| Formulary Chapter 9: Nutrition and blood - Full Chapter
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Vitamin D (Colecalciferol and ergocalciferol)
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Formulary
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Vitamin D3 (colecalciferol) is the vitamin D preparation of choice for treatment of vitamin D deficiency.
Vitamin D2 (ergocalciferol) can be used in people who cannot take vitamin D3 for cultural, dietary, or religious reasons because of the animal sourcing of vitamin D, or the use of gelatine in some preparations.
Local protocols should be consulted where they exist.
 The prescribing of high-dose vitamin D as a short-course treatment, for the correction of deficiency and insufficiency is recommended only following confirmation by vitamin D assay.
- The prescribing of Vitamin D for prophylaxis or maintenance following treatment of deficiency and insufficiency is not recommended.
- Adults (including women who are pregnant or breastfeeding), young people and children over 4 years should consider taking a daily supplement between October and early March. The prescribing of Vitamin D and Vitamin D testing are not recommended.
- Adults, young people and children over 4 years should consider taking a daily supplement throughout the year if they have little or no sunshine exposure or if they have dark skin. The prescribing of Vitamin D and Vitamin D testing are not recommended.
- Do not offer a vitamin D supplement to people to treat or prevent COVID-19.
These positions are not intended to affect the management of patients with osteoporosis, osteopenia, multiple sclerosis or hypoparathyroidism.
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Alfacalcidol (One-Alpha®)
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Formulary
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Capsules 250 nanograms, 500 nanograms, 1 microgram
Oral drops 2 micrograms/mL (1 drop contains approximately 100 nanograms alfacalcidol)
For patients with severe renal impairment requiring vitamin D therapy.
Secondary care prescribers initiating treatment should clearly outline monitoring requirements when transferring prescribing responsiblity to primary care.
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Ergocalciferol
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Formulary
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Injection 300,000 units/1ml
For the correction of deficiency and insufficiency in high-risk, symptomatic patients as a short-course treatment.
Ergocalciferol 400 units is equivalent to 10 micrograms.
Plastic syringes can be used 'off label' providing the injection is administered immediately after being drawn up into the syringe.
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| 09.06.04 |
Vitamin D with Calcium |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine
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Cancer Drugs Fund
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Homecare |
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ICB commissioned |
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NHS England commissioned |
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Blueteq form needed |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance. |
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