| 9.6.1 Vitamin A Group |
GREEN Vitamin A and D capsules (vitamin A 4000units & vitamin D 400 units)
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| RED Vitamin A Palmitate 100000 units per 2mL injections [unlicensed medication] |
| |
| 9.6.2 Vitamin B Group |
| Deficiency of B vitamins is rare (except B12) and usually treated using a compound preparation. Pyridoxine is used to |
| protect against isoniazid neuropathy. Concerns over toxicity from high dose pyridoxine are not yet resolved. |
GREEN Pyridoxine tablets 10mg, 50mg
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| GREEN Thiamine tablets 50mg, 100mg |
| |
| The BNF advises that oral vitamin B complex preparations are less suitable for prescribing, and should not be considered |
| drugs of first choice. |
| |
| Intravenous/Intramuscular Vitamins B & C (High potency) |
CSM advice – Since potentially serious allergic adverse reactions may occur during, or shortly after, parenteral
|
| administration, the CSM advises; |
| > Use to be restricted to patients in whom parenteral administration is essential |
| > Intravenous injections should be administered slowly (over 10mins) |
| > Facilities for treating anaphylaxis should be available when administered |
| |
| AMBER Vitamins B & C High potency IM injection 7ml (in 2 amps) |
| RED Vitamins B & C High potency IV injection 10ml (in 2 amps) |
| |
| For the prevention of re-feeding syndrome only |
| RED Vitamin B Co Strong |
| |
| Vitamin B12 - see hydroxocobalamin Section 9.1.2 |
| |
| 9.6.3 Vitamin C Group |
| Divided doses are necessary due to the low renal threshold of ascorbic acid. |
| Patients should be directed to purchase nutritional supplements. |
| For further information please click here |
| GREEN Ascorbic acid tablets 100mg, 200mg, 500mg |
| |
| |
| 9.6.4 Vitamin D Group |
| Please Note: Treatment doses of Vitamin D for paediatrics should be prescribed by the GP on hospital request and the ongoing maintenance to be purchased over the counter (self-care) |
| |
| Ergocalciferol/ Colecalciferol |
| Simple vitamin D deficiency can be prevented using 10 micrograms (400 units) daily of ergocalciferol (calciferol, vitamin D2) |
| or colecalciferol (vitamin D3). Vitamin D deficiency is not uncommon in Asians consuming unleavened bread and in the |
| elderly living alone, and can be prevented by giving an oral supplement of 20micrograms (800units) of colecalciferol |
| (or ergocalciferol) daily. Patients are encouraged to buy their own supplements for vitamin D insufficiency, but where a |
| clinician identifies a clinical need guidelines have been developed to assist in treatment decisions. |
| |
For East Lancashire Health Economy Guideline Diagnosis and Management of Vitamin D Deficiency in adults for Non-
|
Specialists click here. The patient information leaflet is available to print off for use click here.
