BNF for Children 2011-2012

BNFC 2011–2012 9.6.4 Vitamin D 483Nutritional or physiological supplement; preventionof rickets. By mouthNeonate 400 units dailyChild 1 month–18 years 400–600 units dailyVitamin D deficiency in intestinal malabsorptionor in chronic liver disease. By mouth or by intramuscular injectionChild 1–12 years 10 000–25 000 units daily,adjusted as necessaryChild 12–18 years 10 000–40 000 units daily,adjusted as necessaryPharmacological strengths(see notes above)The BP directs that when calciferol is prescribed or demanded,colecalciferol or ergocalciferol should be dispensed or suppliedErgocalciferol (Non-proprietary)Tablets, ergocalciferol 250 micrograms (10 000 units),net price 100 = £21.99; 1.25 mg (50 000 units), 100 =£30.34Note May be difficult to obtainImportant When the strength of the tablets ordered orprescribed is not clear, the intention of the prescriber orpurchaser with respect to the strength (expressed in microgramsor milligrams per tablet) should be ascertained.Injection A, ergocalciferol, 7.5 mg (300 000 units)/mL in oil, net price 1-mL amp = £8.50, 2-mL amp =£9.85Note Other formulations of ergocalciferol are available from‘special-order’ manufacturers or specialist importing companies,see p. 809Daily supplementsNote There is no plain vitamin D tablet available for treatingsimple deficiency (see notes above). Alternatives include vitaminscapsules (section 9.6.7), preparations of vitamins A and D(section 9.6.1), and calcium and ergocalciferol tablets (seebelow).For prescribing information on calcium, see section 9.5.1Calcium and Ergocalciferol (Non-proprietary)(Calcium and Vitamin D)Tablets, calcium lactate 300 mg, calcium phosphate150 mg (calcium 97 mg or Ca 2þ 2.4 mmol), ergocalciferol10 micrograms (400 units). Net price 28-tab pack= £7.10. Counselling, crush before administration ormay be chewedHypophosphataemic rickets; persistent hypocalcaemiadue to hypoparathyroidism or pseudohypoparathyroidism. By mouth or by intravenous injectionChild 1 month–12 years 25–50 nanograms/kg(max. 1 microgram) once daily, adjusted as necessaryChild 12–18 years 1 microgram once daily,adjusted as necessaryPersistent neonatal hypocalcaemia. By mouth or by intravenous injectionNeonate 50–100 nanograms/kg once daily,adjusted as necessary (up to 2 micrograms/kgdaily may be needed in resistant cases)Prevention of vitamin D deficiency in renal orcholestatic liver disease. By mouth or by intravenous injectionNeonate 20 nanograms/kg once daily, adjusted asnecessaryChild 1 month–12 years, body-weight under20 kg 15–30 nanograms/kg (max. 500 nanograms)once daily; body-weight over 20 kg 250–500 nanograms once daily, adjusted as necessaryChild 12–18 years 250–500 nanograms oncedaily, adjusted as necessaryAlfacalcidol (Non-proprietary) ACapsules, alfacalcidol 250 nanograms, net price 30-cap pack = £5.94; 500 nanograms 30-cap pack =£11.64; 1 microgram 30-cap pack = £15.91One-Alpha c (LEO) ACapsules, alfacalcidol 250 nanograms (white), netprice 30-cap pack = £3.37; 500 nanograms (red), 30-cap pack = £6.27; 1 microgram (brown), 30-cap pack= £8.75Excipients include sesame oilOral drops, sugar-free, alfacalcidol 2 micrograms/mL(1 drop contains approx. 100 nanograms), net price10 mL = £22.49Excipients include alcoholNote The concentration of alfacalcidol in One-Alpha c dropsis 10 times greater than that of the former preparation One-Alpha c solution.Injection, alfacalcidol 2 micrograms/mL, net price0.5-mL amp = £2.16, 1-mL amp = £4.11Excipients include alcohol, propylene glycol (caution in neonates, see,p. 2)Note Shake ampoule for at least 5 seconds before use9 Nutrition and bloodALFACALCIDOL(1a-Hydroxycholecalciferol)Cautions see under Ergocalciferol; also nephrolithiasisContra-indications see under ErgocalciferolPregnancy see under ErgocalciferolBreast-feeding see under ErgocalciferolSide-effects see under Ergocalciferol; also rarelynephrocalcinosis, pruritus, rash, and urticariaIndication and doseSee also notes aboveCALCITRIOL(1,25-Dihydroxycholecalciferol)Cautions see under Ergocalciferol; monitor plasmacalcium, phosphate, and creatinine during dosagetitrationContra-indications see under ErgocalciferolPregnancy see under ErgocalciferolBreast-feeding see under ErgocalciferolSide-effects see under ErgocalciferolLicensed use not licensed for use in childrenIndication and doseSee also notes above