Chapter 9: Nutrition and blood

Guidance: Appropriate Prescribing of Specialist Infant Formulae
Vitamin D Guidance APC adapted for NLaG (3)

9.1 Anaemias and some other blood disorders

9.1.1 Iron-deficiency anaemias

9.1.1.1 Oral iron

i. Ferrous Fumarate Tablets 210mg (68mg of iron)
ii. Ferrous sulphate Tablets 200mg (65mg of iron)
iii. Ferrous Fumarate Syrup 140mg/5ml (45mg of iron)
iv. Ferrous Gluconate Tablets 300mg (35mg of iron)
v. Iron and Folic Acid Compound Tablets (e.g. Pregaday, Galfer FA)
vi. Sodium Feredetate Liquid 190mg/5ml (Sytron, 27.5mg of iron per 5ml)

9.1.1.2 Parenteral iron

i. Iron dextran Injection (Cosmofer) (50mg/ml)
ii. Iron Isomaltoside Injection (Monofer) 100 mg/mL
iii. Iron Sucrose Injection (Venofer) (20mg/ml iron) 5ml

9.1.2 Drugs used in megaloblastic anaemias

i. Folic acid Tablets 5mg
ii. Folic acid Tablets 400 micrograms. Pregnancy only
iii. Folic acid Syrup 2.5mg/5ml
iv. Hydroxocobalamin Injection 1000 micrograms/ml, 1ml

9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias

i. Darbepoetin Alfa. As Per NICE TA323
ii. Epoetin Alfa Injection (Eprex). As Per NICE TA323
iii. Desferrioxamine Injection 500mg
iv. Methoxy Polyethylene Glycol-epoetin Beta Injection
v. Oxymetholone Tablets 50mg. Hospital Only, Named patient

vi Deferasirox flim coated tablets (Novartis have launched a new film-coated formulation, existing dispersible tablets are withdrawn – the dose of the film-coated tablets is different from the dispersible tablets.  Film-coated tablets have a higher bioavailability compared with dispersible tablets.  When converting the patient’s prescription to deferasirox film-coated tablets, the dose of the film-coated tablets should be 30% lower than the dose of dispersible tablets, rounded to the nearest whole tablet)

9.1.4 Drugs used in platelet disorders

i. Anagrelide Capsules
ii. Human Normal Immunoglobulin Injection
iii. Romiplostim. As Per NICE TA221
iv. Eltrombopag. As Per NICE TA293

9.1.6 Drugs used in neutropenia

i. Lenograstim Injection 105 micrograms, 263 micrograms
ii. Filgrastim 300 micrograms/0.5ml (30MU), 480 micrograms/0.5ml (48MU)

9.1.7 Drugs used to mobilise stem cells

i. Plerixifor. Hospital, Consultant Only

9.2 Fluids and electrolytes

9.2.1 Oral preparations for fluid and electrolyte imbalance

9.2.1.1 Oral potassium

i. Potassium Chloride Effervescent Tablets 470mg, 12mmol K+ (Sando K)
ii. Potassium Chloride MR Tablets 600mg, 8mmol K+ (Slow K)
iii. Potassium Chloride Syrup 7.5%, 1mmol/ml K+ (Kay-Cee-L)
iv. Calcium Polystyrene Sulphonate (Calcium Resonium Powder)
v. Sodium Polystyrene Sulphonate 454g (Resonium A Powder)

9.2.1.2 Oral sodium and water

i. Sodium Chloride MR Tablets 600mg, 10mmol Na+ (Slow Sodium)
ii. Oral Rehydration Salts (Dioralyte or Electrolade)

