9.6 Vitamin deficiencies

9.6.1 Multivitamins

Complete multivitamin with minerals and trace elements

Suitable brands include: Forceval^® Capsules, Sanatogen Complete A-Z^® (or equivalent complete multivitamin with trace elements at lowest acquisition cost)

• Forceval^® soluble is reserved for patients with swallowing difficulties or if given via enteral tube.

• These products may be used twice a day for a specified short period of time on the advice of a clinical Dietitian for severe inflammatory states or other conditions that incur higher than normal vitamin / trace element requirements e.g. burns patients. 

• TLS is dependent on indication - see below.

TLS Red indications

• For use according to Refeeding Guidelines
• For use immediately following gastric bypass surgery and sleeve gastrectomy

TLS Amber Specialist Recommended indications

• To maintain normal levels in intestinal failure patients under the care of the nutrition team

TLS Blue indications

• To ensure nutritional adequacy for patients with malnutrition, specifically of micronutrients, under the direction of a dietitian/ nutrition specialist only
• To ensure nutritional adequacy for patients following bariatric surgery, under the direction of a dietitian/ nutrition specialist only 

Please note, all other indications are non-formulary.

Complete multivitamin without minerals and trace elements

Multivitamin tablets (TLS Green)

• Ensure brands with lowest acquisition cost are used

Specific indications/ formulations of multivitamin without minerals and trace elements:

Abidec^® / Dalivit^® (TLS Blue)

• Only if unable to swallow

N.B. Abidec^® & Dalivit^® are not complete multivitamin preparations. They contain no vitamin E and only small amounts of vitamins A, B, C and D. They also do not contain any minerals.

Product contains peanut oil.

Renavit^® (TLS Blue)

• Nutritional Supplement for Haemodialysis or Continuous Ambulatory Peritoneal Dialysis. See BNSSG Renavit Prescribing Guidelines
• Renavit^® contains gelatin. Please be aware that patients may not wish to consume gelatin for cultural reasons. Please check latest SPC for further information
• Only contains water soluble vitamins B and C

Paravit-CF^® (TLS green)

• For Cystic Fibrosis patients only
• Liquid preparation for patients with swallowing difficulties
• Only contains fat soluble vitamins A, D, E, K

Parenteral administration

Nutritain (TLS Red)

• Fat soluble vitamins (A, D, E, K)

Vitlipid N adult (TLS Red)

• Water soluble and fat soluble vitamins (except vitamin K)

Cernevit (TLS Red)

• Water and fat soluble vitamins

9.6.2 Vitamin A

Not recommended

Vitamin A+D (TLS Amber Specialist Recommended)

• For use in deficient patients with intestinal failure

Vitamin A+D (TLS Green)

• For use in Cystic Fibrosis patients only

9.6.3 Vitamin B group

Please refer to local protocols for management of alcohol withdrawal.

Thiamine (oral) (TLS Green)

Pyridoxine (oral) (TLS Green)

Vitamin B compound strong (oral) (TLS Green)

Vitamins B & C high potency (intravenous) (Pabrinex^®) (TLS Red)

• Potentially serious allergic adverse reactions may occur during or shortly after administration of Vitamins B & C high potency intravenous (Pabrinex^®)

Vitamin B and C concentrate (Generic) (Intravenous) (TLS red)

Alternative:

Vitamins B & C high potency (intramuscular) (Pabrinex^®) (TLS blue)

Thiamine hydrochloride solution for injection (TLS Blue)

 See BNSSG Remedy page Alcohol Misuse for further information, including information on Detox in Primary Care

Department of Health and Social Care (DHSC) has issued a medicine supply notification for Pabrinex® (Vitamins B and C) Intravenous and Intramuscular  High Potency solution for injection ampoules. Please see Stock Shortages page for more information. 

9.6.4 Vitamin C

Ascorbic acid (oral & parenteral) (TLS Green)

9.6.5 Vitamin D

BNSSG Adult Vitamin D Primary Care Prescribing Guidance

BNSSG Vitamin D Patient Information Leaflet

UHB leaflet 'Vitamin D for your baby and you' 

UHB Guideline 'Vitamin D Deficiency prevention in pregnancy and for breastfed neonates'

Alfacalcidol capsules/drops (TLS Green)

Alternative:

Calcitriol capsules (TLS Green)

Alfacalcidol (parenteral) (TLS Red)

Specific Indication:

Calcitriol (parenteral) (TLS Red)

• For Renal and Haematology teams only 

Colecalciferol (oral) (TLS Green)

• For the prevention and treatment of vitamin D deficiency
• As an adjunct to specific therapy for osteoporosis in patients with vitamin D deficiency or at risk of vitamin D insufficiency
• A range of licensed formulations are available. Consult product literature for licensed doses as necessary.
• Many products contain bovine gelatine, which may or not be certified Halal or Kosher. Other products contain Arachis (peanut) oil. Consult product literature as necessary

Colecalciferol / Calcium (oral) (TLS Green)

• For the prevention and treatment of calcium, and vitamin D deficiency
• As an adjunct to specific therapy for osteoporosis in patients at risk of vitamin D and calcium combined insufficiencies
• A range of licensed formulations are available. Consult product literature for licensed doses as necessary
• Many products contain bovine gelatine, which may or not be certified Halal or Kosher. Consult product literature as necessary

Ergocalciferol (parenteral) (TLS Red)

9.6.6 Vitamin E

Alpha tocopheryl acetate suspension (TLS Green)

Valupack Vitamin E capsules (TLS Green)

Vita-E capsules (TLS Blue)

9.6.7 Vitamin K

Menadiol sodium phosphate tablets (TLS Green)

Phytomenadione (oral & parenteral) (TLS Green)

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