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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.06.04  Expand sub section  Vitamin D
 note 

COVID-19 rapid guideline: vitamin D

This guideline covers vitamin D use in the context of COVID‑19. It is for adults, young people and children in hospitals and community settings. Vitamin D is important for bone and muscle health. Supplementation should not be offered solely to prevent COVID-19

NICE NG187

Alfacalcidol
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Formulary
Green
  • 250 nanogram & 1 microgram capsules
  • 2 microgram/ml sugar-free oral drops – one drop containing approx. 100 nanograms of alfacalcidol 
  • 1 microgram in 0.5ml & 2 micrograms in 1ml injections
 
 
Calcitriol
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Formulary
Green plus

Capsules: 0.25 micrograms, 0.5 micrograms

 
 
Colecalciferol
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Formulary
Green
  • 20 microgram (800 units) capsules or tablets
    • For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels. 
  • 80 microgram (3,200 units) capsules
    • For use in patients with malabsorption such as patients who have had bariatric surgery and require higher maintenance doses 
  • 500 microgram (20,000 units) capsules.
    • For use in patients requiring high strength therapy for vitamin D deficiency. 
  • 2740iu/ml oral solution (Fultium®-D3 Drops) 
  • 1000iu and 3000iu buccal spray (DLux®) unlicensedunlicensed Red Traffic Light
    • Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.
 
 
Colecalciferol 25,000 unit liquid (Invita D3® )
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Formulary
Green
 
 
Ergocalciferol
(Calciferol)
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Formulary
Green
  • 250 microg. (10,000 units) & 1.25mg (50,000 units) tablets.
    • A 3000 units in 1ml suspension (unlicensedunlicensed) may be supplied if colecalciferol oral solution is not available.

  • 7.5mg (300,000 units) in 1ml injection.
 
 
Calcium Carbonate and Colecalciferol
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Formulary
Green
  • Accrete®
    • Film coated tablet containing calcium carbonate 1.5g and colecalciferol 10 micrograms (400 units)
  • Adcal D3®
    • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units (contains soya and sucrose)
    • Effervescent tablet containing calcium carbonate 1.5g and colecalciferol 400 units
  • Cacit D3®
    • Effervescent granule sachet containing calcium carbonate 1.25g and colecalciferol 440 units
  • Calcichew D3 Forte®
    • Chewable table containing calcium carbonate 1.25g and colecalciferol 400 units
  • Evacal®
    • Chewable tablet containing calcium carbonate 1.5g and colecalciferol 400 units
      • approved as chewable option and also to be used in patients with peanut and soya allergy 
 
 
Calcium and Ergocalciferol Tablets
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Formulary
Green
  • Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units).
 
 
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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
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red

Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment. In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances. For all RED drugs automatically added to the formulary in response to a positive NICE TA: Prescribers need to ensure that local Trust new drug governance procedures and pharmacy processes are followed before any prescribing.  

Amber

Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement. The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber. If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.  

Green plus

Drugs normally recommended or initiated by a specialist (hospital or GP with an extended role https://www.rcgp.org.uk/gpwer), but can be safely maintained in primary care with very little or no monitoring required. In some cases there may be a further restriction for use outlined - these will be defined in each case. Provision of additional information, or an information leaflet, may be appropriate in some cases to facilitate continuing treatment by GPs.  

Green

Drugs where prescribing by GPs is appropriate. Can be initiated and prescribed in all care settings, and if appropriate, discontinued without recourse to secondary care.  

Black

NOT APPROVED: Drugs that have been considered by NTAG or the NENC ICB Medicines Subcommittee (or other approved body) and are not approved for prescribing within the North East and North Cumbria.   

Brown

UNDER REVIEW: drugs whose current formulary status or RAG status is currently under review.  

Not Recomended

NOT REVIEWED: Drugs that haven not been reviewed yet. This usually means that an application is in progress. These drugs are not normally considered appropriate for prescribing in the North East and North Cumbria until such time that a decision is taken on their formulary status.  

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