9.2.1.3 Oral bicarbonate

i. Sodium Bicarbonate Capsules 500mg

9.2.2 Parenteral preparations for fluid and electrolyte imbalance

9.2.2.1 Electrolytes and water

Water for Injection 2ml, 5ml, 10ml, 20ml
Glucose Injection 50%, 50ml
Glucose 5% 50ml, 100ml, 250ml, 500ml, 1000ml
Glucose 10% 250ml, 500ml, 1000ml
Glucose 20% 500ml
Glucose 50% 500ml
Glucose 2.5% + Sodium Chloride 0.45%, 500ml;
Glucose 5% + Sodium Chloride 0.45%, 500ml, 1000ml
Glucose 5% + Sodium Chloride 0.9%, 500ml, 1000ml
Mannitol 10%, 20%, 500ml
Mannitol 20%, 100ml
Potassium 0.15% + Glucose 5% (20mmol K+/litre), 500ml, 1000ml
Potassium 0.3% + Glucose 5% (40mmol K+/litre), 500ml, 1000ml
Potassium 0.15% + Glucose 10% (20mmol K+/litre), 500ml
Potassium 0.3% + Glucose 10% (40mmol K+/litre) 500ml

Potassium 0.15% + Glucose 5% + Sodium Chloride 0.45% (20mmol K+/litre), 500ml **There is currently a temporary supply problem** The way forward is to revert our VRII practice to:
–  Potassium Chloride 0.3% (40mmol) + Glucose 5% in 1000ml  at a rate of 100ml/hour if BM < 14 mmol/L
–  Potassium Chloride 0.3% (40mmol) + Sodium Chloride 0.9% in 1000ml at a rate of 100ml/hour if BM > or = 14 mmol/L

Potassium 0.3% + Glucose 5% + Sodium Chloride 0.45% (40mmol K+/litre) 500ml
Potassium 0.15% + Sodium Chloride 0.9% (20mmol K+/litre), 500ml, 1000ml
Potassium 0.3% + Sodium Chloride 0.9% (40mmol K+/litre), 500ml, 1000ml
Potassium 0.15% (20mmol K+/litre) in Sodium Chloride 0.9% + Glucose 5% 500ml
Potassium 0.6% + Sodium chloride 0.9% (80mmol/litre) 500ml
Potassium 0.6% + Glucose 5% (80mmol/litre) 500ml
Potassium 0.15% + Magnesium 8mmol + Sodium chloride 0.9% (20mmol K+/L) 1000ml
Potassium 0.3% + Sodium chloride 0.45% + Glucose 10% (40mmol K+/L) 500ml
Potassium Chloride Injection 15%, 10ml amp. Restricted use
Potassium chloride 7.5% (1mmol K+/ml) Pre-filled syringe 50ml ITU Only
Sodium Bicarbonate Injection 4.2%, 10ml; 8.4%, 50ml
Sodium Bicarbonate 1.4%, 500ml
Sodium Bicarbonate 4.2%, 500ml
Sodium Bicarbonate 8.4%, 200ml
Trometamol (THAM) Ampoules 4%, 3.6%, 7.2%. Consultant Only
Sodium Chloride 0.18%, 500ml
Sodium Chloride 0.45%, 500ml
Sodium Chloride 0.9%, 50ml, 100ml, 250ml, 1000ml
Sodium Chloride 1.8%, 500ml
Sodium Chloride 3%, 100ml
Sodium Chloride 2.7%. EMBRACE retrieval team – raised intracranial pressure
Sodium Chloride Injection 0.9%, 2ml, 5ml, 10ml, 20ml ampoules
Sodium Lactate Compound (1/2 strength / Glucose)
– Na+ 33mmol, K+ 1.5mmol, Ca++ 0.5mmol, HCO3 7mmol, Cl+ 28mmol, 500ml
Sodium Lactate Compound (1/2 strength)
– Na+ 33mmol, K+ 1.5mmol, Ca++ 0.5mmol, HCO3 7mmol, Cl+ 28mmol, 500ml
Sodium Lactate Compound (Syn: Hartmann’s)
– Na+ 131mmol, K+ 5mmol, Ca++ 2mmol, HCO3 29mmol, Cl+ 111mmol, 1000ml

9.2.2.2 Plasma and plasma substitutes

i. Dextran 70, 500ml in Sodium Chloride or Glucose
ii. Dextran 40, 500ml in Sodium Chloride or Glucose
iii. Succinylated Gelatin (Gelspan)
iv. Plasma Expander – Formulation subject to regional contract Hospital Only
v. Plasma-Lyte. Hospital Only

