcg of cyanocobalamin (vitamin B12). Neuromultivitis is taken orally after meals, without chewing, usually 1 tablet 1-3 times a day. Take with a small amount of liquid. The duration of the course of treatment is determined by the specific clinical situation. The balanced composition of the drug, the possibility of individual dose selection, and the natural route of entry of the drug into the human body open up wide possibilities for the use of this drug in neurological practice.

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Sources of vitamins for the nervous system

Natural sources of vitamins for the nervous system are products of plant origin, which, in addition to vitamins, contain a large number of other nutrients (biologically important elements) necessary for the health of the central nervous system.

Vegetable

The greatest amount of retinol is found in products:

• carrot,
• rose hip,
• green onions,
• tomatoes,
• zucchini,
• dried plum,
• dried apricots.

Thiamine is found in the following:

• buckwheat grain,
• nuts,
• beans,
• asparagus,
• wholemeal bread,
• potato.

Riboflavin is found in:

• white cabbage,
• spinach,
• broccoli.

Large amounts of niacin are found in nuts and green vegetables.

Rich in folic acid:

• mushrooms;
• cauliflower;
• carrot;
• parsley.

Soy contains a large amount of cyanocobalamin.

The list of foods rich in ascorbic acid is long. It includes:

• sea ​​​​buckthorn;
• rose hip;
• black currant;
• cabbage (all types);
• bell pepper;
• orange;
• mandarin;
• lemon;
• grapefruit;
• kiwi;
• chanterelles;
• greens (onions, spinach, sorrel, celery, dill, etc.).

Rich sources of calciferol are:

• soy;
• soy milk;
• cereals;
• mushrooms.

They contain a lot of tocopherol:

1. wheat germ;
2. vegetable oils:
   linen;
3. sunflower;
4. cotton;
5. olive;
6. sea ​​buckthorn;
7. nuts:
   hazelnut;
8. almond;
9. peanut;
10. walnut

Animals

According to recent studies, it has become known that animal products make a person more irritable and emotional. During periods of stress, it is recommended to eat only plant foods.

Folk ways to strengthen the central nervous system

The efficiency of the brain and peripheral nerves is improved by:

Daily exercise helps improve the nervous system.

1. Hardening, contrast baths.
2. A balanced diet, including vegetables, fruits, grains, bran.
3. Physical education - daily gymnastics.
4. Use infusions of peony, motherwort, and valerian as prescribed by a doctor.
5. The use of adaptogens - astragalus, leuzea, ginseng, angelica.

Precautionary measures

To avoid overdose, you should not take the drug for more than 4 weeks in a row, unless your doctor recommends a different treatment regimen. It is also undesirable to use other vitamin complexes at the same time. While taking Neuromultivit, you should avoid drinking alcohol, which is associated with poor compatibility of ethanol with vitamins and a decrease in the absorption of thiamine. Strong black tea works in a similar way.

It is important to remember the mutual influence of drugs. For example, simultaneous use of Neuromultivit and levodopa drugs can lead to a decrease in the effectiveness of antiparkinsonian therapy. Loop diuretics increase the excretion of thiamine (vitamin B1) from the body, and antacids impair its absorption in the gastrointestinal tract. The cytostatic 5-fluorouracil competes with thiamine and suppresses its transformation into cocarboxylase. Isoniazid, Cycloserine, Penicillamine, Hydrolasine and oral contraceptives increase the body's need for pyridoxine (vitamin B6).

Daily value of vitamin b1

The normal daily intake of vitamin b1 (thiamine) for men is approximately 1.2-1.3 mg. For women, the daily norm is slightly lower. 1.1-1.2 mg per day. It should be taken into account that with increased physical, mental or psychological stress, the standard intake of thiamine can be increased.

The maximum daily intake of vitamin b1 for adults is 5 mg.

Long-term thiamine deficiency is accompanied by the development of distal polyneuropathy, similar to alcoholic or diabetic. In addition, the functioning of the gastrointestinal tract, nervous and cardiovascular systems deteriorates. In especially severe cases, a lack of thiamine leads to the development of a disease known as beriberi.

