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9.10 Vitamin deficiency

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

9.10 Vitamin deficiency

 

Multivitamin preparations

 

Vitamin

  • Capsules BPC       

Notes:

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use

 

Vitamin tablets

(with calcium and iodine) for nursing mothers

  • Tablets vitamin A 8mg, ascorbic acid 60mg, ergocalciferol 400 units, calcium hydrogen phosphate 190mg, potassium iodide 130 micrograms, ascorbic acid 60mg

Notes: 

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use
  • Women who are (or may become) pregnant are advised not to take this supplement except on the advice of a doctor or antenatal clinic.

 

 

Forceval® (Amber 1) 

  • Capsules 

Notes:

  • Forceval contains vitamins and minerals and must be recommended by a dietitian/gastroenterologist stating the indication and duration of therapy

    On hospital discharge, patients will receive 2 weeks supply as part of their TTOs and GPs should not continue the prescription, unless they receive a letter from the dietitian/specialist to continue therapy stating an indication and duration of therapy

 

Abidec® (Amber 1) 

  • Oral drops

 

Dalivit® (Amber 1)

  • Oral drops

 

Ketovite® (Amber 1)

  • Tablets
  • Liquid

Note: Ketovite tabs (taken three times a day) and liquid (5ml daily in addition to the tablets) are included for use in disorders of carbohydrate or amino acid metabolism.

 

 

Vitamin A

Vitamin A

  • Injection 100,000 iu in 2ml           

 

 

Vitamin B group

Vitamin B Compound

  • Tablets    

 

Vitamin B Compound Strong

  • Tablets  

 

Thiamine B1

  • Tablets 50mg, 100mg
  • Injection 250mg in 5mL  (Unlicensed)     

 

Pyridoxine B6

  • Tablets 10mg, 20mg, 50mg
  • Injection 50mg in 2mL  (Unlicensed)   

  

Pabrinex® (vitamin B substances with ascorbic acid)

  • Injection I/M High potency
  • Injection I/V High potency  

 

 

Vitamin C

Ascorbic Acid

  • Tablets 50mg,100mg, 500mg

Notes:

  • Should not be prescribed in Primary Care or at Discharge
  • Advise patient to purchase, unless prescription is for long-term regular use
  • Deficiency is rare and ascorbic acid is not recommended.
  • In iron deficiency states ascorbic acid may increase gastro-intestinal iron absorption but its role in clinical practice is not established.

 

 

 

Vitamin D preparations and analogues

 

Vitamin D deficiency in ADULTS

 

Vitamin D deficiency in CHILDREN

 

Vitamin D for AT RISK GROUPS

 

Vitamin D letter

 

Vitamin D deficiency in PREGNANCY

 

Treatment of vitamin D deficiency in pregnancy

  • In line with the guidance from Royal College of Obstetricians and Gynaecologists, MKPAG recommends a treatment dose of Fultium D3 20,000 IU per week for 4 to 6 weeks, followed by a maintenance dose of InVita D3 800 IU daily.
  • The maintenance therapy should be continued throughout the pregnancy.
  • Also in line with the Royal College of Obstetricians and Gynaecologists Guidance, treatment doses should not be given in the first trimester.

 

Vitamin D insufficiency in pregnancy

  • In line with the guidance from Royal College of Obstetricians and Gynaecologists, MKPAG recommends a dose of up to 2000 IU daily. This can be prescribed as one or two Invita D3 800 IU daily and should be continued throughout the pregnancy.
  • For supplementation in pregnancy, MKPAG recommends either Healthy Start vitamins if the woman is eligible or self purchase over-the-counter. These products should not be recommended or supplied as prescribed medication.

 

 

Fultium D3

  • Capsules containing 20,000 IU colecalciferol (= 500 micrograms vitamin D)

 

InVita D3®

  • 800 IU capsules containing colecalciferol 
  • 5,600 IU capsules containing colecalciferol (This strength allows weekly dosing)
  • 50, 000 IU capsules containing colecalciferol 
  • 25,000 units/mL oral solution 
  • 50,000 units/mL oral solution 
  • 2,400 units/mL oral drops, solution      

Note:

  • May be mixed with a small amount of cold or lukewarm food immediately before administration.  

