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9. Nutrition and Blood

NICE NG8: Anaemia management in people with chronic kidney disease

County Durham and Darlington  APC - Guidance for the treatment of Vitamin D insufficiency and deficiency – June 2015

County Durham and Darlington  APC - Adult Vitamin D Guideline – Quick Reference Guide Guidance for the treatment of Vitamin D insufficiency and deficiency – September 2017

CD&D APC Patient Decision Aids Resource available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

CD&D APC “Do Not Prescribe List” and “Grey List – drugs prescribed under limited circumstances” available at: http://medicines.necsu.nhs.uk/guidelines/durham-darlington/

Ferrous Fumarate
BNF | BNFC | SPC

Tablets - 210mg

Syrup - 140mg/5ml

Ferrous Sulphate
BNF | BNFC | SPC

Tablets - 200mg

Sodium Feredetate
BNF | BNFC | SPC

Liquid - 190mg/5ml

Ferric Maltol
BNF | BNFC | SPC

NTAG Sept 2016: The Northern (NHS) Treatment Advisory Group recommends the use of oral Ferric Maltol as an alternative option in patients with mild to moderate IDA with IBD who have tried at least two oral ferrous salts and have a reported intolerance to oral ferrous salts due to adverse effects after an adequate trial. Initiation and prescribing of Ferric Maltol should be carried out by an IBD specialist.

Spatone
BNF | BNFC | SPC
Iron Modified Release Preparations
BNF | BNFC | SPC

MHRA Drug Safety Update (Aug 2013) intravenous iron and serious hypersensitivity reactions: new strengthened recommendations to manage and minimise risk

Iron Sucrose▼
BNF | BNFC | SPC

100mg in 5ml injection

Iron Dextran▼
BNF | BNFC | SPC

100ml in 2ml & 500mg in 10ml injections

Ferric Carboxymaltose▼
BNF | BNFC | SPC

100ml in 2ml & 500mg in 10ml injections


For use as an alternative to iron dextran or iron sucrose. Approved for
use by renal physicians, gastroenterologists and haematologists.
Unlicensed for use in children under 14 years of age.
If used in this age-group, use should only be on the advice of a
consultant with the informed consent of the patient and/or his/her
parents/carers.

Hydroxocobalamin
BNF | BNFC | SPC

Injection - 1mg/ml

Folic Acid
BNF | BNFC | SPC

Tablets - 400microgram, 5mg

Liquid - 2.5mg/5ml

Erythropoietins

See MHRA Drug Safety Update (May 2015) - Epoetin beta (NeoRecormon): increased risk of retinopathy in preterm infants cannot be excluded

Darbepoetin alfa (Aranesp)
BNF | BNFC | SPC

10, 15, 20, 30, 40, 50, 60, 80, 100, 150 & 300 microgram injections in prefilled syringes

20, 40, 60, 80, 100 & 300 microgram Sureclick® pens

Commissioner: NHS England – renal dialysis only as per NICE CG114

Epoetin alfa (Eprex)
BNF | BNFC | SPC

Injection - 20,000units, 30,000units, 40,000units

Prescribed in accordance with NICE TA323

 

Epoetin beta (NeoRecormon)
BNF | BNFC | SPC

Injection

Prescribed in accordance with NICE TA323

Commissioner: NHS England – renal dialysis only as per NICE CG114

Desferrioxamine
BNF | BNFC | SPC

500mg & 2g injections

Deferasirox▼
BNF | BNFC | SPC

125mg, 500mg & 250mg tablets


Approved for iron chelation in patients with myelodysplastic syndromes (MDS) - (as per NECN Haematology Group Guidelines) and recommended for use in patients when treatment with desferrioxamine is no longer considered to be appropriate due to progressive iron overload despite maximally tolerated doses of desferrioxamine. – Initiated by specialists only

Deferiprone
BNF | BNFC | SPC

Commissioner: NHS England

Antilymphocyte Globulin
BNF | BNFC | SPC

NHS England – Not routinely commissioned

Anagrelide▼
BNF | BNFC | SPC

500 microgram capsules

For the treatment of thrombocythaemia as a 2nd line agent in patients poorly/non-responsive to hydroxycarbamide therapy.

