[Skip to content]

Print this page
.

9.6 Vitamin D, vitamin K, multivitamins

9.6.4 Vitamin D

Colecalciferol with calcium

Calcium and ergocalciferol tablets - see notes
Adcal-D3 tablets, effervescent tablets, caplets

 

Colecalciferol

Colecalciferol capsules, 800 units (Fultium-D3), 20,000 units; oral solution (InvitaD3)  - see note
Ergocalciferol injection 300,000 units/ml

 

Others

Alfacalcidol capsules, drops, injection
Calcitriol capsules
Paricalcitol capsules - third line option for management of hypercalcaemia due to secondary hyperparathyroidism (in patients resistant/intolerant to alfacalcidol and cinacalcet. Consultant nephrologist use only. Hospital use only.

 

Notes:

1. Calcium with ergocalciferol tablets should be crushed or chewed.

2. Adcal D3 caplets can be swallowed; Adcal D3 tablets should be chewed.

3. A substitution policy is in place to empower clinical pharmacist to undertake the formulary substitution of calcichew D3 forte with Adcal D3. Substitution of Calcichew used for phosphate binding in renal patients should not be undertaken.

4. Prophylactic doses of calciferol are recommended for simple deficiency. The elderly, Asians and others with little exposure to sunlight are particularly at risk. Prophylaxis is especially recommended in pregnant Asian women. Calcium with ergocalciferol tablets contains a prophylactic dose of calciferol (400 units/tablet) when taken daily. Alternatively a single pharmacological dose has been advocated e.g. 100,000 units inhection 6-12 monthly.

5. Alfacalcidol is preferable to calciferol in osteodystrophy resulting from renal failure; calcitriol is similar but more expensive (but may be prefered with patients with co-existing renal and liver impairment). Both are more potent than calciferol and have a shorter onset and offset of action, useful for acute deficiencies.

Prevention of harm with alfacalcidol preparations - NPSA Signal Sept 2011
Key points include:

  • Patients should have their plasma calcium levels measured from time to time (these should initially be checked once or twice and whenever nausea and vomiting occurs; when the dose is stabilised, measurements may be taken every two to four weeks)
  • incorrect strength prescribed, dispensed or administered due to confusion over micrograms and nanograms in capsules (e.g. 250 micrograms prescribed instead of 250 nanograms)
  • administering wrong oral liquid doses caused by confusion with the product strength (2 micrograms/ml; one drop contains 100 nanograms).
  • Micrograms and nanograms must not be abbreviated.
  • The use of decimals is avoided by using alternative units of measure (e.g. use 250 nanograms instead of 0.25 micrograms).
  • Care is required in selecting the correct alfacalcidol products which are labelled in micrograms with leading zeros.

6. Colecalciferol 20,000iu capsules are available for the treatment of Vitamin D deficiency and insufficiency, osteomalacia and rickets. They are unlicensed. In longer term use, serum and urinary calcium and serum creatinine should be monitored.

GUIDANCE ON THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF VITAMIN D DEFICIENCY IN PRIMARY CARE

 

Dosage:

INDICATION and DOSE - VITAMIN D

i) Prophylaxis

400 units/day (e.g. as one calcium with ergocalciferol tablet)

ii) Prophylaxis during pregnancy and lactation.

400-1200 units daily e.g. (as calcium and ergocalciferol tablets daily)

iii) Osteomalacia /rickets

Usually calciferol 1000-3000 units daily. Up to 40,000 units may be required by patients with malabsorption. May also be given parenterally: 300,000 units by IM injection, repeated at 3-monthly intervals or as required.

iv) Osteomalacia due to prolonged use of anticonvulsants and other enzyme inducing drugs

Calciferol 2,000 to 4,000 units daily.

 

9.6.5 Vitamin E

Alpha tocopheryl acetate suspension

 

9.6.6 Vitamin K

Menadiol sodium phosphate tablets
Phytomenadione injection, capsule

Note:

Menadiol sodium phosphate is a water soluble Vitamin K derivative that is preferable to oral phytomenadione in the presence of fat malabsorption, for example in cholestasis.

This includes obstetric cholestasis, although the evidence for reduced risk of haemorrhage when vitamin K is given is mixed. Menadiol is contra-indicated in late pregnancy (risk of neonatal haemolytic anaemia, hyperbilirubinaemia and kernicterus) but is probably necessary in cases of cholestasis. Patients should be advised of its off-licence use and the neonatologists advised of in utero exposure so that baby can be monitored for haemolytic disease of the newborn. Click here for medicines Q&A for guidance on use of vitamin K in obstetric cholestasis

 

9.6.7 Multivitamin preparations

Abidec drops - see note
Multivitamin tablets
Ketovite tablets, liquid
Forceval capsules (for specialist initiation only)
Renavit tablets - renal vitamins B&C - for use in haemodialysis patients only on a pre-printed prescription form. Dose 1 tablet daily.

Note:

Some babies and children many continue on Dalivit but new patients will be given Abidec.

 

 

 

 

For link to BNF section: 9.6 Vitamins