 

Desunin

  • Tablet 800iu (Colecalciferol)

 

Alfacalcidol (Amber 2)

  • Capsules 250 nanograms, 500 nanograms, 1 microgram
  • Oral drops 2 microgram in 1mL
  • Injection 2 micrograms 1mL (1mL ampoules)

            

Calcitriol (Amber 2) 

  • Capsules 250 nanograms, 500 nanograms
  • Injection 1 microgram in 1mL, 2 micrograms in 1mL            

 

Colecalciferol (vitamin D3)

  • Liquid 3,000 units in 1mL U  

     

Ergocalciferol (vitamin D2)

  • Injection 300,000 units in 1mL  

 

 

Vitamin D Preparations with Calcium

 

Before calcium supplements are initiated, dietary calcium should be optimised. Below are two links from the National Osteoperosis Foundation with information on this:

 

 

Adcal D3®

  • Chewable tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3)
  • Caplets containing 300mg Calcium and 200units of vitamin D (as vitamin D3)
  • Dissolve, effervescent tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3)

Calceos®

  • Chewable tablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3)

Calcichew® D3 Forte

  • Chewable tablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3)

Calcichew® D3 500mg/400iu Caplets

  • Tablets containing 500mg calcium and 400 units of vitamin D (as vitamin D3)

 

 

Vitamin E

 

Alpha tocopheryl acetate (Amber 3)

  • Suspension 500mg in 5ml

 

 

Vitamin K

 

Local Guideline:

 

Phytomenadione (Amber 1) 

  • Injection (Konakion® MM Paediatric) 2mg in 0.2mL  [May be administered by mouth, intramuscular injection or intravenous injection]. See local guideline above
  • Injection (Konakion MM) 10mg in 1ml. Not for intramuscular administration 

Notes:

  • Vitamin K in the newborn – The recommendation of the Chief Medical Officer and the Chief Nursing Officer is that all newborn babies should receive vitamin K to prevent vitamin K deficiency bleeding (previously termed haemorrhagic disease of the newborn).
  • For preterm neonates, see BNF for Children.  

 

Menadiol sodium phosphate (Amber 1) 

  • Tablets 10mg       

Notes:

  • Menadiol sodium phosphate is water-soluble and is included for use where patients have fat malabsorption syndromes.

 

 

 

 

Dried Prothrombin Complex (Octaplex)

  • Available from Pathology - Blood Bank

 

 

 

 

Neural tube defects (prevention in preganancy)

Periconceptional Folic Acid and Food Fortification in the Prevention of Neural Tube Defects (SAC Opinion Paper 4)

Recommendations of an expert advisory group of the Department of Health include the advice that:

  • To prevent recurrence of neural tube defect (in a child of a man or woman with spina bifida, or if there is a history of neural tube defect in a previous child). Women who wish to become pregnant (or who are at risk of becoming pregnant) should be advised to take folic acid supplements at a dose of 5mg daily (reduced to 4mg daily if a suitable preparation becomes available). Supplementation should continue until the twelfth week of pregnancy. Women receiving antiepileptic therapy need individual counselling by their doctor before starting folic acid.
  • To prevent first occurrence of neural tube defect women who are planning a pregnancy should be advised to take folic acid as a medicinal or food supplement at a dose of 400 micrograms daily before conception and during the first 12 weeks of pregnancy. Women who have not been supplementing and who suspect they are pregnant should start at once and continue until the twelfth week of pregnancy.
  • There is no justification for prescribing multiple-ingredient vitamin preparations containing vitamin B12 or folic acid.

 

 

 

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

 

 

 

Return to Chapter: 9. Nutrition and Blood

Last updated by: Sheila Wood on 03-07-2019 10:12