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9: Nutrition and blood

Approved: 4 Oct 2017. Last amended: 5 Jan 2024.

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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

  • Feraccru® (ferric maltol)

    Gastroenterology only, as per Local Guideline

    • 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

    • 9.1.2.2 Vitamin B12

    Vitamin B12 Deficiency Guideline

    Vitamin B12 Deficiency treatment algorithm

    Recommended

  • Cyanocobalamin 100mcg, 1mg tablets

    • Specific Indication

  • Hydroxocobalamin 1mg i.m. injection

    Where oral cyanocobalamin is unsuitable (as per local guideline)

    • 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
  • Roxadustat
    • symptomatic anaemia in chronic kidney disease, as per NICE TA807

    • 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

  • Pegcetacoplan

    As per NICE TA778

  • Ravulizumab

    • 9.1.3.4 Sickle cell disease

    Specific Indication

  • Crizanlizumab

    Prevention of sickle cell crises in sickle cell disease, as per NICE TA743

    • 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

  • Avatrombopag
    • For treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure NICE TA626
    • Primary chronic immune thrombocytopenia NICE TA853
  • Caplacizumab

    Acute acquired thrombotic thrombocytopenic purpura, as per NICE TA667

  • Eltrombopag

    Chronic immune (idiopathic) thrombocytopenic purpura, as per NICE TA293

  • Fostamatinib

    Refractory chronic immune thrombocytopenia, as per NICE TA835

  • 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 Fluids

    9.2.1.1 Oral Rehydration Therapy

    Recommended

  • Oral Rehydration Therapy (ORT)

    • Specific Indication

  • St Mark’s Formula Electrolyte Drink

    Sodium chloride (table salt), glucose powder, sodium bicarbonate powder and water.

    GHNHSFT Patient Information Leaflet

    • 9.2.1.2 Intravenous fluids

    GHNHSFT Treatment Guideline – Intravenous Fluid Management in Adults

    GHNHSFT Treatment Guideline – Intravenous Fluid Management in Children

    9.2.2 Bicarbonate

    Recommended

  • Sodium bicarbonate 500mg capsules
  • Sodium bicarbonate injection / infusion

    • Specific Indication

  • Sodium bicarbonate 1mmol/ml oral solution

    Paediatrics

    • 9.2.3 Calcium

    9.2.3.1 Hypocalcaemia

    GHNHSFT Treatment Guideline – Hypocalcaemia

    Recommended

  • Calci-D®

    (Calcium carbonate 2.5g [equiv. to calcium 1g] / colecalciferol 1,000iu) chewable tablets

  • Calcium gluconate 10% injection

    • Specific Indication

  • Adcal® 1500mg (calcium carbonate) chewable tablets

    Where combined calcium and vitamin D is usuitable

  • Cacit® 500mg (calcium carbonate) effervescent tablets

    Patients unable to tolerate the chewable tablets

    • 9.2.3.2 Hypercalcaemia

    See also Section 6.6 - Drugs affecting bone metabolism

  • 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

    • 9.2.4 Magnesium

    GHNHSFT Treatment Guideline – Hypomagnesaemia

    Recommended

  • Magnesium Hydroxide mixture BP 8% (7mmol/5ml)
  • Magnesium sulphate 50% injection

    • Alternative

  • Magnesium aspartate (Magnaspartate®) sachets
  • Magnesium citrate tablets

    4mmol (97mg)

    • 9.2.5 Phosphate

    9.2.5.1 Hypophosphataemia

    UKMi Treatment Guideline - Hypophosphataemia

    Recommended

  • Phosphate Sandoz® tablets

    Each tablet contains phosphate 16.1mmol, sodium 20.4mmol, potassium 3.1mmol)

  • Phosphates Polyfusor®

    Each 500ml Polyfusor® contains phosphate 50mmol, sodium 81mmol, potassium 9.5mmol)

    • 9.2.5.2 Hyperphosphataemia

    Recommended

  • Renacet®

    (Calcium acetate) tablets. Phosphate binder in renal impairment

    • Alternative

  • Adcal® 1500mg (calcium carbonate) chewable tablets
  • Adcal® D3 (calcium carbonate 1500mg / colecalciferol 400units) chewable tablets

    • Specific Indication

  • Sevelamer carbonate 800mg tablets / 2.4g sachets

    Second-line where calcium-based phosphate binders are ineffective/ unsuitable.

