9.6.4 Vitamin D
- Vitamin D is administered as either D2 (ergocalciferol) or D3 (cholecalciferol) salts. Cholecalciferol has been reported to raise serum vitamin D concentrations more effectively than ergocalciferol and is the drug of choice.
- Licensed vitamin D products are now emerging on the UK market and should be chosen instead of nutritional supplements or ‘specials’ in patients requiring treatment doses. Please click here for a table of licensed vitamin D products.
- Prescribers are asked to avoid generic prescribing of vitamin D 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).
- 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.
- The Department of Health (NI) issued updated advice to the public in 2017 on how much vitamin D they need and how to obtain it. Full details can be found here.
- Advising individuals to purchase over-the-counter is the preferred option for prevention of deficiency. For those on low-income, Healthy Start Vitamins are available. If a prescription is issued, licensed drops (see table) or nutritional supplements (brand names include ProD3®) should be supplied, rather than ‘specials’. Food supplements are however not subject to the same assessments for quality, safety and efficacy as licensed medicines. They are reasonably low cost depending on brand.
- Muslim women are shown to be particularly at risk of vitamin D deficiency, and will need Halal certified vitamin D supplementation (Halal refers to foods or non-food items such as cosmetics or pharmaceuticals permitted by and prepared according to Islamic law. Officially certified Halal products should be independently confirmed as being permitted and prepared in a Halal compliant manner). All products in the Pro D3® range can be considered Halal.
- For patients who require therapeutic doses of vitamin D, a number of licensed vitamin D products are now available and should be selected. See also link to National Osteoporosis Society guidance on Vitamin D and Bone Health.
Calcium and vitamin D supplements
|1st choice||Adcal-D3® Caplets (chewable) containing 750mg calcium and 200 units colecalciferol|
Dose: Two tablets twice a day
|2nd choice||Calceos® chewable tablets containing 500mg calcium and 400 units colecalciferol||Dose: One tablet twice a day|
|Reserve (for patients who cannot swallow caplets or take chewable tablets)||Calfovit D3® powder for oral suspension containing 1200mg calcium and 800 units colecalciferol||Dose: 1 sachet per day (it is advised to take during the evening meal)|
- See section 6.6 for the prevention and treatment of postmenopausal osteoporosis.