PRESCRIBING OF VITAMIN D AS A PREVENTATIVE MEASURE AGAINST COVID-19
You will be aware of various reports relating to a growing optimism about the role of vitamin D in the prevention and treatment of patients with COVID-19. This letter sets out the Department’s current position in respect of the use of vitamin D, with particular attention to the role of vitamin D in the prevention and treatment of patients with COVID-19 in Health and Social Care.
The Department of Health provided updated advice in April 2017 on vitamin D intake for the general public including babies under 1 year, children aged 1 to 4 years, and everyone aged 5 years and over following publication of a Nutrition report on Vitamin D intake by the Scientific Advisory Committee on Nutrition (SACN) on 21 July 20161. This advice related to the general public and did not apply to those who are being treated for an underlying medical condition or deficiency with pharmacological doses as prescribed by their clinician.
The Department has a formal link with the National Institute for Health and Care Excellence (NICE) under which NICE Clinical Guidance is reviewed locally for applicability in Northern Ireland and where found to be applicable is endorsed by the Department for implementation within Health and Social Care (HSC). NICE provides national guidance and advice to improve health care and has a global reputation for rigour, independence and objectivity.
NICE Covid-19 rapid guidelines are automatically endorsed as applicable in Northern Ireland from the date of publication by NICE in accordance with HSC Circular (SQSD) (NICE Covid-19 Procedures) 12/20 which is available at: https://www.health-ni.gov.uk/sites/default/files/publications/health/HSC-SQSD-12-20.pdf
On 17 December 2020 NICE published COVID-19 rapid guideline NG187, available at https://www.nice.org.uk/guidance/NG187, following a review of the current available evidence. This review concluded that there was insufficient evidence of benefit to support the use of vitamin D to prevent or treat COVID-19, outside a clinical trial setting, but that existing UK Government advice on daily vitamin D supplementation to maintain bone and muscle health should continue to be followed during the COVID-19 pandemic.
In light of this latest review, the Department does not intend to make vitamin D available for the treatment or prevention of COVID-19 at this time, however this position will be reviewed in future should further evidence become available that would support its use for this reason.
It remains the case that vitamin D products should continue to be prescribed for those patients who are being treated for an underlying medical condition or deficiency with pharmacological doses. The current guidance on vitamin D prevention for the general public, as set out in HSS(MD) 5/2017, also continues to apply. Some children aged up to 4 years and pregnant women will be entitled to free Healthy Start Vitamins, while all other people should be advised to purchase a Vitamin D supplement containing 10 micrograms of vitamin D from their local community pharmacy, supermarket, or other retail outlet.
We do however recognise that there are some groups of people with very little or no sunshine exposure where it is not feasible to purchase a Vitamin D supplement, such as those individuals who are housebound, or living in institutions such as care homes or prisons, and it may be clinically appropriate to prescribe vitamin D for the prevention of deficiency in these individuals. If a prescription is issued for these individuals, prescribers should prescribe licenced preparations rather than ‘specials’, and should refer to the current prescribing advice in the Northern Ireland Formulary for further information as to currently available products.