Romiplostim
BNF | BNFC | SPC

250 microgram vial

For the treatment of adults with chronic immune (idiopathic) thrombocytopenia purpura NICE TA221.

Pegfligrastim (G-CSF)▼
BNF | BNFC | SPC

6mg in 0.6ml injection in prefilled syringes

Commissioner: NHS England – in accordance with Cancer Network Guidelines

Filgrastim (G-CSF)▼
BNF | BNFC | SPC

300 microgram (30 million units) injection in 0.5ml syringes and 1ml vials
480 microgram (48 million units) injection in 0.5ml syringes – available as Neupogen (original brand) and Ratiograstim – a biosimilar product

Commissioner: NHS England – in accordance with Cancer Network Guidelines

Lenograstim (G-CSF)
BNF | BNFC | SPC

263 microgram (33.6 million units) injection vials

Commissioner: NHS England – in accordance with Cancer Network Guidelines

Plerixafor
BNF | BNFC | SPC

24mg in 1.2ml injectiom

Commissioner: NHS England - Policy - B04/P/c

Drug protocol: hypokalaemia (CDDFT intranet access only)

Drug protocol: hyperkalaemia (CDDFT intranet access only)

Potassium Chloride Liquid
BNF | BNFC | SPC

Liquid - (Kay-Cee-L) 1mmol/ml

Sando-K
BNF | BNFC | SPC

Tablets Effervescent - 12mmol/Tablet

Potassium Chloride MR Tablets
BNF | BNFC | SPC

600mg m/r tablets(8 mmol potassium)

For use where the effervescent tablets or syrup are unsuitable.

Calcium Resonium
BNF | BNFC | SPC

Potassium Removal Polystyrene Sulphonate Resin

Powder (Calcium polystyrene sulphonate)

Resonium A
BNF | BNFC | SPC

Potassium Removal Polystyrene Sulphonate Resins

Powder (Sodium polystyrene sulphonate)

Sodium chloride MR Tablets 600mg
BNF | BNFC | SPC

MR Tablets - 600mg

Approx. 10 mmol sodium & chloride per tablet

Oral rehydration powder – Dioralyte
BNF | BNFC | SPC

Sachets

Sodium 12 mmol, potassium 4 mmol, chloride 12 mmol, citrate 2 mmol & glucose 18 mmol (3.56g) / sachet

Sodium Chloride Oral Solution
BNF | BNFC | SPC

1mmol / ml oral solution
Treatment should only be initiated with the advice of a specialist

Sodium Bicarbonate
BNF | BNFC | SPC

Capsules - 600mg (Approx. 6 mmol each of sodium and bicarbonate)


1mmol/ml oral solution u

Contact Pharmacy for Information

Please refer to County Durham & Darlington Gluten Free Guidelines 

 

Sapropterin
BNF | BNFC | SPC

Commissioner: NHS England - Policy - E12/P/a

Tetrahydrobiopterin
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Cod Liver Oil Capsules
BNF | BNFC | SPC
Gamolenic acid/starflower oil
BNF | BNFC | SPC

Drug protocol: hypocalcaemia (CDDFT intranet access only)

Calcium Carbonate Effervescent 1.25g (Cacit)
BNF | BNFC | SPC

Tablets Effervescent - 1.25g (Cacit)

Calcium Carbonate Suspension
BNF | BNFC | SPC

500mg in 5ml suspensionu

Sandocal Tablets
BNF | BNFC | SPC

Sandocal 1000 tablets (calcium lactate gluconate, calcium
carbonate & citric acid providing 1000mg, 25 mmol calcium)

Alliance Calcium Syrup
BNF | BNFC | SPC

Each 5ml contains 2.5mmol of calcium (in form of calcium lactate and calcium gluconate 20.4mg of soluble calcium or 0.51mmol of calcium per ml)u

