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^{Updated 5.12}

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Vitamin B co strong is used to help replace missing essential vitamins, either to treat it at the time or to help long-term:

• "Vitamin B Co" contains nicotinamide 15mg, riboflavin 1mg and thiamine 1mg. It is used as a prophylactic i.e. taken for many months to make sure there are enough vitamins long-term and that the body's stores are built up again.

• "Vitamin B Co strong" (or "Vitamin B Co forte") contains nicotinamide 20mg, pyridoxine 2mg, riboflavin 2mg and thiamine 5mg. It is used to help replace missing vitamins when the problem presents.

This is common in alcohol dependence and after alcohol withdrawal.

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Vitamin B Co Strong tablets provide the vitamins a person needs for a healthy body and brain. Sometimes the diet doesn't have enough and sometimes the body doesn't absorb it well enough, so having more in tablet form helps. 

Thiamine (also known as Vitamin B1) is needed by the body to keep the tissues healthy e.g. making proteins and enzymes. Thiamine is also needed to metabolise carbohydrates (essential for energy).  Lack of thiamine causes beriberi. Humans cannot make thiamine so have to take it in from food e.g. yeast, meat (especially pork), whole grain cereals and nuts. You need more thiamine the more energy you use. If you don't have enough thiamine, your heart and the brain (especially the memory areas) seem to suffer most.

Lack of thiamine in brain can cause two main problems in the brain, because cells can't be repaired and can be damaged or die:

• Firstly, a short-lived (up to a few days) but severe condition called Wernicke's Encephalopathy (WE). This causes mental confusion, muscle paralysis and poor co-ordination. If not treated, this can be bad enough to be fatal.

• Secondly, a longer-term condition called Korsakoff's psychosis. This is where a person's memory is damaged. The person cannot remember things more than a few minutes afterwards, and can start to make up things (confabulation).

When you drink alcohol, you can have a lack of thiamine. This is because

• You don't eat enough or properly

• You don't absorb thiamine from food as well

• The cells don't use thiamine as well

• Alcohol reduces the amount absorbed

We all need about 1-1.5mg thiamine a day, but the trouble is that it isn't absorbed very well from the stomach. Even if we took 200mg a day of thiamine you would absorb only about 4mg at most. To get round this, thiamine is often given by injection to start with to make sure the lack is corrected. After that, it can be taken by mouth.

Riboflavin (also known as Vitamin B2) is needed to help keep cells healthy and working, in making proteins, and is necessary for energy and breaking down carbohydrates, fats and proteins. Lack of riboflavin causes cracked and swollen lips, oily and scaly skin between the nose and lips and in the groin area, red and itchy eyes, numbness of the hands and being less sensitive to touch, heat and vibration.

Pyridoxine (also known as Vitamin B6) is needed to have healthy metabolism. Lack of pyridoxine can cause anaemia, seizures, irritability, swollen lips and eye problems.

Nicotinamide (also known as Vitamin B3, niacin, and nicotinic acid) is also needed to keep cells healthy. A slight lack of nicotinamide causes indigestion, fatigue, canker sores, vomiting, depression, general weakness, muscular weakness, lack of appetite and skin infections. A severe lack of nicotinamide can also cause pellagra, a skin problem where you get a thick, scaly, darkly coloured rash in areas exposed to sunlight, plus burning in the mouth and a swollen, bright red tongue.

Sometimes the symptoms caused by a lack of these vitamins can be so severe that they look like being intoxicated.

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Take vitamin B co or vitamin B co strong as directed on the medicine label. Try to take it at regular times each day. Taking it at mealtimes may make it easier for you to remember as there is no problem about taking these with or after food.

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Tablets should be swallowed with at least half a glass of water whilst sitting or standing. This is to make sure that they reach the stomach and do not stick in your throat.

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Some of the effects of vitamin B co strong appear soon after taking it. However, the most important action to help the symptoms of vitamin deficiency may take weeks or even months of regular vitamin B co to become fully effective.

^{Updated 10.11}

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You will probably need to take Vitamin B Co Strong for at least 2-3 weeks to start with make sure your body stores are built up again. You may then need to take Vitamin B Co for a lot longer after this to keep your vitamin levels healthy.

^{Updated 10.11}

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Vitamin B Co and Vitamin B Co Strong contain only vitamins and are not addictive.

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Start again as soon as you remember unless it is nearly time for your next dose then take the next dose as normal. There is no harm from having an extra dose to catch up but it won't do too much extra to help either. Missing the occasional dose (e.g. once a week) is probably not a big problem.

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices which can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by the bed etc.

^{Updated 8.11}

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You can, and you probably won't notice any difference. However, the damage to your brain can carry on even without you noticing.

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You are unlikely to have any side effects as these are all vitamins, and your body just excretes any excess if you take too much. If you develop any unusual symptoms ask your doctor, nurse or pharmacist about them next time you meet.

^{Updated 12.11}

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Vitamin B Co Strong should not make you feel drowsy or sleepy.

^{Updated 11.11}

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Vitamin B Co Strong should not make you put on weight.

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Vitamin B Co Strong will not affect your sex-life.

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No, but making sure you have foods rich in vitamins will help your body.

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There is no interaction as such, although you will have even less vitamins if you drink more alcohol.  

It is not safe to drive after drinking alcohol. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

^{Updated 11.11}

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The vitamins in Vitamin B Co Strong do not interact with any other medicines.

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking. However, it seems that there are no extra problems if smoking with Vitamin B Co.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, it seems that there are no extra problems if smoking cannabis with Vitamin B Co.

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with Vitamin B Co and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with Vitamin B Co and ecstasy, but this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with Vitamin B Co.

^{Updated 1.12}

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You should have no problem with Vitamin B Co Strong and the oral contraceptive ("The Pill").

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily Vitamin B Co doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

^{Updated 11.11}

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking Vitamins B & C, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

^{Reviewed 9.11}

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again.

Vitamin B Co strong only contains naturally occurring and essential vitamins. So, there would be no problems if you became pregnant taking these tablets.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

There should be no problems breast-feeding if you are taking a usual dose of Vitamin B Co or Vitamin B Co strong.

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Vitamin B Co and Vitamin B Co Strong will have no effect on driving. But obviously having any alcohol will do.  

If you are taking any medicines, the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

^{Updated 11.11}

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You will not need any blood tests because you are taking Vitamin B Co Strong but you will need blood tests to check on you blood and its stocks of vitamins. 

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