9.6. Vitamins
9.6.1. Vitamin A
9.6.2. Vitamin B group
9.6.3. Vitamin C
9.6.4. Vitamin D
Restrictions:
Restricted to specialist initiation.
Prescribing Notes:
Not suitable for treatment of vitamin D deficiency.
Prescribing Notes:
The current preferred calcium and vitamin D preparations in Acute Services and Primary Care are
- Accrete D3 One A Day chewable tablets (once daily) is first-line preparation
- Accrete D3 film-coated tablets (twice daily) is second-line preparation for patients who do not tolerate the first-line preparation. Not suitable for patients with peanut or soybean allergy, and patients requiring a gelatin free preparation.
- Adcal D3 Dissolve effervescent tablets (twice daily) preparation of choice for patients with swallowing difficulties or who have enteral tubes.
- Adcal D3 chewable tablets are available for oncology patients to reflect oncology protocols. Not suitable for patients with peanut or soybean allergy, and patients requiring a gelatin free preparation.
Please note: Calcium and vitamin D preparations may vary in strength, dosage and frequency.
Restrictions:
These formulations of calcium and vitamin D are restricted to use when Preferred List formulations are not tolerated.
Prescribing Notes:
Calcium and vitamin D tablets, chewable tablets and effervescent tablets are the preferred formulations (see Preferred List).
Please note: Calcium and vitamin D preparations may vary in strength, dosage and frequency
Restrictions:
Not approved for use in osteoporosis.
Prescribing Notes:
excluding Calcijex® preparation.
Restrictions:
Excludes Fultium D3 3,200 unit strength. Invita D3 oral ampoules are restricted to use only when other oral vitamin D preparations are not suitable.
Prescribing Notes:
For NHSGGC guidance on when to measure vitamin D levels and the subsequent management of vitamin D deficiency and insufficiency click here. Also see the Prescribing Resources page for further useful documents.
Vitamin D supplementation usually falls into two broad categories, low dose supplementation and high dose supplementation. Low dose is considered to be doses of 1,000 units daily or less and is used most often for supplementation in insufficiency states. High dose vitamin D is considered to be doses in excess of 20,000 units per week. High dose vitamin D is more likely to be used in deficiency states leading to morbidity.
9.6.5. Vitamin E
Restrictions:
Restricted to specialist initiation .
Prescribing Notes:
Alternative name is alpha tocopheryl acetate. Available as a 500mg/5ml suspension.
9.6.6. Vitamin K
Prescribing Notes:
Menadiol sodium phosphate - a water soluble oral preparation to prevent vitamin K deficiency in malabsorption syndromes. Contraindicated in late pregnancy. BNF link
Phytomenadione - used for the prophylaxis and treatment of vitamin K deficiency bleeding and for the reversal of the anticoagulant effect of warfarin. It is available as tablets and as injection. BNF link
9.6.7. Multivitamin preparations
Restrictions:
Restricted to specialist initiation
- As first-line multi-vitamin preparation only for patients with Cystic Fibrosis related liver disease who require vitamin K supplementation
- As a second-line multi-vitamin treatment option only for patients with Cystic Fibrosis who cannot tolerate standard multi-vitamin regimens.
Restrictions:
Restricted to specialist initiation for use in patients undergoing peritoneal dialysis.