Prescribing Notes
- The Department of Health (NI) issued advice to the public on how much vitamin D they need and how to obtain it. Full details can be found here.
- Vitamin D is available as either D2 (ergocalciferol) or D3 (colecalciferol) salts. Colecalciferol has been reported to raise serum vitamin D concentrations more effectively than ergocalciferol and is the drug of choice.
Prevention of deficiency:
- Advising individuals to purchase a vitamin D preparation over-the-counter is the preferred option for prevention of deficiency. They are reasonably low cost, depending on brand. For those on low-income, Healthy Start Vitamins may be available.
- If a prescription is issued:
- generic prescribing should be avoided to ensure expensive ‘specials’ are not dispensed (‘specials’ is a general term widely used to describe unlicensed medicines made to meet the special clinical need of an individual patient and can only be supplied when there is no available licensed medicine which fully meets the patient’s needs)
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- a licensed product (see table below) or a nutritional supplement should be selected. Food supplements are however not subject to the same assessments for quality, safety and efficacy as licensed medicines.
- muslim women are shown to be particularly at risk of vitamin D deficiency and will need a Halal certified vitamin D preparation. An example halal nutritional supplement is Pro D3 and example licensed products are Fultium D3 or Invita D3.
Treatment of deficiency:
- See NICE CKS ‘Vitamin D deficiency in adults’ on when to treat for deficiency
- In patients requiring treatment doses, generic prescribing should be avoided as above and a licensed vitamin D product should be chosen, not a nutritional supplements or ‘special’. See table of licensed vitamin D products below.
- Pharmacists are asked to order vitamin D preparations via usual pharmacy wholesalers, rather than placing an order for a ‘special’ as this is associated with higher costs.
Licensed Vitamin D Preparations
* This information has been compiled to demonstrate how colecalciferol supplementation may be prescribed using different cost effective licensed preparations of various strengths. Prescribers should refer to the individual product’s SPC for specifics on treatment and prevention doses and durations as well as that in pregnancy or higher risk populations e.g. obese patients, those that are hospitalised or have malabsorptive syndromes.
Calcium and vitamin D supplements
See link to 6.6.1.1