Information for health care professionals - Vitamin supplements

Information for health care professionals

Vitamin supplements

Children with CF may become deficient of fat soluble vitamins (A, D, E and K) due to fat malabsorption. Fat soluble vitamin supplements should be taken with pancreatic enzyme supplements to maximise absorption. Vitamin levels (A, D and E) are measured once a year at annual review. If levels are low, the dose of vitamins is increased.

Vitamin A supplementation

1 microgram of vitamin A is equivalent to 3.3IU

Age Dose (per day)
<6 weeks 2000iu (600 microgram)
6 weeks - 6 months 4000iu (1200 microgram )
>6 months - adult 8000iu (2400 microgram)

Vitamin D supplementation

Note that 1 microgram of vitamin D is equivalent to 40IU

Age Dose (per day)
birth - 12 months 400iu (10 microgm)
1-12 years 400-800iu (10-20 microgm)
12 years-adult 800iu-2000iu (20-50 microgm)

Vitamin E supplementation

Age Dose (per day)
<12 months 50mg
1 - 10 years 100mg
>10 years 200mg

Vitamin K supplementation

Vitamin K should be offered to all children aged 6 years (including pancreatic sufficient) and is mandatory for those with liver disease (with or without clotting abnormalities). The CF Trust nutrition guidelines suggest Vitamin K1 (phytomenadione) is used; unfortunately this is only available as a hospital special and cannot be sourced by community pharmacies. In practice (like the Brompton) we use Menadiol, a man-made water soluble version of vitamin K. The tablet can be swallowed or crushed and dissolved. The dose for 6 years and above is 10 mg once per day. Families that would like to use vitamin K supplements from 2 years of age can do so - the menadiol tablets can be broken, then crushed and dissolved - the dose for 2-6 year old is 5mg once per day.
Patients who take Aquadek are supplemented with vitamin K in the form of phytonadione but only at a low dose, and also need to take menadiol. (dose of vitamin K in Aquadek = 0.4mg/ml of liquid, 0.7mg per softgel, 0.35mg per chewable tablet).

Suitable vitamin preparations

For vitamin A and D

  Vitamin A Vitamin D
Vitamin A & D BPC - 1 capsule 4000iu 400iu
Halibut oil capsules - 1 capsule 4000iu 400iu
Abidec 0.6ml 1500iu 400iu
Dalivit 0.6ml 5000iu 400iu
Calcichew Forte - 1 tablet none 400iu plus 500mg calcium
Aquadek - 1 softgel 18167iu 800iu
Aquadek - 1 chewable tablet 9083iu 400iu
Aquadek liquid -1ml 5751iu 400iu

Our normal recommendation is 0.6ml Dalavit per day for children under 12 months and 1.2ml Dalavit for older children. Children who are able to swallow capsules may prefer A & D capsules (2-5 per day). If available, Aquadek liquid, chewable tablets or gelcaps are a good alternative. Aquadek softgel and chewable tablets have almost twice as much vitamin A for the same amount of vitamin D. For this reason some units recommend only using the liquid Aquadek preparation in children under 8 years of age.

For vitamin E

Vitamin E is also known as alpha tocopheryl. Note that 1mg of vitamin E is equivalent to 1-1.5IU depending on the exact preparation.

  Vitamin E
Vitamin E suspension - 1ml 100mg
Vita E 75 gel capsule 50mg
Vita E 200 gel capsule 134mg
Vita E 400 gel capsule 268mg
Aquadek - 1 softgel 150iu
Aquadek - 1 chewable tablet 50iu
Aquadek liquid -1ml 50iu

Vita E capsules come as 75IU, 200IU and 400IU, but only the 200IU is prescribable. One 200IU capsule per day is suitable for most children over 5 (under 5 they are unlikely to be able to swallow the capsule, which is a bit smaller than a creon capsule).