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
20microgram (800 units) capsules or tablets
For first line use in the long term maintenance treatment of patients with documented vitamin D deficiency following high strength therapy and also for use in patients with symptoms and insufficient levels.
500 microgram (20,000 units) capsules
For use in patients requiring high strength therapy for vitamin D deficiency.
2740iu/ml oral solution (Fultium®-D3 Drops)
1000iu and 3000iu buccal spray (DLux®) unlicensed
Approved for use in paediatric parenteral nutrition patients with short bowel syndrome and adults with metabolic bone disease who have vitamin D deficiency despite previous treatment.
Drugs for hospital use only. The responsibility for initiation and monitoring treatment should rest with an appropriate hospital clinician and the drug should be supplied through the hospital throughout the duration of treatment.
In some very exceptional circumstances (e.g. due to distance from the hospital, storage, supply or mobility/transport problems) it may be appropriate for the GP to be asked to prescribe a Red drug. This should be negotiated on an individual patient basis and should only be done with the GP’s prior informed agreement where the roles of the GP and hospital services are clearly defined and agreed. The GP should not feel under pressure to prescribe in these circumstances.
Drugs initiated by hospital specialist, but where continuing treatment by GPs may be appropriate under a shared care arrangement.
The specialist should send the GP a copy of the shared care agreement to sign. The GP should sign the shared care agreement, or indicate they do not want to be part of such an agreement, and return a copy back to the specialist. Shared care guidelines are available or are being developed for most of the drugs listed as Amber.
If no shared care guideline is available, the hospital specialist should provide the patient’s GP with sufficient information and support to allow treatment to be continued and managed safely in primary care.
Drugs normally recommended or initiated by hospital specialist, but where the provision of an information leaflet may be appropriate to facilitate continuing treatment by GPs. Many of these information sheets are in the process of development.
Drugs where prescribing by GPs is appropriate. Drugs not classified as Red, Amber or Green Plus (formerly blue in North of Tyne) are generally classified as ‘Green’ by default. The Green drugs listed here include those products normally initiated by hospital specialists where there was a need for discussion and debate as to the category in which they should be placed.