Caclium Gluconate Injection
BNF | BNFC | SPC

10% 10ml injection (approx. 2.2mmol, 89mg calcium)

Calcium Chloride Injection
BNF | BNFC | SPC

5 mmol in 5ml & 10 mmol in 10ml injections

Drug protocol: hypercalcaemia (CDDFT intranet access only)

Disodium Pamidronate
BNF | BNFC | SPC

30mg injection

Zoledronic Acid
BNF | BNFC | SPC

4mg injection
- for hypercalcaemia of malignancy and the prevention of skeletal
events in patients with metastatic breast cancer.

Prescribe by brand name (Zometa®) to avoid confusion with a different strength product used to treat osteoporosis and Paget’s disease.

Sodium Clodronate
BNF | BNFC | SPC

520mg or 800mg tablets

Calcitonin (Salmon)/ Salcatonin Injection
BNF | BNFC | SPC

400 units in 2ml injection

Paricalcitol
BNF | BNFC | SPC

1 microgram, 2 micrograms & 4 micrograms capsules & 5
micrograms per ml injection


- approved for use in patients with PTH levels < 800mcg/l but whose treatment with alfacalcidol is restricted due to a high calcium level.

Cinacalcet
BNF | BNFC | SPC

Tablets - 30mg, 60mg, 90mg

Shared care agreement for primary hyperparathyroidism

CDDFT intranet link

Tertiary centre indication:

For the treatment of secondary hyperparathyroidism in patients with end stage renal disease on maintenance haemodialysis where parathyroid gland surgery has failed or is inappropriate. Also for short term use to control symptoms prior to a second attempt at more definitive surgery.

NICE TA117

Commissioner: NHS England - NICE TA117

Drug protocol: hypomagnesaemia (CDDFT intranet access only)

Magnesium Glycerophosphate
BNF | BNFC | SPC

Tabletsu

Unlicensed special 

Evidence summary: unlicensed or off-label medicine

ESUOM4: Preventing recurrent hypomagnesaemia: oral magnesium glycerophosphate

Magnesium-L-aspartate (Magnaspartate)
BNF | BNFC | SPC

6.5g (10 mmol) sachets
-first line for the treatment and prevention of magnesium deficiency

Magnesium Sulphate
BNF | BNFC | SPC

50% 2ml (4 mmol), 50% 10ml (20 mmol) & 10% 10ml (4
mmol) injections

Drug protocol: hypophosphatemia (CDDFT intranet access only)

Phosphate Sandoz
BNF | BNFC | SPC

Effervescent tablets (phosphate 16.1 mmol, sodium 20.4 mmol & potassium 3.1 mmol / tablet)

Phosphate Polyfusor
BNF | BNFC | SPC

500ml intravenous infusion containing 50mmol phosphate per 500ml (PO4 3- 100mmol, K+ 19mmol, and Na+ 162mmol/litre)

Calcium Acetate
BNF | BNFC | SPC

Phosex®
1g tablets (containing 250mg, 6.2mmol of calcium)
Renacet®
475mg (containing 120.25mg, 3mmol of calcium) &
950mg tablets (containing 240.5mg, 6mmol of calcium)

Calcium Carbonate
BNF | BNFC | SPC

1.25g & 2.5g chewable tablets (Calcichew)

Use after calcium carbonate and calcium acetate, but before the much more expensive sevelamer and lanthanum.

Sevelamer Hydrochloride
BNF | BNFC | SPC

800mg f/c tablets

Lanthanum
BNF | BNFC | SPC

500mg, 750mg & 1g chewable tablets
- for 3rd line use

Duraphat® Toothpaste
BNF | BNFC | SPC

Duraphat®
2800 ppm s Sodium fluoride 0.619% (75ml)
Duraphat®
5000 ppm s Sodium fluoride 1.1% (51g)

CD&D APC Grey List: Approved for prescribing by dentists and dental prescribers only.