9.3 Intravenous nutrition

i. KABIVEN 9, 11 & 14 – Complete TPN Solution
ii. Babiven TPN Solution
iii. Glamin C, 2 litres
iv. Glucose 10%, 20%, 40%, 50%
v. Intralipid 10%, 20%, 30%
vi. Structolipid
vii. Vamin Solutions
viii. Vaminolact 100ml, 500ml
ix. Addiphos 20ml
x. Additrace 10ml
xi. Peditrace 10ml
xii. Potassium Acetate 20mmol in 10ml
xiii. Sodium Acetate 20mmol in 10ml
xiv. Sodium Glycerophosphate 21.6% 10ml
xv. Solivito-N
xvi. Vitlipid N Infant
xvii. Vitlipid N Adult
xviii. SMOFlipid

9.4 Oral nutrition

9.4.1 Foods for Special diets

i. Forceval Protein Powder Sachets

9.4.2 Enteral nutrition

Usually on advice of dietician

Enteral nutrition:

Adult

Nutrison Standard 500, 1000ml
Nutrison Multifibre 500, 1000ml
Nutrison Energy 500, 1000ml
Nutrison Energy multifibre 500, 1000ml
Peptisorb 500ml
Nutrison® Low Sodium 500ml
Nutrison Concentrated
Oxepa (Abbott)

Paediatric

Infatrini® 200ml
Nutrini 500ml
Nutrini Multi Fibre 500ml
Nutrini Energy 500ml
Nutrini Energy Multi Fibre 500ml
Tentrini 500ml
Tentrini Energy 500ml
Tentrini Energy Multi Fibre 500ml

Specialised Formula (Baby Milks):       Appropriate Prescribing of Specialist Infant Formulae

SMA® High Energy 250ml
Pepti Junior® 450g
Neocate LCP Powder® 400g
Wysoy® 430g
Nutriprem 2® 900g
Neocate Active sachets® (Blackcurrant) 50g
Neocate Active sachets® (Unflavoured) 100g
Nutramigen AA
Nutramigen Lipil 1
Nutramigen Lipil 2
Alimentum

Sip Feeds:

Adult

Fortisip compact (Various flavours)
Fortisip extra (various flavours) 200ml
Fortisip multifibre 200ml
Fortisip yoghurt style 200ml
Fortijuce 200ml
Provide Extra® (Various flavours) 200ml
Scandishake mix (Various flavours) 50g
E028 Extra Liquid (Various flavours) 250ml

Paediatric

Fortini 200ml (various flavours)
Fortini Multi Fibre 200ml (various flavours, including unflavoured)
Paediasure Plus Juice 200ml (Abbott – various flavours)

Modular Products:

Calogen® (Various flavours) 200ml
Calogen extra (neutral and strawberry) 200ml
Maxijul Super Soluble Powder® 200g, 1kg, 2.5kg, 25kg
Duocal Super Soluble® 400g

Miscellaneous:

Breast Milk Fortifiers

Nutilis 225g
Instant Carobel

Metabolic Formulae:

These products are listed on the Formulary for rare metabolic conditions. They may not be available in stock and may need to be ordered on a when required basis.
PKU Anamix infant® 400g
PKU Gel® 30 x 20g
PKU Express cooler ® 30 x 25g
PKU Cooler®
PKU Lophlex LQ 30x125mls
PKU Lophlex LQ 10 60x 62.5mls
MSUD Express cooler ® 30 x 25g
MSUD Gel® 30 x 20g
Leucine amino acid supplement 30x4g sachets
Add Ins® 18.2g
XP Maximum® 500g
Easiphen® (Various flavours) 250mL cartons
Sno Pro 200ml
Nutrison® Low Sodium 500ml

9.5 Minerals

9.5.1 Calcium and magnesium

9.5.1.1 Calcium supplements

i. Calcium Carbonate 1.25g (12.6mmol calcium) Tablets, Effervescent Tablets
ii. Sandocal® Effervescent Tablets (400=10mmol Ca2+/tablet, 1000=25mmol Ca2+/tablet)
iii. Calcium Sandoz® Syrup (Ca2+ 2.7mmol/5ml)
iv. Calcium Chloride Injection 10%, 10ml; 13.4%, 10ml
v. Calcium Gluconate Injection, Tablets, Mixture GHPS 25mg/ml