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| If it is necessary for the clinician to prescribe on an FP10, it is recommended that only the following brands are used: |
| GREEN Invita® 25,000 iu/ml oral solution [3 x 1ml amps] preferred choice for use in paediatrics |
| GREEN HuxD3® (Colecalciferol) capsules 20,000iu 1st line choice |
| GREEN Osteocaps (Colecalciferol ) capsules 20,000iu |
| GREEN SunVitD3 (Colecalciferol) tablets 20,000iu |
| GREEN ProD3 ® (Colecalciferol) liquid 2,000iu/ml |
| GREEN Aciferol® D3 (Colecalciferol) liquid 2,000units/mL, 3,000units/mL |
| |
| Please note: LIQUID "SPECIALS" MUST NOT BE PRESCRIBED |
| |
| Preparations containing calcium and colecalciferol are available for the management of combined calcium and vitamin D |
| deficiency (see below under prevention & treatment of osteoporosis). |
| |
| Pharmacological strengths of ergocalciferol |
| AMBER Ergocalciferol tablets 250microgram (10,000units) & 1.25mg (50,000units) |
| AMBER Ergocalciferol injection 7.5mg (300,000 units)/ml - 1ml & 2ml ampoules |
| |
| Prevention & treatment of osteoporosis |
Those with, or at risk of, osteoporosis should maintain an adequate intake of calcium and vitamin D. If deficiency is suspected, this should be corrected by increasing dietary intake or taking supplements. Calcium and vitamin D
| supplementation alone may reduce the risk of fracture but it is less effective than other agents. The best evidence
| supports its use in institutionalized or housebound elderly women. Evacal D3®, Adcal D3® and Calcichew D3 Forte®
| | should be given twice daily. Calfovit D3® sachets should be given daily. For moderate to severe renal disease | colicalciferol may not be metabolised to the active metabolite of vitamin D. In these circumstances a suitable alternative
| | would be alfacalcidol. | |
| |
| First Line: Evacal D3® is the preferred choice, most cost-effective option for use in Primary Care |
| [Secondary care will continue to use Adcal D3 which can be changed to Evacal D3 in Primary Care] |
| GREEN Calcium carbonate tablets chewable 1500mg (15mmol Ca) & colecalciferol 10micrograms (Vitamin D 400units) |
| Evacal D3®, Adcal D3®, Accrete D3® (Give 1 tablet twice daily) |
| OR |
| GREEN Calcium carbonate caplets 750mg (7.5mmol Ca) & colecalciferol 5micrograms (Vitamin D 200units) |
| (Adcal D3®) (Give 4 caplets daily) |
| |
| Second Line |
| GREEN Calcium phosphate 1.5g (15mmol Ca) & colecalciferol 10mcg effervescent tablets Vitamin D 400units) |
| (Adcal D3 Dissolve®) (Give 2 tablets daily) |
| For swallowing difficulties |
| GREEN Calcium carbonate tablets chewable 1.25g (12.6mmol Ca) & colicalciferol 10 micrograms (Vitamin D3 400 units) |
| (Calcichew D3 Forte®) (Give 1 tablet twice daily) |
| If patient dislikes taste of chewable Evacal D3®, Adcal D3®, Accrete D3® |
| |
Alfacalcidol and Calcitriol
| Patients with severe renal impairment requiring vitamin D therapy should be prescribed alfacalcidol.
| It is essential that healthcare professionals check that plasma calcium monitoring is undertaken.
| Do NOT abbreviate nanograms or micrograms. Please see link.
| Note that One-Alpha® capsules contain sesame.
| AMBER Alfacalcidol
| | capsules 250 nanograms, 1 microgram | oral drops 2 microgram/ml
| | AMBER Calcitriol capsules 250nanograms | |
| |
| |
| 9.6.5 Vitamin E |
| GREEN Alpha Tocopheryl acetate suspension 500mg/5ml |
| |
| 9.6.6 Vitamin K |
Essential for the production of blood clotting factors, antagonises effects of oral anticoagulants. Menadiol used when there
|
| are malabsorption syndromes, and in obstructive liver disease. |
| Malabsorption syndromes (water-soluble preparation required) |
| GREEN Menadiol sodium phosphate tablets 10mg |
| Fat soluble formula (not malabsorption) |
| RED Phytomenadione 10mg tablets (most cost effective option) |
| AMBER Phytomenadione (vitamin K1) 2mg in 0.2ml amp (Konakion MM Paediatric®) * |
| RED Phytomenadione 10mg in 1ml amp (Konakion MM®) ** |
| *Note – Konakion MM® Paediatric may be administered by mouth or by intramuscular injection or by intravenous injection. |
| **Note – Konakion MM® may be administered by slow intravenous injection or by intravenous infusion in glucose 5%: |
not for intramuscular injection.
|
| |
| Haemorrhagic disease of the newborn |
| If parents do not want their baby to have the intramuscular injection of vitamin K, then Konakion MM® orally or Neokay® |
| may be offered as an alternative |
| Dose 1mg on day 1 and also day 7 & day 28 for breast fed babies. |
| |
| AMBER Phytomenadione capsules 1mg (Neokay®) |
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