Zinc sulphate monohydrate
BNF | BNFC | SPC

Tablets Effervescent - 125mg (Solvazinc®)

Selenium
BNF | BNFC | SPC

50 microgram/ml oral solution

50 microgram/ml injection

For use on ITU only. NOT FOR PRESCRIBING IN PRIMARY CARE.

Ensure that all prescribing is in-line with an ACBS approved indication.

If patients still want to take a vitamin and mineral preparation for dietary supplementation or as a "pickme-up" they should be advised that they can be purchased as self care over-the-counter with the support of the community pharmacist.

Do not initiate new prescriptions for vitamin and mineral preparations unless they are in-line with an ACBS approved indication.

Some patients may be eligible for NHS Healthy Start vitamins rather than receiving a prescription. They are specifically designed for pregnancy, breastfeeding and growing children and available free of charge from local distribution points.

Vitamins A & D
BNF | BNFC | SPC

Capsules

Thiamine
BNF | BNFC | SPC

Tablets - 50mg, 100mg

NICE clinical guideline 100

Pyridoxine
BNF | BNFC | SPC

Tablets - 10mgu , 50mg

Liquid - 10mg/5ml (special)

Vitamin B compound strong
BNF | BNFC | SPC

Tablets

NICE clinical guideline 100

CD&D APC Grey List: Should only be used on the advice of a dietician or in secondary care to prevent "re-feeding syndrome".

Vitamin B & C Injection (Pabrinex® )
BNF | BNFC | SPC

IVHP injection (ascorbic acid 500mg, nicotinamide 160mg, pyridoxine
hydrochloride 50mg, riboflavin 4mg & thiamine hydrochloride 250mg &
1g anhydrous glucose / pair of ampoules)

Pyridoxal Phosphate
BNF | BNFC | SPC

25mg tablets and 50mg capsulesu

Ascorbic Acid
BNF | BNFC | SPC

Tablets - 50mg, 500mg

County Durham and Darlington  APC - Guidance for the treatment of Vitamin D insufficiency and deficiency – June 2015

County Durham and Darlington  APC - Adult Vitamin D Guideline – Quick Reference Guide Guidance for the treatment of Vitamin D insufficiency and deficiency – September 2017

Colecalciferol (Fultium D3) Capsules
BNF | BNFC | SPC

Available as 800 IU, 3200 IU and 20,000 IU capsules
Fultium D3 contain arachis oil (peanut oil)

Colecalciferil (Desunin) tablets
BNF | BNFC | SPC

Available as 800 IU tablets

Colecalciferol (Aviticol) capsules
BNF | BNFC | SPC
Colecalciferol (Plenachol) capsules
BNF | BNFC | SPC
Alfacalcidol
BNF | BNFC | SPC

250 nanogram & 1 microgram capsules
2 microgram/ml sugar-free oral drops – one drop
containing approx. 100 nanograms of alfacalcidol
1 microgram in 0.5ml & 2 micrograms in 1ml injections

Ergocalciferol (Calciferol) Injection
BNF | BNFC | SPC

7.5mg (300,000 units) in 1ml injection

Invita-D3 oral solution
BNF | BNFC | SPC

For use when an oral liquid preparation is required.

Fultium D3 oral drops
BNF | BNFC | SPC

For use when an oral liquid preparation is required

For use in primary care:
• Accrete D3
• Evacal

For use in secondary care:
• Adcal D3 tablets and caplets
• Calcichew D3 Forte® tablets
(alternative to Adcal D3)

1.5g (600mg Ca) 400 units

Alternatives
• Calfovit D3 sachets
Calcium phosphate 3.1g (1.2g calcium) & Vitamin D3 800 units
• Calcium & Ergocalciferol Tablets:
Calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg, 2.4 mmol) & ergocalciferol 10 micrograms (400 units)

Accrete D3
BNF | BNFC | SPC

Film coated tablet containing calcium carbonate 1.5g and
colecalciferol 10 micrograms (400 units)

