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Safety of megavitamin therapy.

Carbon compounds that are needed in small amounts in the diet because they are not made in the body of vertebrates are defined as vitamins. Excluded from this definition are vitamins D, K, and niacin which can be synthesized by the organism or, as in the case of vitamin K, by the host's intestinal bacteria. Lack of such vitamins can result in characteristic deficiency diseases. The therapeutic use of such compounds (megavitamin intake) is based on the spectacular effect of vitamins on deficiency diseases; however, evidence that the ingestion of large amounts of vitamins beyond the "Recommended Daily Allowances" (RDA) is beneficial is not within the basic concept of nutrition. Vitamins, like many substances, may be toxic when taken in large quantities, especially the fat-soluble vitamins, and the concept of "more is better" is a common misconception. Vitamin supplements can be suggested only in the unusual cases of patients having inadequate intake, disturbed absorption (genetic or otherwise), or increased tissue requirements. A well-balanced diet that includes a wide variety of foods from each of the four food groups is adequate for the supply of vitamins, as well as other nutrients, in healthy people. This paper will review some of the recent findings regarding vitamin toxicity and the mechanisms of toxicity.

Ascorbic Acid↗

In vivo antimutagenic effect of vitamins C and E against rifampicin-induced chromosome aberrations in mouse bone-marrow cells.

-The genotoxic effect of rifampicin (RMP), one of the most active antituberculosis agents is studied. Also, the possible protection provided by the natural antioxidant vitamins C (VC) and E (VE) against the genotoxic effect of RMP is assessed. Mice were orally treated by gavage with 10, 50, 150 and 300 mg RMP kg(-1) body weight (bw). Also, oral treatment was conducted with RMP plus the vitamins. Mice received 300 mg RMP kg(-1) bw plus 100, 200 and 400mg VC or VE kg(-1) bw. Samples were taken 24h after the treatment. Repeated treatments with: (1) the therapeutic dose of RMP (10 mg kg(-1) bw); (2) RMP plus a dose of 25, 50 and 75 mg VC kg(-1); (3) RMP plus 10, 20 and 40 mg VE kg(-1) bw for 30 consecutive days were conducted. The tested doses of RMP induced a significant increase in the percentage of chromosome aberrations. However, a lower percentage of chromosome aberrations was observed when animals were treated with the therapeutic dose for 30 consecutive days. The obtained results revealed that chromosome aberrations induced by RMP decreased to a significant extent when mice were treated with RMP plus VC. The repeated doses of VC reduced the percentage of chromosome aberrations induced by RMP in a significant and dose-dependent manner. On the other hand, repeated doses of VE were not very effective in reducing the percentage of chromosome aberrations induced by RMP. Only the highest dose (3 x 40 mg kg(-1) bw) showed a significant effect (P<0.01). The results on the induction of chromosome damage clearly show that only VC appears able to efficiently protect the bone-marrow cells when given together with RMP, while no significant reduction in the yield of chromosome aberrations was observed for VE in combination with the antituberculosis drug.

Animals↗

[Evaluation of therapeutic effectiveness of prednisolone in patients with chronic active hepatitis based on the morphometry of liver biopsy specimens].

In 42 patients with chronic active hepatitis (CAH), liver biopsies were subjected to histological study and morphometry before and after prednisolone treatment (21 patients comprising group I) and treatment with a complex of vitamins B1, B6, B12 and C (21 patients comprising group II). Combined study of liver biopsies during treatment makes it possible to evaluate objectively enough the results of prednisolone therapy of CAH patients. The authors confirmed the efficacy of prednisolone therapy of patients with sero-negative CAH. These patients demonstrated a reduction in dystrophic alterations, volume of inflammatory cells in the portal tracts and in the areas of necrosis, a lowering of the number of aggressive lymphocytes. Prednisolone was discovered to have an adverse effect on seropositive CAH, to activate virus replication in liver tissue, intensify necrotic alterations in the parenchyma and inflammatory reaction in the portal tracts.

Ascorbic Acid↗

[A study on the value of vitamin C in treating skeletal fluorosis].

Three hundred and sixteen patients diagnosed as skeletal fluorosis roentgenologically and having no other diseases were divided randomly into 2 groups, matchable in sex distribution, age, functional state and X-ray findings. In the treated group every patient took 200mg vitamin C twice a day, while in the control group placebo tablets. The duration of treatment was 3 months. The therapeutic effect was evaluated by measuring the joint angle and power of gripping and studying the X-ray film and electromyogram. 38 kinds of biochemical parameters were measured simultaneously with a MCA-3 autobiochemical analyser. The results were as follows, (1) The total effective rate in the treated group was 12.84%, chi 2 = 0.556, P > 0.05, so there is no obvious effect in treating skeletal fluorosis with vitamin C. (2) The electromyogram in the treated group showed a recovering rate of 20.00%, chi 2 = 5.9, P > 0.01. It is further shown that there is no effect in treating skeletal fluorosis with vitamin C. (3) 38 kinds of biochemical parameters measured simultaneously and the X-ray findings also showed that vitamin C is not effective. Thus the validity of using vitamin C as the drug of first choice to treat skeletal fluorosis is to be queried.

Adult↗

Effect of vitamin C and vitamin E on prostaglandin synthesis by fibroblasts and squamous carcinoma cells.

Dietary levels of vitamins C and E have been associated with cancer prevention and to a lesser extent with therapeutic enhancement of cancer treatment. Inhibition of prostaglandins (PGs) by pharmacological agents has been demonstrated to enhance immunocompetence, and to suppress growth of tumors in animals and humans. We report here on the effect of vitamins C and E on PGE2 production by human gingival fibroblasts and SCC-25 oral squamous carcinoma cells. The results indicate: 1. vitamins C and E exert a dose-dependent effect on arachidonic acid (AA) release and PGE2 synthesis; 2. vitamin E has a biphasic effect which is stimulatory at 1 and 10 microM and inhibitory at 100 microM; 3. vitamin E is considerably more potent than vitamin C in its inhibitory effect on AA and PGE2 in both cell types; 4. a combination of the two vitamins has a consistent dose-dependent inhibitory effect on AA and PGE2; 5. vitamin C stimulates PGE2 synthesis from exogenous AA in fibroblasts, and inhibits it in SCC-25 cells. The in vivo significance of these findings requires further investigation.

Adult↗

Nutritional antioxidants as therapeutic and preventive modalities in exercise-induced muscle damage.

Several mechanisms have been forwarded to explain the etiology of exercise-induced muscle damage. Free-radical mediated processes appear to be an important component of the inflammatory mediated response. Free radicals have also been demonstrated to be a contributing factor in the loss of calcium homeostasis within the cell. Therefore, one of the proposed treatments for preventing or reducing the extent of this damage is the intervention of free-radical mediated processes. Antioxidants are agents that typically work to prevent free-radical mediated alterations within cells by quenching free radicals. The traditional dietary antioxidants most commonly investigated to inhibit free-radical damage are vitamin E, vitamin C, and beta carotene. Other nutritional agents have also been noted to contain antioxidant properties. Isofavonoids and some phytochemicals have been proposed to contain antioxidant properties. This paper briefly reviews some aspects of these agents and the! ! ir role, either proven or proposed, in the prevention of oxidative stress and muscle damage.

Animals↗

Effect of free radical scavengers on changes in ion conductance during exposure to therapeutic ultrasound.

Ultrasound has been used in physical therapy for > 4 decades. Recent studies indicate that non-thermal mechanisms such as cavitation are involved in the observed effects. Free radicals and other highly reactive compounds are known to form during sonochemical reactions associated with acoustic cavitation. Using frog skin as a biological model, the possibility that the increase in ionic conductance (Gt) upon exposure to therapeutic ultrasound is due to the effect of free radicals generated by sonochemical reactions, was investigated. It was found that the presence of cystamine, cysteamine and sodium ascorbate significantly reduced the increase in conductance caused by the exposure to 300 mW/cm2 (1 MHz CW) therapeutic ultrasound. The attenuation in the effects was dependent on the concentration of the radical scavengers/antioxidants used, the incubation time, and the intensity of ultrasound. The effects were also dependent on the lipid solubility of free radical scavengers/antioxidants. The time constant for the recovery process of Gt in the presence of free radical scavengers and antioxidants after exposure to ultrasound was found to be not significantly different from control. These results suggest that the increase in Gt due to ultrasound is induced by free radicals and other reactive species generated from acoustic cavitation. This study provides an indirect evidence to the contingent that free radicals are generated and act inside the cells. Furthermore, the radical scavengers and antioxidants used provide protection from oxidative damage without being involved in the recovery of Gt towards steady state values after sonication.

Animals↗

C-reactive protein and nutrition.

