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9.5 Minerals

9.5 Minerals

9.5.1 Calcium & Magnesium
 Return to main page 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) 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) Magnesium 
 Return to main page
       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 = £7.95.  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 Phosphate supplements 
       GREEN      Phosphate-Sandoz® effervescent tablets (16.1mmol phosphate) 
       RED           Phosphates intravenous infusion (100mmol/litre phosphate) 500ml 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
       RED           Lanthanum carbonate  (patients on dialysis)   Prescribe generically                                   NHS England commissioned  
       AMBER     Lanthanum carbonate (hyperphosphataemia with CKD and not on dialysis as per NICE CG157 )  
                         500mg, 750mg, 1g tablets . Prescribe generically        
                        Also Adcal® and Calcichew® see section
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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 Toothpaste
         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]
         In a small group of patients who are post radiotherapy for head and neck cancer, the high strength fluoride toothpaste will               be initiated by secondary care specialists / consultants [Max Fax]. 
         AMBER            Duraphat® 5000 [High Fluoride Toothpaste]      
        'Mouth Care for Head and Neck Chemotherapy/ Radiotherapy Patients' - Patient Information Leaflet <click here>. 
 Return to main page
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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 members of the public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service 

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