Vitamin D with calcium supplementation is also recommended for those with osteoporosis receiving treatment, for example with bisphosphonates. All the major trials ensured adequate calcium and vitamin D intake, most frequently with concomitant supplementation
All inpatients with a Fractured Neck of Femur resulting from a fall from standing height or less should be prescribed Calcium and Vitamin D (Adcal D3® or Calceos®) unless osteoporosis has been excluded or some other cause for fragility fracture has been identified. Exception: patients with hypercalcaemia or hypocalcaemia.
Calcium and Vitamin D supplementation in elderly ambulatory patients in nursing and residential care homes has been shown to reduce the incidence of hip fracture (Local guidance recommends 1000 to 1200mg of Calcium and 800iu units Vitamin D3) Supplementation is also recommended for patients who have received oral corticosteroids for longer than 3 months
Vitamin D with calcium supplementation is also recommended for those who have undergone bariatric surgery. Calcium citrate may be better absorbed than calcium carbonate in the presence of reduced gastric acid. Hence for those who have undergone sleeve gastrectomy or gastric bypass procedures Cacit D3® is available under restriction.
Colecalciferol (vitamin D3) preparations are normally first choice, if oral treatment / supplementation is required for deficiency or insufficiency. Some of these preparations hold a UK marketing license e.g. Fultium-D3, however a number of products are unlicensed.
Take care when prescribing twice weekly preparations as there have been reports locally of patients taking these daily despite being informed of correct dosage frequency
Use if both calcium and vitamin D supplementation is required.
Each chewable tablet contains 600mg elemental calcium plus 400iu of vitamin D3 with a dose of one twice a day.
Also available as a caplet which contains 300mg elemental calcium plus 200iu of vitamin D3 with a dose of two caplets morning and evening.
Each tablet contains 500mg elemental calcium plus 400iu of vitamin D3 Alternative choice if both calcium and vitamin D supplementation is required.
NB Once daily dosing
Each tablet contains 1000mg elemental calcium plus 880iu of vitamin D3
Lower cost choice
Calcium and Ergocalciferol Tablets
Each tablet contains 97mg elemental calcium plus 400iu of vitamin D2
Can be used if low dose vitamin D only required. Calcium content low.
Each tablet contains 600mg elemental calcium plus 400iu of vitamin D3
Soluble preparation if both calcium and vitamin D supplementation is required. Reserve for those not able to take chewable preparations as more costly.
Capsules, oral drops.
For treatment of osteodystrophy resulting from renal failure; more potent than calciferol and has a shorter onset and offset of action, making it useful for acute deficiencies.
Prescribe as One-Alpha® as non-proprietary capsules more costly.
Each sachet of granules contains 500mg elemental calcium plus 440iu colecalciferol. Restricted for those who have had sleeve gastrectomy or gastric bypass bariatric procedures.
Ergocalciferol injections are not recommended (unless unable to take oral supplements). Please see vitamin D guidance for further information
Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety.
All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry
Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).
Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.
Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.
Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.
Drugs not yet reviewed
Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence. See comments under individual entries