NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

What's new with vitamin D

New high dose preparations

Several new high dose colecalciferol (vitamin D) preparations have recently been licensed in the UK, including:
• Aviticol         20,000 unit capsule
• Fultium D3   20,000 unit capsule
• InVita D3     25,000 unit oral solution

Other products may be in the pipeline and SMC have advised these will now be out of remit. The NHSGGC Formulary does not specify a preferred product and generic prescribing is advised.  The Formulary notes that InVita D3 should only be used where other preparations are unsuitable. This product is a liquid formulation presented in an oral ampoule and there are concerns that the packaging could potentially be confused for an injectable product. Staff prescribing or administering InVita D3 should take extra care to make clear that the product has to be given orally.

The launch of these colecalciferol preparations gives prescribers a range of licensed strengths and formulations to choose from and therefore, it is expected that very few patients will require an unlicensed formulation.

 

High dose or low dose?

In adults, low dose is typically described as doses less than 1,000 units each day.   Low doses are generally used for relatively mild deficiency states (most likely due to inadequate intake of dietary vitamin D or limited exposure to sunlight).  High dose preparations tend to be > 20,000 units and are generally prescribed once weekly.  High doses are indicated for more clinically important insufficiency e.g. osteomalacia.

It is noted that although the Scottish Government recommend supplementation of 10 microgram (400 units) for specific patient groups, there are currently no licensed single 400 unit (10 micrograms) colecalciferol preparations available.  In this situation the NHSGGC guidelines recommend that that licensed 800 unit products are used.

 

Guidelines

High dose vitamin D is included in NHSGGC guidance on the management of osteomalacia and is used for correction of vitamin D deficiency prior to intravenous zoledronic acid or subcutaneous denosumab. This guidance will be updated to reflect the availability of new high dose vitamin D preparations which will replace unlicensed ergocalciferol. 

The NHSGGC Vitamin D Supplementation Frequently Asked Questions (FAQ) document is being updated to reflect the above changes and will include advice for patients with specific dietary requirements e.g. halal/kosher or vegetarian/vegan.   UK Medicines Information Q&As also provide advice for patients with specific dietary requirements;  these are accessed via the ‘search’ facility on the NICE Evidence website (please contact the NHSGGC Medicines Information Service on 0141 211 4407 if you require assistance in accessing these documents).