NHS England (NHSE) has published new prescribing guidance for items of limited clinical effectiveness that should not be routinely prescribed in primary care (quick reference guide). This included vitamins and minerals, unless there is a medically diagnosed deficiency, or when using calcium and vitamin D for osteoporosis, or for treating malnutrition including alcoholism. The guidance also excludes patients suitable to receive Healthy Start vitamins.

Many vitamin products are cheap to buy and are readily available over the counter along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Vitamins

• Capsules (ascorbic acid 15mg, nicotinamide 7.5mg, riboflavin 500 micrograms, thiamine hydrochloride 1mg, vitamin A 2500 units, vitamin D 300 units) (£0.48 = one daily)

Healthy Start

• Children's vitamin drops: Available free of charge to children under 4 years in families on the Healthy Start Scheme.
• Vitamins for women: (containing ascorbic acid, vitamin D, and folic acid) are also available free of charge to women on the Healthy Start Scheme during pregnancy and until their baby is one year old. Further information for healthcare professionals can be accessed at www.healthystart.nhs.uk. Deficiency of vitamin A is rare in Britain. Cod liver oil capsules have not been included because there is no good evidence base to support their use.

Vitamin A and D

• Capsules vitamin A 4000unit and vitamin D 400unit (£8.42 = 84 capsules)

Abidec

• Oral drops, vitamins A, B group, C, and D (£4.32 = 25ml)

Notes

• Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
• Includes arachis (peanut) oil

Dalivit

• Oral drops, vitamins A, B group, C, and D (£7.69 = 25ml)

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Vitamin and mineral supplements and adjuncts to synthetic diets

Forceval

• Capsules (£33.09 = 90 capsules)
• Soluble tablets (£11.43 = 30 tablets)
• Junior soluble tablets (£10.29 = 30 tablets)

Indications

• Vitamin and mineral deficiency and as adjunct in synthetic diets
• Long-term supplementation following bariatric surgery

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Forceval is for use only if there is concern about the adequacy of micronutrient intake. To be considered by healthcare professionals with the relevant skills and training in nutrition support who are able to determine the nutritional adequacy of a patient's dietary intake
3. Forceval capsules contain vitamin A in the beta carotene form and may be taken preconception and during pregnancy.
4. Forceval soluble tablets contain vitamin A in the retinol form and should not be taken preconception and during pregnancy

Ketovite

• Tablets (£28.19 = 100 tablets)
• Liquid (£119.10 = 150ml)

Indications

• Prevention of vitamin deficiency in disorders of carbohydrate or amino-acid metabolism and adjunct in restricted, specialised, or synthetic diets

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Use Ketovite tablets (taken three times a day) and liquid (5mL daily) together for complete vitamin supplementation.

Multivitamins in chronic kidney disease (CKD)

Vitamin deficiencies are common in patients with renal disease due to dietary restrictions, changes to metabolism and vitamin loss during dialysis.

Renavit

• Tablets containing vitamin B1, B2, B3, B5, B6, B8, B9, B12 and vitamin C (£4.70 = one tablet daily)

Indications

• Prevention of water soluble vitamin deficiency in patients undergoing haemodialysis

Dose

• Take one daily

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Vitamin deficiencies are common in patients with renal disease due to dietary restrictions, changes to metabolism and vitamin loss during dialysis
3. Renavit should only be initiated by a renal dietician, on-going prescribing in primary care is acceptable
4. The commissioning of Renavit is accepted in Devon for the dietary management of water soluble vitamin deficiency in renal failure patients receiving haemodialysis (see Commissioning Policy for more details)

Multivitamins in cystic fibrosis (CF)

DEKAs Plus

• Liquid (£37.05 = 60ml)
• Chewable tablets (£47.45 = 60 tablets)
• Softgels capsules (£47.45 = 60 capsules)

Indications

• Dietary management of CF patients on the recommendation of a specialist

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. DEKAs Plus formulations contain vitamins and minerals, including fat soluble vitamins A, D, E, and K.
3. DEKAs Plus liquid is recommended for use in patients aged 0-3 years
4. DEKAs Plus chewable tablets are recommended for use in patients aged 4 years and above
5. DEKAs Plus softgels capsules are recommended for use in patients aged over 10 years

DEKAs Essential

• Capsules (£40.70 = 60 capsules)

Indications

• Dietary management of CF patients on the recommendation of a specialist

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. DEKAs Essential capsules contain the fat soluble vitamins A, D, E, and K
3. DEKAs Essential capsules are recommended for use in patients aged 4 years and above

Paravit-CF

• Liquid (£33.12 = 7ml)

Indications

• Dietary management of CF patients on the recommendation of a specialist

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)
2. Paravit-CF liquid contains the fat soluble vitamins A, D, E, and K
3. Paravit-CF liquid should be reserved for use in babies (as it is taste free/odour free) and patients with swallowing difficulties