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9.5 Minerals

9.5.1 Calcium & Magnesium 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 
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 Phosphorus 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 (Renvela®) 
RED           Lanthanum carbonate  (patients on dialysis)                                     NHS England commissioned  
AMBER     Lanthanum carbonate (hyperphosphataemia with CKD and not on dialysis as per NICE CG157 )  
                  500mg, 750mg, 1g tablets (Fosrenol®)         
                  Also Adcal® and Calcichew® see section

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]
      In a small group of patients who are post radiotherapy for head and neck cancer, the high strength fluoride toothpaste will be           prescribed by secondary care specialists consultants [Max Fax]
      RED            Duraphat® 5000 [High Fluoride Toothpaste]      
      'Mouth Care fior Head and Chemotherapy Radiotherapy Patients' - Patient Information Leaflet <click here>. 

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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