A fixed-dose combination of three active, bioavailable forms of essential B-vitamins. L-Methylfolate is the predominant circulating form of folate, Methylcobalamin is an active coenzyme form of Vitamin B12, and Pyridoxal-5-phosphate (P-5-P) is the active coenzyme form of Vitamin B6. This combination bypasses common enzymatic conversion defects (e.g., MTHFR polymorphism) and is indicated for the management of hyperhomocysteinemia and associated neurological and vascular complications, as well as for nutritional deficiencies where standard B-vitamins are ineffective.
Adult: One tablet/capsule once daily, or as directed by the physician. Usually taken with or without food.
Note: Administer orally with a glass of water. Can be taken with meals to reduce potential gastrointestinal discomfort. Do not crush or chew sustained-release formulations. For best absorption, avoid taking within 1-2 hours of cholestyramine, colestipol, or antacids.
The combination works synergistically in the one-carbon metabolism cycle to remethylate homocysteine to methionine. L-Methylfolate provides the methyl group. Methylcobalamin acts as a cofactor for methionine synthase, the enzyme facilitating this transfer. Pyridoxal-5-phosphate is a cofactor for cystathionine beta-synthase, which converts homocysteine to cystathionine in the transsulfuration pathway. This three-pronged approach effectively lowers plasma homocysteine levels and supports myelin synthesis, neurotransmitter production (serotonin, dopamine, norepinephrine), and nucleotide synthesis.
Pregnancy: Category A (US FDA). L-Methylfolate is the preferred form of folate in pregnancy, especially for women with MTHFR polymorphism, as it reduces the risk of neural tube defects independent of maternal enzymatic conversion ability. Methylcobalamin and P-5-P are also essential. Recommended dose should be as per obstetrician's advice; often 1mg L-Methylfolate is sufficient.
Driving: No known effects on driving ability. Rarely, initial nervousness or dizziness might occur.
| Levodopa | Pyridoxal-5-phosphate can increase peripheral metabolism of levodopa, reducing its central efficacy. This effect is less pronounced with carbidopa/levodopa combinations but caution is advised. | Major |
| Phenobarbital, Phenytoin | Folate can reduce serum levels of these anticonvulsants, potentially leading to breakthrough seizures. | Moderate |
| Methotrexate | Folate can reduce the hematological toxicity of methotrexate but may also interfere with its anti-neoplastic effect in high doses. Use only under oncologist's guidance. | Major |
| Chloramphenicol | May antagonize the hematopoietic response to Vitamin B12. | Moderate |
| Proton Pump Inhibitors (Omeprazole), H2 Blockers (Ranitidine) | Long-term use impairs B12 absorption by reducing gastric acid and intrinsic factor. This combination therapy is often used to correct the resulting deficiency. | Moderate |
| Metformin | Long-term use can impair B12 absorption. This combination is therapeutic for the deficiency caused by metformin. | Moderate |
Same composition (L-Methyl Folate (1mg) + Methylcobalamin (1500mcg) + Pyridoxal-5-phosphate (500mcg)), different brands: