1.1  Therapeutic Indications:

V2 plus capsules contain vitamins, minerals and standardized Ginseng Extract G115 in amounts which suit the body's daily requirements.

The capsules are indicated for relief of temporary periods of: States of exhaustion (e.g. caused by stress), tiredness, feeling of weakness, vitality deficiency.

Prevention and treatment of symptoms caused by ill-balanced or deficient nutrition

For situations of short term tiredness and exhaustion, V2 plus capsules are recommended for 4 weeks. If symptoms have not shown any improvement after 4 weeks, consult a doctor. It may be taken for periods of up to 12 weeks. For longer term use consult a doctor.

Adults:                The recommended daily dosage is one capsule per day. 

The capsule should preferably be taken in the morning with food.

Children:            Not recommended for use in children.

Elderly:           There are no special dosage recommendations for the elderly

Patients with a family history of haemochromatosis should seek medical advice before taking V2 plus capsules.

An allowance should be made for vitamins or minerals obtained from other sources.

In states of exhaustion (e.g. caused by stress), clinical trials have shown that improvement starts usually within 4 weeks of treatment. If symptoms have not shown any improvement during that time, or you are concerned, please consult your doctor.

V2 plus must be kept out of reach of children since an iron overload may be fatal.

Patients taking warfarin (or other coumarin anticoagulants) should have increased monitoring of their INR levels when starting or stopping treatment with ginseng containing products.

Each capsule contains a small amount of lactose (26 mg). Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine

In case of concomitant intake of ginseng preparations and anticoagulants, the effect of oral blood thinning medication (e.g. warfarin) may potentially be reduced. Patients on blood thinning medications should seek medical advice before starting this product.

Interactions of iron with tetracycline antibiotics (tetracycline, doxycline, minocycline) and vitamin B₆ and levodopa are known. Patients on any of these medications should seek medical advice before starting this product.

Pregnancy and lactation 

Reproduction studies with animals using the standardized Panax ginseng extract G115 showed no teratogenic effects. However, controlled studies with pregnant women are not available.

Controlled studies with women using multivitamin-mineral preparations at the usual dosage during the course of the first trimester resulted in no fetal risks. There are no signs indicating a risk if this type of preparation is taken during the second and third trimesters, and the probability of injuring the fetus appears to be very low.

Large doses of vitamin A (10,000 IU per day) have been found to be teratogenic if administered during the first trimester of pregnancy. Vitamin D given during the last trimester of pregnancy may cause hypercalcaemia in infants. As with many other medicines an 

assessment of benefits versus risks should be made before this product is administered during this period.

V2 plus capsules should not be taken during pregnancy or lactation. Fertility 

No studies on the effect on human fertility have been conducted.

Reproduction studies with animals using the standardized Panax ginseng extract G115 showed no adverse effects on fertility. 

No studies on the effects on the ability to drive and use machines have been performed.

Adverse events have been ranked under headings of frequency using the following convention:

data.

Immune system disorders: 

Not known: hypersensitivity, anaphylactic reaction Nervous system disorders: 

Common: headache

Not known: dizziness

Gastro-intestinal disorders: 

Common: nausea, vomiting

Uncommon: diarrhoea

Not known: abdominal pain

Skin and subcutaneous tissue disorders: 

Not known: rash, pruritus

Psychiatric disorders 

Not known: insomnia

Nervousness may occur following an overdose of the product.

The toxicity of the product in large overdoses is caused by the toxicity of the liposoluble vitamins A and D. A safe dose for both vitamins is considered to be 5-10 x RDA (each capsule contains the EU %RDA for vitamins A and D).

Prolonged supply of larger amounts corresponding to 37 capsules for vitamin A and 10 capsules for vitamin D can cause symptoms of chronic toxicity such as vomiting, headache, drowsiness, and diarrhoea. Acute toxic symptoms are only seen at even higher doses.

The acute toxic dose in adult humans corresponds to about 25,000 to 50,000 IU for vitamin D (contained in 125 to 250 capsules) and about 300,000 to 900,000 IU for vitamin A (contained in 112 to 337 capsules).

The chronic toxic dose in adult humans corresponds to about 2,000 IU for vitamin D (contained in 10 capsules) and about 100,000 IU (contained in 37 capsules) for vitamin A.

Zinc: In general the total daily intake should not exceed 15 mg.

Iron: Severe acute toxicity in man has been reported from doses of iron ranging from 12-1500 x RDA (each capsule contains the UK %RDA for iron). Most incidents of acute iron toxicity have resulted from accidental oral ingestion of iron pills by children. Longer-term doses of iron up to 6-7 x RDA have been reported to have no toxic effect.

Symptoms: Initial symptoms include nausea, vomiting, diarrhoea, abdominal pain, haematemesis, rectal bleeding, lethargy and circulatory collapse. Hyperglycaemia and metabolic acidosis may also occur.

Treatment: To minimise or prevent further absorption of the medication, as follows:

Induce vomiting e.g. by administration of an emetic.

Gastric lavage with desferrioxamine solution (2g/l). Then desferrioxamine (5 - 10g in 50100ml water) should be introduced into the stomach to be retained.

Severe poisoning: Shock and/or coma with high iron levels (serum iron >90µmol/l in children, >142µmol/l in adults); immediate supportive measures plus i.v. infusion of desferrioxamine should be instituted.

Less severe poisoning: i.m. desferrioxamine is recommended (1g 4-6 hourly in children; 50mg/kg up to a maximum dose of 4g in adults).

V2 plus capsules exert a stimulant effect at physical and psychological levels through the combined action of various substances on the basic metabolic processes.

The standardised ginseng extract G115 raises the general level of cellular activity, which is expressed by a pronounced increase in the physical and mental capacity.

In animal experiments, it caused a reduction of lactic acid concentration in muscles during exercise. An increase in the dopamine and noradrenaline content and a reduction in the serotonin content in the brain stem could be observed. 

Vitamins, minerals and trace elements correct and prevent impairment of the cell metabolism in situations with increased demands. Low supply of vitamins, minerals, and trace elements may cause disturbances, such as debility, tiredness, decrease in vitality, reduced force of resistance, and decelerated convalescence. The composition and dosages of the preparation were chosen according to the European RDA-requirements for food supplements.

Choline, inositol, linoleic acid and linolenic acid, in the form of lecithin, improve energy output and lipid metabolism

Pharmacokinetic studies of V2 plus capsules have not been carried out, because of the complex composition of the product and the small quantities of the active ingredients contained. Moreover, these substances are well known.

Pharmacokinetic studies of the standardized ginseng extract G115 are not possible, because it is a complex extract. In the ginseng root more than 200 substances have been identified to date. Pharmacokinetic studies of individual purified ginsenosides have been carried out in various animal species:

Using radioactively labelled (¹⁴C) Ginsenoside Rgl, originated from the standardized Panax ginseng extract G115, a bioavailability of 30% was determined in mice.

With intraperitoneal application, depending on the tested animal species and the Ginsenoside type, a half-life of between 27 minutes and 14.5 hours was measured.

Acute toxicity 

The oral LD₅₀ of the standardized Panax ginseng extract G115  is more than 5 g/kg of body weight in the mouse and the rat, and more than 2 g/kg in the mini-pig.

Reproduction toxicity 

The effect of standardized Panax ginseng extract G115 on reproductive performance was studied in two generations of Sprague-Dawley rats. Animals of both sexes were fed either control diet or diet supplemented with the standardized Panax ginseng extract G115 at dose levels of 1.5, 5 or 15 mg/kg body weight/day. Parameters of reproduction and lactation in the treated groups were comparable to those of the controls for two generations of dams and pups. No treatment-related effects were seen in weekly body weights and food consumption, haematological and blood chemistry parameters, and ophthalmic, macroscopic and histopathological examinations.

Fetal toxicity 

The standardized Panax ginseng extract G115, administered to pregnant Wistar rats and pregnant New Zealand rabbits, caused no abnormality in the foetal development.

The rats were treated with 40 mg/kg/day from the 1st to the 15th day after mating.

The rabbits were treated with 20 mg/kg/day from the 7th to the 16th day after mating.

The fetuses were removed by caesarean section on the 21st day in the rats and on the 27th day in the rabbits

Excipients:               

Soya-bean Oil

Lecithin

Ethyl Vanillin

Shell Components:

Gelatin

Sorbitol 70%

Glycerol 85%

Sodium Ethyl Hydroxyl benzoate

Sodium Propyl Hydroxyl benzoate

Iron Oxide Black

Cochineal Red

Titanium Dioxide 6.2

None stated.

Store below 30°C, protect from moisture.

Container:

A box containing two blisters (each of 12 Soft Gelatin Capsules) and the pamphlet.

Immediate Packaging

The Blisters:

Two blisters, each contains 12 soft gelatin capsules. The blister is made of transparent PVC for heat seal, with a back of hard aluminium foil, printed in one color.

External Packaging:

The Carton Box:

The box is made of chromo-duplex carton.

The Pamphlet:

The pamphlet is made of white paper (offset printed in one color.)

None stated