Multivitamin (Multivitamin and Multimineral Supplement)
Also sold as: Becosule, Supradyn, Centrum, Revital, Seven Seas, Multivit, Polybion
Pregnancy
Cat A
Lactation
Safe
Schedule
OTC
Forms
Tablet (standard multivitamin) +4
Indications
- Prevention and treatment of vitamin and mineral deficiencies
- Nutritional supplementation in poor dietary intake
- Pregnancy and lactation (prenatal vitamins)
- Geriatric supplementation (age-related nutrient depletion)
- Post-surgical / Malabsorption states (bariatric surgery, IBD, celiac disease)
- Vegans / Vegetarians (B12, iron, zinc, omega-3 deficiency prevention)
- Patients on prolonged medications causing nutrient depletion (metformin, PPIs, isoniazid)
- Recovery from illness, infection, or major surgery
Adult Dosing
General supplementation / Deficiency prevention
1 tablet / capsule once daily
Daily; ongoing or for a defined supplementation period
Take with food to improve absorption and reduce GI side effects
Pregnancy (prenatal vitamins)
1 prenatal multivitamin tablet once daily
Throughout pregnancy and during breastfeeding
Ensure contains folic acid ≥400–800 mcg, iron 27mg, calcium, iodine, DHA. Start preconception if possible.
Therapeutic use (active deficiency states)
1–2 tablets daily or as directed by physician
Until deficiency corrected; then maintenance
Pediatric Dosing
Use pediatric-specific multivitamin formulations. Chewable for children 2–12 years. Drops/syrup for infants. Avoid adult multivitamins in children — many exceed pediatric safe limits.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CKD stage 3–5 / Dialysis | AVOID standard multivitamins — they contain vitamin A and D at levels toxic to CKD patients. Use renal-specific formulations (e.g., Nephrovit — without vitamins A, D, K; low potassium, low phosphorus). |
Hepatic Adjustment
Severe hepatic impairment: avoid high-dose vitamin A (hepatotoxic) and avoid iron supplements without confirmed deficiency (iron overload in liver disease). Use with caution.
Pregnancy & Lactation
Pregnancy: Category A
Essential in pregnancy. CRITICAL WARNING: High-dose vitamin A (>10,000 IU/day or >3000 mcg RAE/day) is teratogenic — causes fetal malformations (craniofacial, cardiac, CNS). All prenatal vitamins must have vitamin A as beta-carotene (safe) rather than preformed retinol (toxic). Folic acid 400–800 mcg essential from preconception through first trimester to prevent neural tube defects.
Lactation: Safe
Multivitamins are safe and beneficial during breastfeeding. Ensures adequate nutrient transfer to infant through breast milk. Breastfeeding women should continue prenatal vitamins. Ensure iodine (150 mcg), DHA, vitamin D content.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Iron supplements (within multivitamin) | Iron chelates with calcium, zinc, magnesium, copper — reduces absorption of all; calcium particularly reduces iron absorption by up to 60% | Moderate |
| Antibiotics (tetracyclines, fluoroquinolones) | Multivitamins containing calcium, magnesium, iron, or zinc chelate with these antibiotics and significantly reduce antibiotic absorption; separate by 2–4 hours | Major |
| Levothyroxine (thyroid hormone) | Calcium, iron, and magnesium in multivitamins reduce levothyroxine absorption; separate by ≥4 hours | Moderate |
| Warfarin | Vitamin K in multivitamins may reduce warfarin efficacy; maintain consistent intake and monitor INR | Moderate |
| Bisphosphonates (alendronate, risedronate) | Minerals in multivitamins reduce bisphosphonate absorption; separate by at least 30–60 minutes | Moderate |
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Side Effects
Common
- Nausea (especially if taken on empty stomach)
- Constipation (due to iron content)
- Metallic taste
- Dark/black stools (iron)
- Bright yellow urine (riboflavin / B2 — harmless)
- Mild abdominal discomfort
Serious / Discontinue If
- Vitamin A toxicity (hypervitaminosis A) — headache, liver damage, hair loss, bone pain, teratogenicity with high-dose preformed retinol
- Vitamin D toxicity (hypervitaminosis D) — hypercalcemia, renal stones, metastatic calcification (unlikely with standard MV doses)
- Iron overload — liver damage, hemochromatosis in susceptible individuals (hereditary hemochromatosis; avoid iron-containing MV)
- Vitamin B6 toxicity (sensory neuropathy) with high-dose formulations >100mg/day
- Folic acid masking B12 deficiency — high-dose folic acid can correct megaloblastic anemia while allowing neurological damage from B12 deficiency to progress
Contraindications
- Hypervitaminosis A or D (do not supplement if already toxic)
- Hemochromatosis or iron overload disorders (avoid iron-containing MV)
- CKD (avoid standard MV — use renal-specific formulations)
- Hypercalcemia (avoid calcium and vitamin D)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Becosule | Pfizer Ltd | 20 cap ₹65 |
| Supradyn | Bayer AG (India) | 15 tab ₹145 |
| Centrum | Pfizer Ltd / Wyeth | 30 tab ₹320 |
| Revital H | Sun Pharmaceutical | 30 cap ₹298 |
| Polybion | MSD India (Merck) | 30 tab ₹95 |
| Multivit | Cipla Ltd | 30 tab ₹85 |
| Zevit | GlaxoSmithKline (GSK India) | 30 cap ₹120 |
Monitoring Required
- No routine monitoring required for standard multivitamin use
- Serum vitamin levels (if specific deficiency suspected or monitored)
- INR (if patient on warfarin — ensure consistent vitamin K intake)
- Serum calcium (if high-dose vitamin D suspected)
- Iron studies (serum ferritin, transferrin saturation) in hereditary hemochromatosis
Patient Counseling Points
- Take multivitamins with food to reduce stomach upset and improve fat-soluble vitamin absorption
- Do not take antacids, calcium, or iron supplements within 2 hours of your antibiotic (ciprofloxacin, doxycycline) — they reduce the antibiotic's effectiveness
- Bright yellow/orange urine is normal and harmless — it is from vitamin B2 (riboflavin)
- More is NOT better — do not take multiple multivitamin supplements simultaneously
- Pregnant women: check that prenatal vitamin contains folic acid 400–800 mcg (NOT just folate) and that vitamin A is listed as beta-carotene (safe), NOT retinol or retinyl palmitate (harmful to baby in high doses)
- If you have kidney disease, ask your doctor specifically for a renal-safe vitamin formulation
- Keep out of reach of children — iron in adult multivitamins can be toxic or even fatal to young children
- Separate thyroid medication (levothyroxine) by at least 4 hours from multivitamins
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Clinically reviewed by: Dr. Nisha Patel, MD (Medicine), DNB (Nutrition and Dietetics), NIMHANS Bangalore
Last reviewed: 2026-04-01
References
- ICMR — Recommended Dietary Allowances (RDA) for Indians 2020
- WHO — Vitamin and Mineral Requirements in Human Nutrition 2nd Edition
- FSSAI — Food Safety Standards for Dietary Supplements India
- Drugs.com — Multivitamin Monograph
- UpToDate — Vitamin and mineral supplements: Overview