Vitamin B6 (pyridoxine)

Pyridoxine (a form of vitamin B6) is necessary for the normal functioning of the nervous system. It accelerates the absorption of proteins from the intestines, transferring them from the bloodstream to tissue structures. Pyridoxal phosphate (vitamin B6) appears in the transformation reactions of aminocarboxylic acids, is indispensable in the formation of serotonin, GABA, heme, prostaglandins, increases the contractile function of the heart muscle, normalizes the amount of blood cholesterol, and inhibits platelet aggregation.

Pharmacy vitamin complexes for nerves

Vitamin complexes sold in pharmacies help replenish the lack of substances in the body with a limited diet.

For adults

Aevit is available in capsules and ampoules.
On sale are the drugs Aevit, Neuromultivit, Milgamma, Neurovitan, Neurorubin, Combilipen, Neurostrong, Vitrum Superstress, which strengthen the central nervous system and PNS.

Aevit is a complex of retinol and tocopherol. Sold in capsules and solution in ampoules. Neuromultivit, Neurorubin, Combilipen are available both in tablets and in solution for intramuscular injection.

Contains thiamine, pyridoxine and cyanocobalamin. Prescribed for diabetic neuropathies, post-stroke conditions, encephalopathies of various origins.

Cytoflavin is available in solution for intravenous administration. Contains riboflavin, inosine, nicotinamide, succinic acid. Used for cerebral atherosclerosis.

For children

Neurologists prescribe the most effective complexes for children:

1. Multitabs - contains all the essential vitamins (A, B, C, D, E) and minerals (iodine, selenium, iron, manganese, zinc, copper).
2. Children's alphabet.
3. Vitrum for children.

Vitamin complex Vitrum for children.
These vitamin complexes are necessary to calm hyperactive children, increase their learning ability and resistance to mental and psychological stress. Their use is indicated for ADHD, dementia, and logoneurosis.

Daily value of vitamin b2

Children:

• up to 1 year - 0.4 mg per day
• from 1 to 3 years - 0.9 mg per day
• from 4 to 8 years - 1.3 mg per day
• from 9 to 13 years - 1.9 (boys) 1.7 (girls) mg per day

Men over 14 years old - 1.7 mg per day Women over 14 years old - 1.8 mg per day

Pregnant women need approximately 2 mg of vitamin b2 per day, breastfeeding women need a little more. 2.2 mg per day.

Riboflavin is registered as a food additive for fortifying food with vitamin b2 and as a food coloring under the index E101

Vitamin b2 (riboflavin or lactoflavin)

Riboflavin is necessary for our body to produce red blood cells and antibodies, and to absorb iron. Vitamin b2 is also useful for hair growth and healthy skin and nails (and in general for the general health of the body). It is not for nothing that it is also called the antiseborrheic vitamin.

Seborrhea - from Latin sebum (fat) and Greek. ρεω (leak) is a skin disease characterized by increased sebum secretion due to disruption of the nervous and neuroendocrine regulation of the functions of the sebaceous glands of the skin. There are dry and hot seborrhea.

Contraindications and side effects

Side effects when using Neuromultivit develop infrequently. This may include a rash and itching of an allergic nature, nausea, and tachycardia. If such reactions occur, you should inform your doctor about this; the drug will most likely be discontinued. In addition, the appearance of such side effects may indicate an overdose of certain vitamins.

Contraindications for prescribing Neuromultivit are intolerance to at least one component, children under 12 years of age. Studies of the effectiveness and safety of the drug for children have not been conducted. In addition, the presence of a film coating eliminates the possibility of dividing the tablet and selecting the dosage of Neuromultivit in accordance with the age of the child. During pregnancy and lactation, the drug is not prescribed due to the lack of proven safety of the drug for the body of a woman and child.

What foods contain B6?

Vitamin b6 in which foods: complete list