High sensitivity C-reactive protein (hsCRP) is a proven method to better predict the cardiovascular risk and target therapeutic interventions. Serum concentrations of hsCRP were measured in an adult apparently healthy population aged 19-75 years of different nutrition: a vegetarian group (lacto- and lacto-ovo-vegetarians who consumed plant food, dairy products and eggs) and a group of non-vegetarians (general population) on traditional mixed diet. The average hsCRP concentration was significantly reduced in the vegetarian group (0.72 +/- 0.07 vs 1.62 +/- 0.12 mg/l) with no risk values >3 mg/l vs 14 % in non-vegetarians. In non-vegetarians, a positive linear correlation of hsCRP values and age (r=0.35, p<0.001) was recorded vs horizontal trend line in vegetarians. Low and age independent concentration of hsCRP in vegetarians is the consequence of a long-term consumption of fruits and vegetables. These food commodities are important sources of dietary salicylates as well as other anti-inflammatory compounds (Tab. 1, Fig. 1, Ref. 15).

Adolescent↗

Effect of vitamins on the lipid profile of patients on regular hemodialysis.

OBJECTIVE: The aim of this study was to investigate the lipid-lowering effect of vitamins compared to placebo and their short-term supplementation safety in patients on hemodialysis. MATERIAL AND METHODS: Eighty-four hemodialysis patients were randomly allocated to four therapeutic groups. Each group (n = 21) received one of the following treatments: vitamin C (200 mg), E (200 mg), D3 (50,000 IU) or placebo daily. Serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) were measured before and following 3 months of vitamin therapy. RESULTS: LDL-c and total cholesterol levels as well as the ratios of LDL-c to HDL-c and cholesterol to HDL-c significantly decreased after vitamin C therapy. Triglyceride and the ratio of triglyceride to HDL-c significantly decreased following vitamin D3 therapy. HDL-c increased and the ratio of LDL-c to HDL-c decreased significantly after vitamin E therapy. No major side-effects were encountered during the 3 months' trial. CONCLUSIONS: Short-term supplementary vitamins are safe and beneficial for treatment of lipid abnormalities in hemodialysis patients.

Adult↗

Fluorimetric determination of ampicillin by use of non-toxic catalysts. Estimation of beta-lactamase activity and parameters.

A fluorescence assay based on the use of biological reducing agents as catalysts rather than heavy metal ions has been developed for estimation of ampicillin concentrations. The assay is based on the conversion of ampicillin to its penicilloate, by treatment with sodium hydroxide, then neutralization, dilution with 0.5 M acetate buffer at pH4 and heating for 30 min at 100 degrees C in the presence of ascorbic acid (0.5 mg) and EDTA (50 microM). Reduced glutathione, cysteine and N-acetylcysteine also catalysed the development of fluorescence. A practical sensitivity range of 0.5-50 microM ampicillin was used. The assay was used to estimate ampicillin in some biological solutions to which the antibiotic has been added. Milk, blood serum, trypticase soy broth and nutrient broth containing 25 microM antibiotic assayed at 18.5, 21.7, 16.5 and 14.7 microM, respectively, with standard deviations between 1.2 and 0.7%. The low results were attributed to binding of some ampicillin by proteins or peptides which were removed by pretreatment. Urine containing 5 mM ampicillin assayed at 4.97 mM with a standard deviation of 3%. A modification of the procedure was used to measure beta-lactamase activity against ampicillin in several organisms in a fixed time assay. Kinetic parameters of a commercial beta-lactamase preparation from Bacillus cereus could also be determined by an additional modification. In both instances a correction was required for the intrinsic fluorescence of ampicillin remaining in the solution. The preparation examined had a Michaelis constant (Km) of 0.32 mM, a maximum velocity (Vmax) of 5398 micromol ampicillin hydrolysed mg(-1) min(-1), an apparent catalytic constant (Kcat, turnover number) of 20,220 s(-1) and a Kcat/Km ratio of 0.63 x 10(7) M(-1) s(-1). The major advantage of using this assay technique is that toxic metals are not used in the development of fluorescence so it is more environmentally acceptable. The technique is useful for examining beta-lactamase activity against ampicillin and might be useful for pharmaceutical products-for determining available therapeutic levels and for monitoring the activity of penicillin acylase against the penicilloate of ampicillin.

Ampicillin↗

Pharmacokinetic drug interactions with oral contraceptives.

