9: Nutrition and blood
Approved: 4 Oct 2017. Last amended: 16 Dec 2020.
9.1 Anaemias and some other blood disorders
9.1.1 Iron deficiency anaemia
9.1.1.1 Oral iron
Recommended
Ferrous fumarate 322mg tablets
Alternative
Ferrous sulfate 200mg tablets
Specific Indication
Ferrous fumarate liquid 140mg/5ml
Patients unable to swallow iron tablets
Sodium feredetate liquid
Neonate / Paediatric use
9.1.1.2 Oral iron with folic acid
Specific Indication
Ferrous fumarate (305mg) with folic acid (350mcg) Galfer FA®
9.1.1.3 Parenteral iron
Specific Indication
Cosmofer® (iron dextran)
Cosmofer® guideline
Sample Cosmofer® prescription chart
Diafer® (ferric derisomaltose)
Renal dialysis patients only
Ferinject® (ferric carboxymaltose)
Sample Ferinject® prescription chart
Monofer® (ferric derisomaltose)
Sample Monofer® prescription chart
9.1.2 Megaloblastic anaemia
9.1.2.1 Folic Acid
Recommended
Folic acid tablets
Specific Indication
Folic acid liquid
Patients unable to swallow tablets
9.1.3 Hypoplastic, haemolytic and renal anaemias
9.1.3.1 Erythropoeisis Stimulating Agents
Recommended
Aranesp® (darbepoetin)
- anaemia in people with cancer having chemotherapy, as per NICE TA323
- anaemia associated with chronic kidney disease, as per NICE NG8
Mircera® (methoxy polyethylene glycol-epoetin beta)
- anaemia associated with chronic kidney disease, as per NICE NG8
Specific Indication
Other erythropoeisis stimulating agents
- as per NICE TA323 / NICE NG8
9.1.3.2 Iron Chelators
Deferasirox
Deferiprone
Desferrioxamine mesilate
Dexrazoxane
9.1.3.3 Atypical haemolytic uraemic syndrome and paroxysmal nocturnal haemoglobinuria
Eculizumab
As per NICE HST1
9.1.4 Drugs Used in Platelet Disorders
Anagrelide
Essential thrombocythaemia in patients at risk of thrombo-haemorrhagic events who have not responded adequately to other drugs or who cannot tolerate other drugs
Eltrombopag
Chronic immune (idiopathic) thrombocytopenic purpura, as per NICE TA293
Lusutrombopag
Thrombocytopenia in people with chronic liver disease needing a planned invasive procedure, as per NICE TA617
Romiplostim
Chronic immune (idiopathic) thrombocytopenic purpura, as per NICE TA221
9.1.5 Drugs used in neutropenia
Recommended
Filgrastim
Specific Indication
Lenograstim
Pegfilgrastim
9.1.6 Drugs used to mobilise stem cells
Plerixafor
9.2 Fluid and electrolyte imbalances
9.2.1 Bicarbonate
9.2.2 Calcium
9.2.2.1 Hypocalcaemia
9.2.2.2 Hypercalcaemia
Cinacalcet
- Secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy, as per NICE TA117
- Primary hyperparathyroidism if surgery has been unsuccessful or is unsuitable, as per NICE NG132
Etelcalcetide
- Secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy, where cinacalcet is unsuitable, as per NICE TA448
9.2.3 Magnesium
9.2.4 Phosphate
9.2.4.1 Hypophosphataemia
9.2.4.2 Hyperphosphataemia
Specific Indication
Renacet®
(Calcium acetate) tablets. Phosphate binder in renal impairment
9.2.5 Potassium
9.2.5.1 Hypokalaemia
GHNHSFT Treatment Guideline – Hypokalaemia
Recommended
Sando K® effervescent tablets (12mmol K+ per tablet)
Intravenous potassium
Use pre-made infusion bags
Specific Indication
Kay Cee L® liquid (1mmol K+ per ml)
Patients unable to tolerate Sando K
9.2.5.2 Hyperkalaemia
GHNHSFT Treatment Guideline – Hyperkalaemia
Specific Indication
Sodium zirconium cyclosilicate
Hyperkalaemia, as per NICE TA599
Patiromer
Hyperkalaemia, as per NICE TA623
9.2.6 Sodium
9.3 Metabolic disorders
Elosulfase alfa
Mucopolysaccharidosis type IVa, as per NICE HST2
Migalastat
Fabry disease, as per NICE HST4
Eliglustat
Type 1 Gaucher disease, as per NICE HST5
Asfotase
Paediatric-onset hypophosphatasia, as per NICE HST6
Inotersen
Hereditary transthyretin amyloidosis, as per NICE HST9
Patisiran
Hereditary transthyretin amyloidosis, as per NICE HST10
Cerliponase alfa
Neuronal ceroid lipofuscinosis type 2, as per NICE HST12
9.4 Trace element deficiencies
Not currently included in the Joint Formulary
9.5 Nutrition
Not currently included in the Joint Formulary
9.6 Vitamin deficiencies
9.6.1 Vitamin A
9.6.2 Vitamin B
9.6.3 Vitamin C
9.6.4 Vitamin D
GHNHSFT Vitamin D Treatment Guideline
9.6.4.1 High Dose Colecalciferol
Recommended
HuxD3®
(colecalciferol 20,000iu) capsules
Specific Indication
Colecalciferol
300,000iu in 1ml injection
9.6.4.2 Low Dose Colecalciferol
Stexerol-D3®
(colecalciferol 1,000iu) tablets
9.6.4.3 Calcium with Vitamin D
Calci-D®
(Calcium carbonate 2.5g [equiv. to calcium 1g] / colecalciferol 1,000iu) chewable tablets