A fixed-dose combination product containing a B-vitamin (Nicotinamide), a thyroid hormone (Thyroxine), and another B-vitamin (Pyridoxine). It is primarily indicated for the management of pellagra and associated nutritional deficiencies, often seen in specific at-risk populations in India. The thyroxine component is present in a very low, non-hormone replacement dose, historically posited to have metabolic or dermatological effects, though this use is not supported by modern endocrinology guidelines. The combination is not a standard therapy for hypothyroidism.
Adult: One tablet once daily, or as directed by the physician. Typically taken in the morning on an empty stomach.
Note: Take tablet on an empty stomach, at least 30 minutes before breakfast, with a full glass of water. Do not take with coffee, milk, or antacids. Maintain a consistent daily schedule.
Nicotinamide: Precursor to NAD and NADP, essential coenzymes in redox reactions, DNA repair, and cellular energy metabolism. It also inhibits poly(ADP-ribose) polymerase (PARP) and has anti-inflammatory effects on skin. Levothyroxine (at 15mcg): The physiological role of such a micro-dose is unclear; it may provide trace hormone support but is insufficient to treat hypothyroidism. It may have subtle effects on basal metabolic rate. Pyridoxine: Converted to pyridoxal phosphate (PLP), a cofactor for over 140 enzymes involved in amino acid, glucose, and lipid metabolism, neurotransmitter synthesis (serotonin, dopamine, GABA), and heme synthesis.
Pregnancy: Levothyroxine is Category A; requirements often increase during pregnancy. Nicotinamide and Pyridoxine are generally safe. However, this fixed-dose combination is not a recommended source of levothyroxine for hypothyroidism in pregnancy. Use only if clearly needed and under strict supervision. Pyridoxine is used for nausea in pregnancy at higher doses.
Driving: Usually no effect. However, if symptoms of hyperthyroidism (nervousness, tremor) occur, may impair ability to drive or operate machinery.
| Oral Anticoagulants (Warfarin) | Levothyroxine may potentiate anticoagulant effect; increased INR risk. | Major |
| Antidiabetic Agents (Insulin, Sulfonylureas) | Levothyroxine may reduce glycemic control; adjust dose. | Moderate |
| Digoxin | Levothyroxine may decrease serum digoxin levels. | Moderate |
| Antacids (Calcium, Aluminum, Magnesium) | Decrease absorption of levothyroxine. Separate by at least 4 hours. | Major |
| Iron Supplements | Decrease absorption of levothyroxine. Separate by at least 4 hours. | Major |
| Proton Pump Inhibitors (Omeprazole) | May reduce levothyroxine absorption by altering gastric pH. | Moderate |
| Phenytoin, Carbamazepine | Increase metabolism of levothyroxine, may increase dose requirement. | Moderate |
| Isoniazid | May increase pyridoxine requirements/antagonize effect. | Moderate |
Same composition (Nicotinamide (25mg) + Thyroxine (15mg) + Vitamin B6 (Pyridoxine) (1mg)), different brands: