Leyla Hannbeck, chief pharmacist at the NPA, answers common questions from community pharmacists about vitamin D

Following the updated recommendation on vitamin D intake from Public Health England earlier in 2016, community pharmacists across the UK have been contacting the NPA for advice.

Two common customer queries are:

Do I need to take a vitamin D supplement now that it’s winter and how much should I take?

The new guidelines state that everyone should consider taking a daily supplement containing 10 micrograms of vitamin D in autumn and winter. Most people are able to make enough vitamin D by spending time out in the sun, without sunscreen, from April to September. Between October and March, there is not enough UVB radiation in sunlight hours for our skin to make vitamin D.

What will happen if I take too much vitamin D?

High doses can raise calcium levels in the blood. Symptoms of high calcium include thirst, passing a lot of urine, nausea and vomiting, dizziness and headaches. Pharmacists should be aware that some OTC products contain more than the recommended amount of vitamin D that is required for the prevention of vitamin D deficiency.

Business planning

You can also look into ways of promoting this advice and connecting it to vitamin D products in your pharmacy. Ensure you are familiar with the recommendations made by the National Institute for Health and Care Excellence Public Health Guidance 56 document ‘Vitamin D: increasing supplement use among at-risk groups’.

Check that your pharmacy staff understand the updated guidance and, particularly in areas where there is a large demographic of at-risk groups, they know the correct doses of vitamin D for these groups. If you are not involved in the Healthy Start initiative, a UK wide Government scheme, contact your Local Pharmaceutical Committee to see if you can be included.

Recommend vitamin D in all cases of pregnancy and breastfeeding, and identify other at-risk patients collecting medicines or making OTC purchases. Make a recommendation and records of vitamin D supplementation during Medicines Use Reviews.

Safety and additional considerations

Some people may need to be assessed by a prescriber, particularly if deficiency or insufficiency is suspected. Pharmacists should make a professional decision as to whether to refer the patient to a clinician for further assessment, for example, if there are additional risk factors.

Vitamin D deficiency and insufficiency are normally treated by clinicians with prescription-only or unlicensed medicines. Pharmacists are reminded that where a licensed product is available to meet the clinical needs of a patient, this should be recommended to prescribers where unlicensed products have been prescribed. Licensed vitamin D products, such as Fultium-D3 capsules, are manufactured in a number of strengths, which means that prescribers have the option to tweak the dosage according
to need.

This is an extract from more detailed NPA guidance and factsheets on vitamin D. Members can download the latest advice at npa.co.uk/ information-and-guidance/ vitamin-d-updated-guidance.