Oral contraceptive steroids are used by an estimated 60 to 70 million women world-wide. Over the past 20 years there have been both case reports and clinical studies on the topic of drug interactions with these agents. Some of the interactions are of definite therapeutic relevance, whereas others can be discounted as being of no clinical significance. Pharmacological interactions between oral contraceptive steroids and other compounds may be of 2 kinds: (a) drugs may impair the efficacy of oral contraceptive steroids, leading to breakthrough bleeding and pregnancy (in a few cases, the activity of the contraceptive is enhanced); (b) oral contraceptive steroids may interfere with the metabolism of other drugs. A number of anticonvulsants (phenobarbital, phenytoin, carbamazepine) are enzyme-inducing agents and thereby increase the clearance of the oral contraceptive steroids. Valproic acid has no enzyme-inducing properties, and thus women on this anticonvulsant can rely on their low dose oral contraceptive steroids for contraceptive protection. Researchers are now beginning to unravel the molecular basis of this interaction, with evidence of specific forms of cytochrome P450 (P450IIC and IIIA gene families) being induced by phenobarbital. Rifampicin, the antituberculous drug, also induces a cytochrome P450 which is a product of the P450IIIA gene subfamily. This isozyme is one of the major forms involved in 2-hydroxylation of ethinylestradiol. Broad spectrum antibiotics have been implicated in causing pill failure; case reports document the interaction, and general practitioners are convinced that it is real. The problem remains that there is still no firm clinical pharmacokinetic evidence which indicates that blood concentrations of oral contraceptive steroids are altered by antibiotics. However, perhaps this should not be a surprise, given that the incidence of the interaction may be very low. It is suggested that an individual at risk will have a low bioavailability of ethinylestradiol, a large enterohepatic recirculation and gut flora particularly susceptible to the antibiotic being used. Two drugs, ascorbic acid (vitamin C) and paracetamol (acetaminophen), give rise to increased blood concentrations of ethinylestradiol due to competition for sulphation. The interactions could have some significance to women on oral contraceptive steroids who regularly take high doses of either drug. Although on theoretical grounds adsorbents (e.g. magnesium trisilicate, aLuminium hydroxide, activated charcoal and kaolin) could be expected to interfere with oral contraceptive efficacy, there is no firm evidence that this is the case. Similarly, there is no evidence that smoking alters the pharmacokinetics of oral contraceptive steroids. These agents are now well documented as being able to alter the pharmacokinetics of other concomitantly administered drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Ginkgo biloba affords dose-dependent protection against 6-hydroxydopamine-induced parkinsonism in rats: neurobehavioural, neurochemical and immunohistochemical evidences.

Ginkgo biloba extract (EGb), a potent antioxidant and monoamine oxidase B (MAO-B) inhibitor, was evaluated for its anti-parkinsonian effects in a 6-hydroxydopamine (6-OHDA) rat model of the disease. Rats were treated with 50, 100, and 150 mg/kg EGb for 3 weeks. On day 21, 2 microL 6-OHDA (10 microg in 0.1% ascorbic acid saline) was injected into the right striatum, while the sham-operated group received 2 microL of vehicle. Three weeks after 6-OHDA injection, rats were tested for rotational behaviour, locomotor activity, and muscular coordination. After 6 weeks, they were killed to estimate the generation of thiobarbituric acid reactive substances (TBARS) and reduced glutathione (GSH) content, to measure activities of glutathione-S-transferase (GST), glutathione reductase (GR), glutathione peroxidase (GPx), catalase, and superoxide dismutase (SOD), and to quantify catecholamines, dopamine (DA) D2 receptor binding, and tyrosine hydroxylase-immunoreactive (TH-IR) fibre density. The increase in drug-induced rotations and deficits in locomotor activity and muscular coordination due to 6-OHDA injections were significantly and dose-dependently restored by EGb. The lesion was followed by an increased generation of TBARS and significant depletion of GSH content in substantia nigra, which was gradually restored with EGb treatment. EGb also dose-dependently restored the activities of glutathione-dependent enzymes, catalase, and SOD in striatum, which had reduced significantly by lesioning. A significant decrease in the level of DA and its metabolites and an increase in the number of dopaminergic D2 receptors in striatum were observed after 6-OHDA injection, both of which were significantly recovered following EGb treatment. Finally, all of these results were exhibited by an increase in the density of TH-IR fibers in the ipsilateral substantia nigra of the lesioned group following treatment with EGb; the lesioning had induced almost a complete loss of TH-IR fibers. Considering our behavioural studies, biochemical analysis, and immunohistochemical observation, we conclude that EGb can be used as a therapeutic approach to check the neuronal loss following parkinsonism.