  • Lanthanum

    Third-line where calcium-based phosphate binders and sevelamer are ineffective / unsuitable.

    • 9.2.6 Potassium

    9.2.6.1 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

    • 9.2.6.2 Hyperkalaemia

    GHNHSFT Treatment Guideline – Hyperkalaemia

    Specific Indication

  • Sodium zirconium cyclosilicate

    Hyperkalaemia, as per NICE TA599

    Shared Care Guideline

  • Patiromer

    Hyperkalaemia, as per NICE TA623

    • 9.2.7 Sodium

    9.2.7.1 Hyponatraemia

    GHNHSFT Treatment Guideline – Hyponatraemia

    Recommended

  • Slow Sodium® (sodium chloride modified-release) tablets

    Each tablet contains 10mmol sodium

  • Demeclocycline
  • Intravenous sodium chloride

    • Specific Indication

  • Samsca® (tolvaptan)

    Consultant Endocrinologist only.

    Restricted to patients with symptomatic hyponatraemia (secondary to SIADH) who have failed to respond to fluid restriction and demeclocycline.

    • 9.2.8 Zinc

    Recommended

  • Solvazinc® (zinc sulphate) effervescent tablets

    • 9.3 Metabolic disorders

  • Asfotase

    Paediatric-onset hypophosphatasia, as per NICE HST6

  • Avalglucosidase alfa

    Pompe Disease, as per NICE TA821

  • Cerliponase alfa

    Neuronal ceroid lipofuscinosis type 2, as per NICE HST12

  • Cipaglucosidase alfa

    Late-onset Pompe disease, as per NICE TA912

  • Eladocagene exuparvovec

    Aromatic L-amino acid decarboxylase deficiency, as per NICE HST26

  • Eliglustat

    Type 1 Gaucher disease, as per NICE HST5

  • Elosulfase alfa

    Mucopolysaccharidosis type 4A, as per NICE HST1919

  • Inotersen

    Hereditary transthyretin amyloidosis, as per NICE HST9

  • Lumasiran

    Primary hyperoxaluria type 1, as per NICE HST25

  • Migalastat

    Fabry disease, as per NICE HST4

  • Patisiran

    Hereditary transthyretin amyloidosis, as per NICE HST10

  • Pegunigalsidase alfa

    Fabry disease, as per NICE TA915

  • Sebelipase alfa

    Wolman disease, as per NICE HST30

  • Velmanase alfa

    Alpha-mannosidosis, as per NICE HST29

    • 9.3.1 Acute porphyrias

  • Givosiran

    Acute hepatic porphyria, as per NICE HST16

  • Haem Arginate (Normasang®)

    • 9.4 Nutrition

    9.4.1 Foods for special diets

  • Sapropterin
    • hyperphenylalaninaemia in phenylketonuria, as per NICE TA729

    • 9.4.2 Enteral Nutrition

    Primary Care Enteral Nutrition Formulary

    Secondary Care Enteral Nutrition Formulary - under development

    9.5 Vitamin deficiencies

    9.5.1 Vitamin A

    9.5.2 Vitamin B

    Vitamin B12 Deficiency Guideline

    Vitamin B12 Deficiency treatment algorithm

    9.5.3 Vitamin C

    9.5.4 Vitamin D

    GHNHSFT Vitamin D Treatment Guideline

    9.5.4.1 High Dose Colecalciferol

    Recommended

  • HuxD3®

    (colecalciferol 20,000iu) capsules

    • Specific Indication

  • Colecalciferol

    300,000iu in 1ml injection

    • 9.5.4.2 Low Dose Colecalciferol

  • Stexerol-D3®

    (colecalciferol 1,000iu) tablets

    • 9.5.4.3 Calcium with Vitamin D

  • Calci-D®

    (Calcium carbonate 2.5g [equiv. to calcium 1g] / colecalciferol 1,000iu) chewable tablets

    • 9.5.5 Vitamin E

    9.5.6 Vitamin K

    9.5.7 Multivitamin Preparations

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    Key

    Hospital / Specialist only

    Specialist initiated / advised (with Shared Care Guideline)

    Specialist initiated / advised (without Shared Care Guideline)

    Non-specialist or Specialist

    Treatment Guidelines

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