9.5.1.2 Hypercalcaemia and hypercalciuria

i. Sodium Clodronate (Bonefos®) Capsules 400mg, Injection – Hospital Only
ii. Sodium Clodronate (Loron®) Tablets 520mg Disodium Pamidronate Injection- Hospital Only
iii. Trisodium Edetate Injection
iv. Zoledronic Acid 4mg Injection
v. Cinacalcet. Hospital Only, NICE TA117 
vi Etelcalcetide – RED – Hospital Only – As per NICE TA448

9.5.1.3 Magnesium

i. Magnesium Chloride Injection
ii. Magnesium Glycerophosphate Tablets (U)
iii. Magnesium Sulphate Injection, Mixture
iv. Magnesium Sulphate 10mmol in Sodium Chloride 0.9% 500ml. HYCCN Regimen

9.5.2 Phosphorus

9.5.2.1 Phosphate supplements

i. Phosphate Sandoz Soluble Tablets
ii. Phosphate Polyfusor® 500ml (100mmol phosphate in 1Litre)
iii. Joulies Solution (4.9mmol phosphate in 5ml). Hospital Only (U)
iv. Neutral Sodium Phosphate Oral Solution (1mmol phosphate in 1ml). Hospital Only (U)

9.5.4 Zinc

i. Zinc Sulphate (Solvazinc®) 125mg Effervescent tablets

9.6 Vitamins

9.6.1 Vitamin A

Vitamin A & D Capsules

9.6.2 Vitamin B group

i. Vitamin B Compound Strong Tablets
ii. Vitamin B Compound Tablets
iii. Vitamin B Complex Syrup Hospital Only
iv. Thiamine Tablets
v. Hydroxocobalamin Injection
vi. Pyridoxine Tablets
vii. Forceval Soluble Tablet Hospital Only
viii. Vitamins B+C Strong IV (Pabrinex® IV) Injection
ix. Vitamins B+C Strong IM (Pabrinex ® IM) Injection

9.6.3 Vitamin C

Ascorbic Acid Injection, Tablets

9.6.4 Vitamin D

i. Ergocalciferol capsules 50,000 units
ii. Ergocalciferol Liquid 3,000 units/ml & 10,000 units/ml
iii. Calcium and Ergocalciferol Tablet (Calcium Lactate 300mg, Calcium Phosphate 150mg)
iv. Calcium Carbonate 1.5g/Colecalciferol 10 mcg Chewable Tablets
v. Calcium Carbonate 750mg/Colecalciferol 5 mcg Caplets
vi. Calcium Carbonate 1.25g/Colecalciferol 10 mcg Chewable Tablets
vii. Alfacalcidol Capsules 250 nanograms, 1 microgram
viii. Alfacalcidol Drops (2 micrograms/ml, 10ml 1 drop = 100 nanograms)
ix. Colecalciferol 10 000 units/ml drops
x. Ergocalciferol injection 300 000 units/ml

Please refer to the Vitamin D Guidance 

Please Note:

Calcium Carbonate 1.5g = 15.1mmol Calcium = Calcium 600 mg
Calcium Carbonate 1.25g = 12.6mmol Calcium = Calcium 500 mg
Calcium Carbonate 750mg = 7.5mmol Calcium = Calcium 300 mg
Colecalciferol 10mcg = 400units Colecalciferol
Colecalciferol 5mcg = 200units Colecalciferol

9.6.5 Vitamin E

i. Alpha Tocopheryl Acetate Suspension

9.6.6 Vitamin K

i. Phytomenadione 10mg Tablets (U)
ii. Phytomenadione 1mg Capsules
iii. Phytomenadione (Konakion MM®) 10mg/ml
iv. Phytomenadione Injection (Konakion MM® Paediatric) 2mg/0.2ml

9.6.7 Multivitamin preparations

i. Vitamin BPC Capsules
ii. Forceval Capsules
iii. Dalivit Drops
iv. Ketovite Tablets, Liquid
v. DekaPlus. restricted for Cystic Fibrosis patients.

9.9 Miscellaneous

i. PreOp Carbohydrate Cartons

Please Note:

mcg = micrograms. Prescribe as micrograms NOT mcg.

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