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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

Nutrition/Blood related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Nutrition/Blood related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

Self-care

Many of the products in this chapter are available for purchase over-the-counter, and patients are encouraged to self-care, with the support of their community pharmacist, in the first instance.

For further information on self-care & the NHS, please refer to https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/

 Details...
09.06.04  Expand sub section  Vitamin D
 note 

At risk groups to receive Vit D   Updated 19th Jan 2021
DHSC guidance for anyone who is CEV and/or in residential and nursing care homes, and has been offered a free supply of vit D supplements in England: 

·         Vitamin D and clinically extremely vulnerable (CEV) guidance

·         Vitamin D and care homes guidance

Healthcare professionals with queries concerning the guidance for care homes can email:
BaNES- BSWCCG.banes.moch@nhs.net
Swindon- BSWCCG.swindon.moch@nhs.net
Wiltshire- BSWCCG.wiltshire.moch@nhs.net

The BSW Medicines Optimisation Team remind prescribers that vit D should only be prescribed for proven vit D deficiency and only for patients who are classified as high risk for prevention or maintenance of vit D deficiency. All other patients should purchase their vit D over the counter. Colecalciferol is available at most pharmacies, large supermarkets and health food shops.

Routine monitoring of serum vit D levels is also not recommended. Monitoring and prescribing advice can be found in the BSW vitamin D guidance: Treatment of vitamin D deficiency in adults

The British Dietetic Association has advised that you cannot boost your immune system and no specific food or supplement will prevent you catching COVID-19/Coronavirus here. Good hygiene practice remains the best means of avoiding infection. Patients should be advised to only take vit D as recommended by PHE https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d.

SPS Which oral vitamin D products are suitable for people with vegetarian or vegan diets?

Colecalciferol and calcium carbonate
(Accrete D3)
(Tablet)
View adult BNF View SPC online
First Choice
traffic lightGreen
  • First line for primary care across BSW; Cost effective alternative to Calceos
  • Film coated tablet - calcium carbonate 1.5 g (calcium 600 mg) and colecalciferol 10 micrograms (400 units) [Dose: 1 tablet twice daily]
  • Chewable tablet - calcium carbonate 2.5 g (calcium 1000 mg) and colecalciferol 22 micrograms (880 units) [Dose: 1 tablet once daily]
 
Colecalciferol and calcium carbonate
(Adcal-D3)
(Oral)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Caplets containing 300mg/ 7.5mmol calcium and 200 units/5micrograms of vitamin D (as vitamin D3/coleclciferol. Dose: 2 caplets twice daily
  • Chewable tablets containing 600mg/15 mmol calcium and 400 units/ 10micrograms of Vitamin D (as vitamin D3/colecaciferol). Dose: 1 tablet twice daily.
  • Dissolve, effervescent tablets containing 600mg calcium and 400 units of vitamin D (as vitamin D3). Dose: 1 tablet twice daily. 
  • First line choice within GWH
 
 
Colecalciferol and calcium carbonate
(Calfovit D3)
(Powder)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • For patients unable to take chewable tablets or capsules.
  • Powder- calcium phosphate (calcium 1.2g/ 30mmmol) and 800 units/20micrograms colecalciferol per sachet.
  • For patients requiring calcium and vitamin D via enteral feeding. Calcium phosphate 1.2g or 30mmmol calcium and colecalciferol 20micrograms or 800 units per sachet. 
  • CALFOVIT D3 is indicated in adults and elderly. The safety and efficacy of CALFOVIT D3 in children has not been established; therefore, CALFOVIT D3 should not be used in this population. No data are available.
 
 
Colecalciferol and Calcium carbonate
(Calcichew-D3 Forte)
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Chewable tablets containing 500mg / 12.5mmol calcium and 400 units /10micrograms of vitamin D (as vitamin D3) Dose: 1 tablet twice a day
  • Not on formulary at GWH
 
 
Colecalciferol and calcium carbonate
(Calceos)
(Tablet)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Chewable tablets containing 500mg/12.5mmol calcium and 400 units/ 10micrograms of Vitamin D (as Vitamin D3/colecalciferol)
  • Dose: 1 tablet twice daily. 
 
 
Alfacalcidol
(One-Alpha)
(Oral)
View adult BNF View SPC online
Formulary
  • Green Salisbury 
  • Amber Swindon
  • Amber with Shared Care BaNES
  • Capsules 250 nanograms, 500 nanograms, 1 microgram
  • Oral drops- 2 micrograms/mL, one drop contains approximately 100 nanograms
  • BaNES : Recommended brand - One- Alpha
  • Note: Patients receiving alfacalcidol or calcitriol should have their plasma calcium levels checked regularly (at intervals recommended by specialist, usually evey 3-6 months)
  • Traffic light under review (March 2021)
 
Link  RUH - Alfacalcidol for the treatment of hypocalcaemia Shared Care Document
 
Calcitriol
(Capsule)
View adult BNF View SPC online
Formulary
traffic lightAmber
  • 250 nanograms, 500 nanograms
  • For renal indication only. 
  • Note: Patients receiving alfacalcidol or calcitriol should have their plasma calcium levels checked regularly (at intervals recommended by specialist, usually every 3-6 months)
 
 
Colecalciferol
(Fultium D3)
(capsule)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Note: These are not included in the BSW Vitamin D guidance but may be in use in acute trusts in line with hospital contract
  • 20,000 unit, 3200 unit, 800 unit available 
  • Licensed for use in children 12-18 years old and adults.
  • Please note capsules contain gelatin

 

 
 
Colecalciferol (Stexerol D3)
(Tablets)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • 25,000 unit or 1,000 unit.
  • Tablets containing 25,000 units vitamin D3 (625 micrograms) colecalciferol
  • Loading Dose: TWO tablets (50,000 units) per week for 6 weeks
  • Maintenance dose: ONE tablet (25,000 units) monthly (packs of 12) 
  • Tablets containing 1,000 units Vitamin D3 ( 25 micrograms) colecalciferol
  • Maintenance dose: ONE tablet (1,000 units) daily
  • Stexerol film-coated tablets are suitable for vegetarians, certified halal & kosher, peanut oil free, soya oil free, gelatine free, & gluten free. The tablets can be crushed or swallowed whole and can be taken with food. The vitamin D is derived from sheep’s wool so they may not be suitable for vegans but they are suitable for vegetarians.
  • Use as per local vitamin D guidance above.
 
 
Colecalciferol 25,000 unit/ml
(Invita D3)
(Liquid)
View adult BNF View SPC online
Formulary
traffic lightGreen
  • Licensed for use in children 0-18 years old and adults with swallowing difficulties.
  • May be mixed with a small amount of cold or lukewarm food immediately before administration. 
  • Use as per local vitamin D guidance above.
 
 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Traffic LightRed

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Traffic LightAmber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Traffic LightAmber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Traffic LightGreen

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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