Amphetamine↗

The evaluation of therapeutic efficacy of hachimi-jio-gan (traditional Chinese medicine) to mouse hereditary cataract.

This study was of a series of the evaluation of Hachimi-Jio-Gan (Rehmannia Eight Formula, pa-wei-ti-huang-wan or Bawei dihuang wan) to the various cataracts. In this study, the drug was evaluated for its therapeutic efficacy to mouse hereditary cataract from the delay effect of cataract appearance age and the suppression rates of variation of some biochemical parameters. The dose of 200 mg of Hachimi-Jio-Gan/day/100 g of mouse body weight significantly delayed the cataract appearance age by 4 days as compared to that of non-treated group. We estimated that the delay effect of 4 days in mouse may be corresponded to 13.9 years, when it was converted into the case of human. This drug also suppressed variation of sodium and potassium ions level in the lens with cataractogenesis. Furthermore, the drug dramatically reactivated the sodium-potassium ATPase activity damaged with the cataract formation, and also had a slight action of reducing agent. From these facts, we presumed that the drug may have a prophylactic efficacy to the cataract caused by the inhibition of sodium-potassium ATPase activity and also the oxidation of lens protein.

Administration, Oral↗

Multifocal atrophic gastritis: pathogenesis and therapeutic implications.

OBJECTIVE: This study, carried out on 51 patients with multifocal atrophic gastritis (MAG) and 92 age and sex-matched dyspeptic controls, was designed to examine both exocrine (gastric acid) and endocrine (gastrin) gastric secretion before and after therapeutic intervention including Helicobacter pylori eradication and vitamin C treatment. METHODS: Fasting and gastrin-releasing peptide-induced gastric acid secretion, serum levels of gastrin and proinflammatory (IL-1beta, IL-8, TNF-alpha) as well as gastric mucosal gene expression of ornithine decarboxylase (ODC), cyclooxygenase 2 (COX-2) and growth factors (epidermal growth factor and transforming growth factor alpha) were determined before and after the eradication of Helicobacter pylori and therapy with large doses (1 g/d) of vitamin C for 3 months. RESULTS: The H. pylori eradication, assessed by C-urea breath test, and vitamin C therapy failed to reverse the histological atrophy of the gastric mucosa but improved significantly the functional status of the atrophied mucosa, especially its exocrine and endocrine secretory activities, attenuated the expression of premalignant markers such as ODC and COX-2, raised the production of growth factors and diminished the release of proinflammatory cytokines. CONCLUSIONS: These results indicate that MAG may be considered as an environmental disease of the gastric mucosa, whose functional status can be improved by the eradication of H. pylori combined with antioxidant therapy with large doses of vitamin C.

Adult↗

[Free radicals and antioxidants: human physiology, pathology and therapeutic aspects].

Oxygen has invaded progressively, and through the ages, an initially anaerobic world. Living organisms had to invent, in the course of evolution, diverse and ingenious defence systems, to survive the toxicity of this element, which was new for them. Strengthened by this experience over billions of years, the present superior organisms, and particularly human species, are thoroughly adapted to 21 per cent of atmospheric oxygen. Nevertheless, the equilibrium is fragile and the menace of oxygen hovers continually. This deleterious potential of oxygen is attributed to the formation, in vivo, of free radicals, a free radical being, by definition, any chemical species possessing one or several mismatched electrons. These free radicals are, in general, very active. They trigger chain reactions able to damage the different constituents of the living organism. Basic oxygen, must be pre-activated to manifest its toxicity. Such an activation can be achieved in two ways: it can be photodynamic, ending mainly in singlet oxygen, it can be reducing, followed by the formation of the anion hydrogen peroxide and of radical hydroxyl; the latter is the most reactive chemical species in the biological world. The reductive process is accelerated in the presence of transition metals, such as iron and copper, and/or specific enzymes (monoxygenase and certain oxydases). This activation takes place in different cellular compartments: mitochondria, microsomes, peroxysomes, cytoplasmic membrane. To this potential toxicity of oxygen the organism opposes different anti-oxidant defence systems. A first group works up the radical chain, inhibiting activation mechanisms. Such a group, as a consequence, warns of the initiation of radical reactions. The second group neutralizes the free radicals already formed and thus stops the chain of propagation. In this group can be found detoxifying enzymes, notably superoxide dismutase and catalase, producing jointly peroxidases, particularly peroxidase glutathions. Such enzymes for the most part have trace elements as cofactors. In this second group can also be found various molecules which act like 'substrate suicide', or as an anti-oxidant shield. Among these molecules, some can act in the lipidic phase, such as tocopherols, carotenoïds and ubiquinones. Other molecules which are lipophobic, mainly ascorbic acid and uric acid, are active in a hydrated environment. In the case of a weakening of such an antioxidant defence or excess production of radicals, a state of oxidative stress occurs. Uncontrolled, these radicals will damage different biological targets: lipids, DNA, proteins. Disturbances of cellular metabolism will occur, unless corrective defences intervene. The identification of these radical phenomena is an obligatory stage. But because of the very short life span of free radicals, identification poses a real analytical problem. However, three approaches are possible: identification of free radicals, either directly by means of paramagnetic electron resonance, or indirectly by identifying some more stable intermediates. evaluation of the traces of radical attack on biological molecules, for example by high performance liquid chromatography, gas-liquid chromatography, colorimetric tests, estimation of the antioxidant status, for example by colorimetric tests, immunoenzymatic methods, high performance liquid chromatography.

