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^®)

Alternative:

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