9.6.4 Vitamin D

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)
    • 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

Licensed Vitamin D Preparations

Dosage

Price (28 days)

As per DM+D March 2022

400IU Daily

Invita D3® 400IU (10mcg) caps

†note this dose is off-label

1 daily†£1.85

Invita D3® 2400IU/ml drops ‡ (1 drop contains 67 IU)

‡only licensed in children, pregnancy and breastfeeding

6 drops daily (400IU/10mcg)

£1.68

800IU Daily

Strivit D3® 800IU (20mcg) caps

1 daily£2.33

Invita D3® 800IU (20mcg) caps

1 daily£2.50

Desunin® 800IU (20mcg) tabs

1daily£3.36

Fultium D3® 800IU (20mcg) caps

1 daily£3.36

Thorens® 10,000IU/ml drops (1 drop contains200IU)

4 drops daily (800IU/20mcg)£1.31

1000IU Daily

Stexerol D3® 1000IU (25mcg) tabs

1 daily

£2.95

5600IU weekly

Invita D3® 5600IU (140mcg) caps

1 weekly£2.50

3200IU daily

Fultium D3® 3200IU (80mcg) caps

1 daily£12.43

Strivit D3® 3200IU (80mcg) caps

1 daily£8.70

4000IU daily

Desunin® 4000IU (100mcg) tabs

1 daily£6.36

Stexerol D3® 1000IU (25mcg) tabs

4 daily£11.80

20,000IU weekly

Strivit D3® 20,000IU (500mcg) caps

1 weekly£3.84

Fultium D3 20,000IU caps

1 weekly £4.54

Plenachol D3 20,000IU caps

1 weekly £3.60

25,000IU weekly

Thorens® 25,000IU/2.5ml drops

2.5ml weekly£5.85

InVita 25,000IU caps

1 weekly £5.26

Stexerol D3 25,000 tabs

1 weekly £5.67

40,000IU weekly

Fultium D3® 20,000IU (500mcg) caps

2 weekly£9.09

Plenachol® 40,000IU (1000mcg) caps

1 weekly£6.00

50,000IU weekly

Invita D3® 50,000IU (1250mcg) caps

1 weekly£6.60

Invita D3 50,000/ml oral solution

1ml weekly £8.33

Stexerol D3® 25,000IU (625mcg) tabs

2 weekly£11.33

* 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