9.5 Minerals

9.5.1 Calcium & Magnesium

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9.5.1.1 Calcium supplements

supplementation are required.

See section 9.6.4 for such preparations.

First line

GREEN Cacit® tablets

Second line

GREEN Calcium carbonate tablets chewable 1.25g (12.6mmol Ca) (Calcichew®)

GREEN Calcium glubionate/calcium lactobionate syrup (2.7mmol Ca/5ml) (Calcium-Sandoz®)

Injections - for hypocalcaemia, cardiac resuscitation

GREEN Calcium chloride injection Min-I-Jet® (6.8mmol calcium/10ml)

RED Calcium chloride injection ampoule (2.5mmol calcium/5ml)

RED Calcium chloride injection 13.4% ampoule (9.1mmol calcium/10ml)

RED Calcium gluconate injection 10% (2.2mmol calcium/10ml)

9.5.1.2 Hypercalcaemia and hypercalciuria

Dehydration should be corrected before other treatment is started.

> For IV bisphosphonates see section 6.6.2

> For calcitonin see section 6.6.1

> For corticosteroids see section 6.3

Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance

dialysis therapy

> Cinacalcet is not recommended for the routine treatment of secondary hyperparathyroidism in patients with

end-stage renal disease on maintenance dialysis therapy.

> Cinacalcet is recommended for the treatment of refractory secondary hyperparathyroidism in patients with end-stage

renal disease (including those with calciphylaxis) only in those:

> who have 'very uncontrolled' plasma levels of intact parathyroid hormone (defined as greater than 85 pmol/litre [800pg/ml]) that are refractory to standard therapy, and a normal or high adjusted

serum calcium level, and

> in whom surgical parathyroidectomy is contraindicated, in that the risks of surgery are considered

> Response to treatment should be monitored regularly and treatment should be continued only if a reduction in

the plasma levels of intact parathyroid hormone of 30% or more is seen within 4 months of treatment,

including dose escalation as appropriate.

RED Cinacalcet f/c tablets 30mg, 60mg,90mg (NHS England Commissioned)

Secondary Hyperparathyroidism in adults with Chronic Kidney Disease on haemodialysis - NICE TA448

Etelcalcetide is recommended as an option for treating secondary hyperparathyroidism in adults with chronic kidney disease

on haemodialysis, only if:

> treatment with a calcimimetic is indicated but cinacalcet is not suitable and

> the company provides etelcalcetide with the discount agreed in the patient access scheme

RED Etelcalcetide 2.5mg, 5mg, 10mg solution for injection (CCG Commissioned)

9.5.1.3 Magnesium

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GREEN Magnesium glycerophosphate chewable tablets 95mg (4mmol Mg2+) PRESCRIBE BY BRAND - MagnaPhate®

RED Magnesium sulphate injection 10% 10ml (1gram) ampoule

RED Magnesium sulphate injection 50%

2ml (1gram) ampoule

10ml (5gram) ampoule

10ml (5gram) prefilled syringe

Note: Magnesium sulphate 1gram is equivalent to Mg2+ approx. 4 mmol. For intravenous injection concentration of magnesium

sulphate should not exceed 20%.

Magnesium Aspartate (Magnaspartate®)

This product is a ‘food for special medical purposes’ and is indicated for the management of magnesium deficiency. It is

available as an oral powder, containing magnesium-L- aspartate 6.5 g (10 mmol Mg2+)/sachet, at a net price 10-sachet pack =

£9.45 [Drug tariff]. It can be prescribed on FP10 prescriptions in primary care, and is now available from Alliance Healthcare, or

directly from KoRa Healthcare, Co Dublin, Ireland, UK Tel: 0845-3038631. It will be used where there is intolerance or poor

response to other oral magnesium products, to prevent use of intravenous magnesium where appropriate.

AMBER Magnesium Aspartate sachets (Magnaspartate®)

9.5.2 Phosphorous

9.5.2.1 Phosphate supplements

GREEN Phosphate-Sandoz® effervescent tablets (16.1mmol phosphate)

RED Phosphates intravenous infusion (100mmol/litre phosphate) 500ml

9.5.2.2 Phosphate binding agents

AMBER Calcium acetate tablets 475 mg (Renacet®)

AMBER Calcium acetate 435mg/235mg (OsvaRen®)

AMBER Calcium acetate 1g tablets (Phosex®)

AMBER Sevelamer carbonate tablets 800mg Prescribe generically as 'Sevelamar carbonate' - see switch leaflet

AMBER Lanthanum carbonate (patients on dialysis) Prescribe generically NHS England commissioned

AMBER Lanthanum carbonate (hyperphosphataemia with CKD and not on dialysis)

500mg, 750mg, 1g tablets . Prescribe generically

See NICE NG203 - updates and replaces NICE CG157

Also Adcal® and Calcichew® see section 9.5.1.1

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9.5.3 Fluoride

When the fluoride content of drinking water is less than 700micrograms per litre (0.7 parts per million), daily administration

of fluoride tablets or drops provides suitable supplementation.

Provision of such supplements should be via the dentist and patients should have regular 6 monthly visits to monitor oral health.

High Strength Fluoride (sodium) Toothpaste 1.1%

Primary Care Prescribing

The Position Statement for the Prescribing of High Strength Fluoride Toothpaste, [dental prescribing only] in primary care is available <click here>

BLACK Duraphat® 5000 [High Fluoride Toothpaste] - Dental Prescribing only in primary care

Head and neck cancer patients [Max Fax: Restricted to dental care in cancer patients]

Restriction: to be prescribed on the advice from a secondary care specialist

In a small group of patients who have had surgery, radiotherapy and/or chemotherapy for head and neck cancer.

GREEN (restricted) Duraphat® 5000 [High Fluoride Toothpaste]

'Mouth Care for Head and Neck Chemotherapy/ Radiotherapy Patients' - Patient Information Leaflet <click here>.

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9.5.4 Zinc

Zinc should only be given where there is good evidence of deficiency.

GREEN Zinc Sulphate tablets effervescent 125mg (45mg zinc)

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The material in this section is aimed at health care professionals, but is information currently held in the public domain

members of the public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service

Email: info.elmmb@nhs.net