| 9.6.1 Vitamin A Group |
GREEN Vitamin A and D capsules (vitamin A 4000units & vitamin D 400 units)
|
| RED Vitamin A Palmitate 100000 units per 2mL injections [unlicensed medication] |
| |
| Return to main page |
| 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
|
| 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 |
| |
| Prescribing Post Bariatric Surgery |
| AMBER Vitamin B Co Strong - on advice of Secondary Care following Roux-en-Y Gastric Bypass Surgery only |
| see Guidelines for the prescribing of nutritional supplements post bariatric surgery |
| |
| Vitamin B12 - see hydroxocobalamin Section 9.1.2 |
| |
| Return to main page |
| 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 |
| |
| Return to main page |
| 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.
|
| 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 Evacal D3®, Adcal D3®, (Give 1 tablet twice daily)
|
| (Calcium carbonate tablets chewable 1500mg (15mmol Ca) & colecalciferol 10micrograms (Vitamin D 400units) |
| GREEN Accrete D3®, TheiCal chewable tablets |
| (Calcium carbonate 2.5 gram, Colecalciferol 880 unit) |
| 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 | |
| |
| Return to main page |
| 9.6.5 Vitamin E |
| GREEN Alpha Tocopheryl acetate suspension 500mg/5ml |
| |
| Return to main page |
| 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®) |
| |
| Return to main page |
| 9.6.5 Vitamin E |
| |
| GREEN Alpha Tocopheryl acetate suspension 500mg/5ml |
| |
| Return to main page |
| 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 Orakay® |
| may be offered as an alternative (although Orakay® is unlicensed for this indication). |
| Dose 1mg on day 1 and also day 7 & day 28 for breast fed babies. |
AMBER Phytomenadione capsules 1mg (Orakay®) (unlicensed)
| |
| Return to main page |
| 9.6.7 Multivitamin preparations |
| Prescribing of Multivitamins and phenylalanine-free amino acid substitutes for adults and children with phenylketonuria (PKU) |
| There is no requirement to use specific multivitamins for people with PKU e.g Phlexy-Vit |
| Please refer to Position Statement |
| |
| AMBER Multivitamins for adults and children with PKU (specialist initiation) |
| AMBER Phenylalanine-free amino acid substitutes for adults with PKU (specialist initiation) |
| |
| Dietary management of patients with Cystic Fibrosis - Paravit-CF® capsules/liquid |
| Paravit-CF® is a 'Food for Special Medical Purposes' for the dietary management of patients with cystic fibrosis, which offers |
| patients a decreased oral medication load whilst also being a cost-effective option. |
| AMBER Paravit-CF® capsules (specialist initiation) one capsule contains: |
| Vitamin A (retinyl palmitate) 1500 micrograms (=5000 IU) |
| Vitamin D3 (cholecalciferol) 37.5 micrograms (=1500 IU) |
| Vitamin E (tochopheryl acetate) 100 milligrams (=150 IU) |
| Vitamin K1 (phytomenadione) 5000 micrograms |
| AMBER Paravit-CF® liquid (specialist initiation) - for use in young children or patients with swallowing difficulties. |
NOTE: The prescriber should ensure that when patients with cystic fibrosis are initiated or switched to Paravit-CF® that existing
|
prescriptions for individual ingredients that are included in Paravit-CF ® are discontinued
|
| |
| GREEN Dalivit® drops 25ml |
| GREEN **Abidec® drops 25ml |
| GREEN Vitamin capsules/tablets |
| |
| Vitamin and mineral supplements and adjuncts to synthetic diets |
| ** ELHT neonatal formulary recommends that babies started on Sytron® and/or Abidec® on the Neonatal Intensive Care Unit |
(ELHT) should remain on the treatment for 1 year post birth. GPs in Primary care are requested to continue to prescribe these
|
| products for neonates until the age of 1 year old. |
| |
| GREEN Ketovite® tablets |
| GREEN Ketovite® liquid |
| |
| Forceval® |
| Indications for prescribing of forceval capsules post bariatric surgery. See full guideline |
| |
| Post-surgery if gastric bypass (Roux-en-Y) [See full guideline] |
| AMBER Forceval caps |
| |
| Post-surgery if an adjustable gastric band fitted or sleeve gastrectomy [See full guideline] |
| BLACK Forceval® capsules |
| Patients should be directed to purchase nutritional supplements. |
| |
| NB: Patients that have proceeded with bariatric surgery privately and have subsequently opted to switch their care back to |
| the NHS should be prescribed supplements equivalent to that offered to NHS patients in accordance with the advice |
| above and within the Policy Guidance. [see below] |
| The full Guidance for the prescribing of nutritional supplements post bariatric surgery is available here |
| |
| For the prevention of re-feeding syndrome only |
| RED Forceval® capsules |
|
| |
