| Formulary Chapter 9: Nutrition and blood - Full Chapter
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| Notes: |
This chapter of the formulary is under continual development, please let the team know if you have any comments about the contents: mlcsu.lscformulary@nhs.net.
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| Chapter Links... |
 LSCMMG: PKU - Prescribing of Multivitamins & Phenylalanine-free amino acid substitutes for adults and children |
| Details... |
| 09.06 |
Vitamins |
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Paravit CF®
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Formulary
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Paravit-CF is a ‘Food for Special Medical Purposes’ for the dietary management of patients with cystic fibrosis and is reimbursable on FP10.
Paravit CF Capsules contain:
• Vitamin A 1.5 mg (=5,000IU)
• Vitamin D3 37.5 µg (=1,500IU)
• Vitamin E 100 µg (=150IU)
• Vitamin K 5 mg
Paravit CF capsules provide an alternative vitamin supplementation option for Cystic Fibrosis patients, which offers patients a decreased oral medication load whilst also being a cost-effective option.
Paravit CF liquid is only available as an option for patients with swallowing difficulties or young children.
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| 09.06.01 |
Vitamin A |
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| 09.06.02 |
Vitamin B group |
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Pyridoxine Hydrochloride
(Vitamin B6)
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Formulary
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Tablets 10mg, 50mg
 in East Lancashire
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Thiamine
(Vitamin B1)
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Formulary
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Tablets 50mg
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Thiamine (Pabrinex®)
(Vitamins B & C)
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Formulary
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High potency
Intravenous injection 10mL (2 amps)
Intramuscular injection 7mL (2 amps)
MHRA/CHM advice:serious allergic adverse reactions - see BNF
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 MHRA: Pabrinex: allergic reactions
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| 09.06.02 |
Oral vitamin B complex preparations |
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Vitamin B complex preparations (Vigranon B®)
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Formulary
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Not to be prescribed on TTO
Not for use in alcohol dependence
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Vitamin B Tablets, Compound Strong
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Formulary
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For refeeding and Post Bariatric Surgery only
Refer to local policies
Not for use in alcohol dependence - thiamine may be used
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LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
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| 09.06.02 |
Other compounds |
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| 09.06.03 |
Vitamin C |
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Ascorbic Acid
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Formulary
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Tablets 50mg, 100mg, 200mg & 500mg
Effervescent tablets 1g with zinc
Only to be used for prophylaxis and treatment of scurvy
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| 09.06.04 |
Vitamin D |
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Alfacalcidol (One-Alpha®)
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Formulary
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Capsules 250 nanograms, 1 microgram
Oral drops 2 micrograms/mL (1 drop = 100 nanograms)
For severe renal impairment
Prescribers initiating treatment should indicate monitoring requirements.
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SPS - Alfacalcidol monitoring
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Calcitriol (Rocaltrol®)
(1,25-dihydroxycolecalciferol)
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Formulary
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Capsules 250 nanograms
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Colecalciferol
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Formulary
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Follow local protocols
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Colecalciferol 40000 unit (Plenachol®)
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Formulary
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Capsules 40000 units
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Colecalciferol and Calcium Carbonate
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Formulary
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Ergocalciferol (RPH Pharmaceuticals)
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Formulary
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Injection 300,000 units
Consultant initiation only
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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| 09.06.05 |
Vitamin E |
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Alpha Tocopheryl Acetate
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Formulary
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Suspension 500mg/5mL
Other preparations may be available but are unlicensed - contact pharmacy for advice
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| 09.06.06 |
Vitamin K |
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Menadiol Sodium Phosphate
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Formulary
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Tablets 10mg
water soluble preparation for patients with fat malabsorption
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Phytomenadione
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Formulary
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Injection 10mg/1mL (Konakion MM®) for IV injection only, not for IM injection.
Injection 2mg/0.2mL (Konakion MM Paediatric®)
Konakion MM Paediatric® may be administered by mouth, by IM injection or by IV injection - see UHMB guideline for administration of vitamin k to neonates
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| 09.06.07 |
Multivitamin preparations |
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Multivitamin preparations (Abidec®)
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Formulary
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Vitamins A, B group, C and D
Oral drops
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Multivitamin preparations (Dalivit®)
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Formulary
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Vitamins A, B group, C and D
Oral drops
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Mutivitamin
(Vitamins BPC capsules)
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Formulary
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LSCMMG: Over the Counter Items that Should not be Routinely Prescribed in Primary Care Policy
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Renavit®
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Formulary
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Dietary management of water-soluble vitamin deficiency in adults with renal failure on dialysis
For G.P prescribing
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| 09.06.07 |
Vitamin and mineral supplements and adjuncts to synthetic diets |
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Vitamin and mineral supplements (Forceval, & Forceval Soluble®)
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Formulary
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Tablets
On dieticians request only for patients with swallowing difficulties or enteral feeding tubes
Post-surgery if gastric bypass
For use post bariatric surgery please consult link below
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LSCMMG: Guidelines for the prescribing of nutritional supplements post bariatric surgery
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Vitamin and mineral supplements (Ketovite®)
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Formulary
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Tablets
Liquid
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| Non Formulary Items |
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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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NHS England |
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Homecare |
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ICB |
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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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| Status |
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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