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 Formulary Chapter 9: Nutrition and blood - Full Chapter
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09.06  Expand sub section  Vitamins
09.06.02  Expand sub section  Vitamin B group
Thiamine
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Formulary
Green

In line with NICE guidance, oral thiamine should be prescribed for the prevention of WE to harmful or dependent drinkers in whom any of the following apply:

  • They are malnourished or at risk of malnourishment
  • They have decompensated liver disease 
  • They are in acute withdrawal
  • Before and during a planned medically assisted alcohol withdrawal

The recommended dose is 200 to 300 mg daily in divided doses.

Thiamine should be continued for as long as malnutrition is present and/or during periods of continued alcohol consumption.

Following successful alcohol withdrawal, thiamine should be continued for 6 weeks. If after this time the patient remains abstinent and has regained adequate nutritional status, thiamine should be discontinued. Thiamine should be restarted if the patient starts drinking again. Continuing need for thiamine should be reviewed at appropriate intervals which may depend on individual patient circumstances.

For further advice, please see the RMOC vitamin B supplementation in alcoholism

 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
Link  RMOC Oral vitamin B supplementation in alcoholism
Vitamin B & C high potency injection
(Pabrinex®)
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Formulary
Red
 
Link  NICE CG100: Management of alcohol-related physical complications
Link  NICE CG115: Alcohol dependence - diagnosis, assessment and management
09.06.02  Expand sub section  Oral vitamin B complex preparations
Vitamin B Tablets, Compound Strong
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Green

Due to a lack of evidence on their efficacy and safety, vitamin B complex preparations (vitamin B compound and vitamin B compound strong tablets) should not be prescribed for prevention of Wernicke’s Encephalopathy (WE) in alcoholism.

  • Vitamin B complex preparations should not be prescribed for preventing deficiency or for maintenance treatment following treatment for deficiency.
  • Vitamin B complex preparations should not be prescribed as dietary supplements. Patients who wish to use them for dietary supplementation should be advised to purchase them over the counter.
  • Vitamin B compound strong tablets may be prescribed on a short-term basis (10 days) for patients at risk of refeeding syndrome. This also applies to patients who are not harmful or dependent drinkers.

In rare cases where there might be a justifiable reason for prescribing vitamin B complex e.g. medically diagnosed deficiency or chronic malabsorption, vitamin B compound strong and not vitamin B compound should be prescribed as it represents better value for money.

For further advice, please see the RMOC Oral vitamin B supplementation in alcoholism

 

 
Link  RMOC Oral vitamin B supplementation in alcoholism
09.06.02  Expand sub section  Other compounds
09.06.04  Expand sub section  Vitamin D to top
Colecalciferol and Calcium Carbonate
(Theical ® Calci-D ® Accrete D3 One a Day®)
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First Choice
Green

Once daily dosing

TheiCal widely accepted and good compliance

Reduced pill burden

 
Colecalciferol and Calcium Carbonate
(Calcichew-D3 Forte®)
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First Choice
Green Hospital

First choice in hospital

Patients to be reverted back to pre admission option on discharge, unless no longer clinically indicated.

 
Colecalciferol and Calcium carbonate
(Adcal-D3®)
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Second Choice
Green

Second line Ca/Vit D combination product after OD dosing options exhausted.

 

 
Colecalciferol
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Formulary
Green

For use where proven symptomatic defciency (<30nmol/L) and rapid correction is justified

Patients post correction or with insufficiency should be encouraged to self manage through sunlight diet and OTC supplements

Where deemed clinically appropriate please ensure licensed products are prescribed.

 
Alfacalcidol
(One-Alpha®)
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Formulary
Green

Hydroxylated Vitamin D analogue:

Typically limited to patients with severe renal impairment and requiring supplementation

Plasma calcium concentrations need monitoring due to risk of hypercalcaemia at high doses. Hypercalcaemia is indicator of vitamin D toxicity 

ALL patients receiving pharmacological doses of vitamin D require plasma calcium concentrations checking at intervals (once or twice weekly initially and when nausea and vomiting occurs) 

 

 
Calcitriol (Rocaltrol®)
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Formulary
Red
 
Ergocalciferol
(Injection)
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Formulary
Red
 
09.06.06  Expand sub section  Vitamin K
Phytomenadione
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Formulary
Green
 
Menadiol Sodium Phosphate
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Formulary
Yellow
 
09.06.07  Expand sub section  Multivitamin preparations
Mutivitamins
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Formulary
Green

Not routinely used

Exceptions include Individuals with severe malabsorption conditions and on advice of dietician.

Renavit suitable for patients on dialysis to replace water soluble vitamin loss

(Healthy Start Vitamins are not to be prescribed by GP's)

 
09.06.07  Expand sub section  Vitamin and mineral supplements and adjuncts to synthetic diets
Vitamin and mineral supplements
(Forceval®)
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Restricted Drug Restricted
Green

Recommended post bariatric surgery

 
Vitamin and mineral supplements
(Ketovite®)
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Restricted Drug Restricted
Green plus

Prevention of vitamin deficiency in disorders of carbohydrate or amino-acid metabolism

Adjunct in restricted, specialised, or synthetic diets

 
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Drugs that may be initiated, stabilised and maintained by primary, secondary or tertiary care Secondary and tertiary care prescribing may be continued by primary care. [this does not indicate first/second line choice]  

Green Hospital

Items used by the Hospital but would not normally be continued into primary care. Primary care prescribers can change to GREEN first or second.   

Green plus

Initiation of drugs by primary care following written advice from secondary/ tertiary care advice.  

Yellow

Drugs that may be continued in primary care following initiation and stabilisation in secondary/tertiary care  

Amber

Items requiring a shared care agreement. These items should be initiated and stabilised by secondary or tertiary care. The GP should only be asked to take over prescribing through a formal shared care agreement. Secondary care will be expected to continue prescribing until the agreement is made.  

Red

Hospital/ Trust ONLY. These are items the secondary and tertiary care are responsible for prescribing and will need to continue to prescribe for long term maintenance. These items will NOT be prescribed in primary care. But primary care should be informed the patient is receiving these items. This will include NHSE funded items requiring repatriation.  

GP - Black

Items covered by NHSE ‘Should not prescribe in primary care list’ – See CCG policy on Drugs of limited clinical value  

GP - Grey

Grey List: Items covered by NHSE ‘Should not prescribe in primary care list’ that are not to be routinely prescribed but may be suitable in a defined population – See CCG policy on Drugs of limited clinical value  

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