Antioxidants↗

Randomized, double-blind, placebo-controlled pilot study to assess the value of free radical scavengers in reducing inflammation induced by cryotherapy.

The inflammation which follows cryotherapy is a significant disadvantage of this therapeutic modality. To date, the only treatment shown to reduce this inflammation is application of topical corticoids. We have therefore conducted a pilot study to investigate whether pretreatment with the free radical scavengers, vitamins C and E might alleviate the signs and symptoms of inflammation following liquid nitrogen cryotherapy of common warts. We undertook a randomized, double-blind, placebo-controlled, parallel group study. We recruited 40 adult patients, of whom 38 returned for evaluation. Treatments comprised vitamin C (2000 mg) and vitamin E (800 IU) daily or matching placebo for 7 days prior to cryotherapy to a hand wart. Oedema volume, erythema level, pain intensity and the presence or absence of blistering were assessed 24 h after cryotherapy. There were no significant differences between the two treatment groups in any of the parameters assessed. This study yielded no suggestion of benefit from the use of pretreatment with free radical scavengers in conjunction with liquid nitrogen cryotherapy.

Adolescent↗

Drugs producing vitamin deficiencies.

Many drugs produce vitamin deficiencies. They belong to the most important and common therapeutical classes: analgesics, antianemics, antibacterial and antiblastic agents, antibiotics, antidiabetics, antimalarials, antiphlogistics, antipyretics, diuretics, laxatives and purgatives, tranquilizers and anticonvulsives, radiomimetics, hormones and vitamins themselves. The vitamin deprivation processes may be produced by a variety of mechanisms and may involve all vitamins. Recent experiments indicate that there is a competition for binding sites on proteins between vitamin C and salicylate and between dicoumarol and vitamin K. Usually a drug exerts a "devitaminizing" action with respect to only one vitamin. However there are examples of multiple vitamin deficiencies induced by a single drug, like salicylate which deprives the organism of vitamins C, K and pantothenate. These deficiencies may develop either all at the same time or successively. A direct and concomitant vitamin depriving action occurs when an antibiotic blocks the production of vitamins by the enteric flora. A different mode of action occurs in the drug induced folic acid deficiency, which in turn induces a deficiency of vitamin B12. It has been reported that a vitamin deficiency may result from intake of high pharmacological doses of other vitamins. These data need confirmation in patients treated with high doses of nicotinic acid. The drug induced vitamin deficiencies are studied with the same methodology employed for avitaminoses in general; hence they can be diagnosed using the same criteria.

Analgesics↗

Effects of combination treatment with vitamins E and C on chloasma and pigmented contact dermatitis. A double blind controlled clinical trial.

A multi-clinical double-blind study on therapeutic effect of combination preparation of vitamins E and C was undertaken in comparison with single preparation of vitamin E and vitamin C in the treatment of chloasma or pigmented contact dermatitis (PCD). Combination treatment resulted in significantly better clinical improvement than vitamin C alone in both diseases. Objective data compiled from color difference measurements and color photographs revealed significantly better results with combination treatment in chloasma than vitamin C alone and, in PCD, than vitamin E or C alone. Differences in skin luminosity between hyperpigmented and normal areas significantly decreased in all three groups, with the combination group producing the most significant change. The total serum lipoperoxide level and its ratio to total serum lipids tended to decline in the combination group, and decreased significantly in vitamin E group. The sebum lipoperoxide level decreased significantly only in the combination group (EC).

Ascorbic Acid↗