Methylfolate (L-methylfolate), methylcobalamin, and acetylcysteine (often called N-acetylcysteine or NAC) are three compounds commonly used in nutritional and medical contexts for various reasons. Here's a brief overview of each:

• Methylfolate (L-methylfolate):
  • This is the biologically active form of folic acid, which is one of the B vitamins.
  • It plays a role in the synthesis of DNA, the formation of red blood cells, and the conversion of homocysteine to methionine in the body.
  • Methylfolate is important for brain health and mood regulation. Some individuals have a genetic mutation (such as MTHFR) that reduces their ability to convert folic acid to its active form, methylfolate. They may benefit from direct supplementation with methylfolate.
  • It's also prescribed to pregnant women to prevent neural tube defects in their unborn children.
• Methylcobalamin:
  • This is the active form of vitamin B12.
  • Vitamin B12 plays a crucial role in the formation of red blood cells, nerve function, and the synthesis of DNA.
  • B12 deficiency can lead to a range of symptoms, including fatigue, weakness, constipation, loss of appetite, weight loss, poor memory, or numbness and tingling in the hands and feet.
  • Methylcobalamin is sometimes preferred over other forms of B12 (like cyanocobalamin) because it is the active form and doesn't require conversion in the body.
• N-acetylcysteine (NAC):
  • NAC is a derivative of the amino acid cysteine.
  • It has several uses in medical settings, including as a treatment for acetaminophen (paracetamol) overdose. When taken in time, it can prevent liver damage from an overdose.
  • NAC is also a powerful antioxidant and has been researched for various other conditions, including psychiatric disorders, respiratory conditions (like chronic bronchitis), and infertility in polycystic ovary syndrome.
  • It helps replenish the body's levels of glutathione, one of the primary antioxidants.

CerefolinNAC tablets contain Methylfolate, methylcobalamin, and acetylcysteine. Methylfolate and methylcobalamin are involved in the breakdown of homocysteine, thus lowering plasma homocysteine levels. Acetylcysteine reduces oxidative stress and lowers plasma homocysteine levels.

CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine) Uses:

• It is used as a medical food in patients with neurovascular oxidative stress, cognitive impairment, and/or hyperhomocysteinemia

Note:

• Unlike pharmaceuticals, medical foods are not subject to FDA regulation. Before dispensing, there is no need for an oral or written prescription, review or approval before marketing, or proof of their efficacy and safety.
• Medical foods are formulated to be administered per oral for the management of specific diseases or conditions for which distinctive nutritional requirements are established by medical evaluation.

Methylfolate, methylcobalamin, and acetylcysteine Dose in Adults:

CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine) Dose in Adults as a medical food:

• Oral: One tablet daily

Dose in children:

Not indicated.

Use in Pregnancy and breastfeeding:

See specific drug's monographs (Methylfolate, methylcobalamin, and acetylcysteine)

Dose in renal disease:

No dosage adjustments are required.

Dose in Liver disease:

No dosage adjustments are required.

Side effects of CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine):

• Allergic reactions may occur following the use of oral L-methyl folate Calcium.
• Diarrhea
• Itching
• Transient rash
• Body swelling
• Nausea
• Vomiting
• Diarrhea
• Flushing
• Epigastric pain
• Constipation.

Contraindications to CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine):

• Allergies to any ingredient of the formulation.
• Patients with vitamin B-12 deficiencies associated with neurological manifestations (subacute mixed degeneration of the chord) should avoid methyl folate. 
• It may also mask an underlying vitamin B-12 deficit.
• Patients on nitrates can develop headaches or symptoms that may be exacerbated by a preexisting nitrate-induced migraine.
• Patients with cysteine renal stones should avoid Acetylcysteine. 
• Acetylcysteine should be avoided by patients in critical condition and those with peptic ulcer disease.
• It may cause disruption of the mucosal barrier. Acetylcysteine may also give false-positive results for ketones. 

(Methylfolate, methylcobalamin, and acetylcysteine): Drug Interaction

Monitoring Parameters:

None mentioned. May need to monitor plasma homocysteine levels.

How to administer CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine)?

Administer one caplet daily as recommended by the physician.

Mechanism of action of CerefolinNAC (Methylfolate, methylcobalamin, and acetylcysteine):

See individual agents:

• Deplin (Methylfolate) Tablets
• Methylcobalamine
• Acetylcysteine (mucolator)

International Brand Names of Methylfolate, methylcobalamin, and acetylcysteine:

• CerefolinNAC
• Metafolbic Plus
• Metafolbic Plus RF

Methylfolate, methylcobalamin, and acetylcysteine Brand Names in Pakistan:

No Brands Available in Pakistan.