Evacal
BNF | BNFC | SPC

Chewable tablets containing calcium carbonate 1.5g and
colecalciferol 10 micrograms (400 units)
-approved as a chewable option and also to be used in patients with
peanut and soya allergy

Adcal D3
BNF | BNFC | SPC

Tablets and Caplets - for use in secondary care

Calcichew D3 Forte
BNF | BNFC | SPC

Tablets - for use in secondary care

Calcium Phosphate & Vitamin D (Calfovit D3 ®)
BNF | BNFC | SPC

Powder in sachets – calcium phosphate 3.1g (1.2g calcium) &
Vitamin D3 800 units

Calcium and Ergocalciferol Tablets
BNF | BNFC | SPC

Tablets – calcium lactate 300mg, calcium phosphate 150mg (Ca 97mg,
2.4 mmol) & ergocalciferol 10 micrograms (400 units)

Alpha Tocopheryl Acetate
BNF | BNFC | SPC

Suspension - 500mg/5ml

Menadiol sodium phosphate
BNF | BNFC | SPC

Tablets - 10mg

Water soluble derivative of vitamin K for use in patients with fat malabsorption, especially in hepatic disease or biliary obstruction including cystic fibrosis patients.

Phytomenadione (Vitamin K1)
BNF | BNFC | SPC

- 50 microgram in 0.25ml drops (NeoKay®)u
- 1mg capsule = Preferred product for use in neonates
- 10mg in 1ml injectionu
- 2mg in 0.2ml mixed micelles injection (Konakion® MM Paediatric) N.B. May be taken by mouth as well as being given by IM or IV injection


N.B. Phytomenadione 10mg tabs now discontinued

Drug protocol: administration of vitamin K (CDDFT intranet access only)

Flowchart for Neonatal Vitamin K prophylaxis (CDDFT intranet access only)

Abidec
BNF | BNFC | SPC

Drops

Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol 400 units, nicotinamide 5mg, pyridoxine HCL 500micrograms, riboflavine 400 micrograms, thiamine 1mg & vitamin A 1,333 units- To be used in children and adults.

Multivitamin
BNF | BNFC | SPC

Tablets

Vitamins BPC
Capsules containing ascorbic acid 15mg, nicotinamide 7.5mg, riboflavine 500 micrograms, thiamine HCl 1mg, vitamin A 2,500 units, & vitamin D 300 units

Forceval
BNF | BNFC | SPC

Capsules & junior capsules
-For limited use as a vitamin and mineral supplement in patients with
phenylketonuria The capsules are also approved as an oral supplement
in burns patients with malnutrition or alcohol dependency and patients
with major burns after discontinuation of IV therapy, and have also been
approved for use in patients with severe anorexia nervosa and in patients with re-feeding syndrome.. Treatment initiated with specialist advice.


Soluble
- approved for short term use in patients who are unable to swallow Forceval capsules

Ketovite
BNF | BNFC | SPC

 

 

Tablets and liquid - see BNF for details of content

Dalivit
BNF | BNFC | SPC

Drops containing in each 0.6ml dose ascorbic acid 50mg, ergocalciferol 400 units, nicotinamide 5mg, pyridoxine HCl 500 micrograms, riboflavine 400 micrograms, thiamine 1mg & vitamin A 5,000 units). Dalivit drops are to be retained for use in patients requiring a full supplement of vitamin A.

Carnitine
BNF | BNFC | SPC

30% oral solution
1g in 5ml injection

Commissioner: NHS England – via specialist services only

Agalsidase alfa
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Agalsidase Beta
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Algucosidase alfa
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Betaine
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Carglumic Acid
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Sodium Phenylbutyrate
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Galsulfase▼
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Idursulfase▼
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Laronidase▼
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Imiglucerase
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Velaglucerase Alfa
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Migalastat▼
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Nitisinone
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Mercaptamine
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only

Human Arginate
BNF | BNFC | SPC

Commissioner: NHS England – via specialist services only