9.6.4 Vitamin D

Alfacalcidol and calcitriol are forms of activated vitamin D which should only be prescribed under the advice of a specialist.

NPSA Safety alert for Alfacalcidol: Highlighting issues with patients developing renal failure due to lack of monitoring of their calcium levels whilst taking alfacalcidol. It states the necessity for the monitoring of bloods to minimise the chance of associated renal problems.

Patients receiving alfacalcidol and calcitriol should have their plasma calcium and phosphate levels checked regularly, at intervals recommended by specialists. Monitoring should be carried out by blood tests taken 1 month after starting, then every 3-6 months depending on the CKD stage. Monitoring is usually completed by specialist services.

Good prescribing principles for alfacalcidol and calcitriol:

  • Micrograms and nanograms should not be abbreviated
  • Avoid the use of decimals by using alternative units of measure (e.g. use 250 nanograms instead of 0.25 micrograms).
  • Take additional care with alfacalcidol oral drops, 2 micrograms/ml; one drop contains approximately 100 nanograms.
Alfacalcidol
  • Capsules 250 nanograms, 500 nanograms, 1 micrograms (click here for preferred brand)
  • Oral drops 2 micrograms in 1ml (£21.30 = 10ml)
  • Injection 2 micrograms in 1ml

Indications

  • Vitamin D supplementation in severe renal impairment

Dose

  • As recommended by specialist

Notes

  1. To be prescribed by a specialist for patients with CKD only
  2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Calcitriol
  • Capsules 250 nanograms, 500 nanograms (£10.10 = 500 nanograms daily)
  • Injection 1 microgram in 1ml, 2 micrograms in 1ml

Indications

  • Vitamin D supplementation in severe renal impairment

Dose

  • As recommended by specialist

Notes

  1. To be prescribed by a specialist for patients with CKD only

Colecalciferol (vitamin D3)

For guidance on the management of vitamin D deficiency, please refer to Management of vitamin D deficiency.

For guidance on the use of vitamin D in patients with osteoporosis please refer to Osteoporosis guidance.

Clinicians should use the cheapest preparation available after consideration of clinical indications and potential risks.

Vitamin D is a fat soluble vitamin. Supplements containing vitamin D should therefore be taken with food to aid absorption.

Colecalciferol

Indications and corresponding dose

  • Tablets
    • Treatment of vitamin D deficiency in adults: 50,000 units/week for 6 weeks
    • Maintenance therapy following treatment of deficiency in adults / Prevention of deficiency in adults / Adjunct to specific therapy for osteoporosis in adults: 25,000 units/month or 1,000 units/day. In certain situations higher doses may be required
  • Oral solution
    • Vitamin D deficiency in adults: 50,000 units per week for 6-8 weeks
    • Prevention of adult vitamin D deficiency: 25,000 units per month, higher doses may be required in certain situations
    • Adjunct to specific therapy for osteoporosis: 25,000 units per month

Notes

  1. When using the oral solution, the 50,000 units / ml, 1ml ampoule, should be used for the treatment of vitamin D deficiency.
  2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Fultium-D3®

(Colecalciferol)

  • Capsules 80 micrograms (3200 units) (£12.43 = one daily)

Notes

  1. To be used only in patients with hyperparathyroidism in the perioperative period.
  2. For specialist initiation only.
Ergocalciferol
  • Injection 300,000 units in 1ml

Colecalciferol (vitamin D3) plus calcium

For specific advice on the use of calcium with or without Vitamin D in osteoporosis see section 6.6.2 Bisphosphonates

It is accepted that patients post bariatric surgery may require non-formulary products and/or off-label doses. Specialists should be consulted for further advice.

Colecalciferol with calcium carbonate

Notes

  1. The chewable tablets are a once daily preparation which may aid patient compliance
  2. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Colecalciferol with calcium phosphate

Notes

  1. Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)

 

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