Guidance
When can multivitamins and minerals supplements be considered?
Prescribing of multivitamins is supported by UK guidance in appropriate circumstances and for appropriate patients. Please see below for further details on circumstances in which multivitamin and mineral supplements can be prescribed.
This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital, in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.
This clinical guideline includes recommendations on:
- Screening for malnutrition and the risk of malnutrition
- Indications for nutrition support
- What nutrition support to give
- Monitoring of nutrition support
- Oral nutrition support
- Enteral tube feeding
- Parenteral nutrition
Multivitamin specific content:
Section 1.6 – Oral nutrition support in hospital and community
“If there is concern about the adequacy of micronutrient intake, a complete oral multivitamin and mineral supplement providing the reference nutrient intake for all vitamins and trace elements should be considered by healthcare professionals with the relevant skills and training in nutrition support who are able to determine the nutritional adequacy of a patient’s dietary intake.”
Click here to visit the NICE CG 32
NICE: The National Institute for Health and Care Excellence.
This quality standard covers care for adults (aged 18 and over) who are malnourished or at risk of malnutrition in hospital or in the community. It includes identifying people at risk of malnutrition and providing nutrition support, including dietary changes and artificial nutrition support given through feeding tubes (enteral nutrition) or directly into a vein (parenteral nutrition).
NICE QS 24 highlights the need to ensure that any care plans aim to meet a patient’s complete nutritional requirements:
“It is important that nutrition support goes beyond just providing sufficient calories and looks to provide all the relevant nutrients that should be contained in a nutritionally complete diet. A management care plan aims to provide this and identifies condition specific circumstances and associated needs linked to nutrition support requirements.”
Click here to visit the NICE QS 24
The BOMSS Guidelines summarise existing evidence for the monitoring and replacement of vitamins and minerals prior to, and following bariatric surgery, and to make recommendations for practice in the UK setting.
Preoperative care
Patients should have a comprehensive nutritional assessment prior to surgery including a dietitian-led assessment. Nutritional deficiencies identified should be investigated and corrected prior to surgery.
Postoperative care
Patients should be monitored post-surgery to ensure that they are meeting their nutritional requirements and to reduce the risk of developing any procedure-related deficiencies.
“A complete multivitamin and mineral supplement (containing iron, selenium, zinc and copper) is recommended after all bariatric procedures.”
BOMSS Guidelines for patients undergoing bariatric surgery recommend Forceval® Capsules as a suitable multivitamin supplement following a range of bariatric surgery options, such as:
- Gastric balloon
- Gastric band
- Gastric bypass
- Sleeve gastrectomy
- Duodenal switch
Click here to visit the BOMMS Guidelines
Please note: Forceval® Capsules does not contain vitamin K.
This guide provides GPs with a BOMSS nutritional guidance summary to support GPs managing adults who have had bariatric surgery.
It is noted within the guidance that this document does not replace obtaining clinical support and advice from a bariatric surgery unit.
“If patients have one deficiency, they often have others, so it is recommended that if one is identified full screening bloods are requested.”
“There are a wide range of multivitamin and mineral supplements available over the counter (OTC). Unfortunately, their composition varies widely, and they rarely contain sufficient zinc and copper as recommended in the BOMSS guidelines.
We recommend the multivitamin and mineral supplement is complete and contains a minimum of 400 to 800 micrograms folic acid, 15 mg zinc and 2 mg copper. Consequently, many OTC supplements will have to be doubled to meet these. Forceval is the only vitamin and mineral supplement available on prescription that meets these requirements.”
Click here to visit the BOMMS GP Guidelines
Please note: Forceval® Capsules does not contain vitamin K.
This guidance provides recommendations for items that are available over the counter (OTC) and should not be routinely prescribed in primary care because:
- There is limited evidence of clinical effectiveness for the item
- The item would be prescribed for a condition that is self-limiting and will clear up on its own without the need for treatment
- The item would be prescribed for a condition that is appropriate for self-care
These items include medicines, devices, food supplements and other items that can be prescribed.
This guidance is for prescribing healthcare professionals, integrated care boards (ICBs) and organisations that commission services.
Multivitamin specific content:
Recommendation – Do not prescribe vitamins and minerals, except:
When the patient has a medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition, or have undergone surgery that results in malabsorption.
Continuing need should however be reviewed on a regular basis.
Maintenance or preventative treatment is not an exception.
- Calcium and vitamin D for osteoporosis.
- Prescription-only vitamin D analogues such as alfacalcidol.
- Malnutrition, including from alcoholism.
Click here to visit the NHS England Guidance
The document provides advice to clinicians and health boards in Wales, with the aim of reducing unwarranted variation in the use of items that should not routinely be prescribed.
Multivitamin specific content:
Recommendation – Advise to minimise the prescribing of items that offer low clinical effectiveness to patients or where more cost-effective treatments are available, such as vitamins and minerals, which should not be routinely prescribed in primary care except for:
- Products suitable for medically diagnosed deficiency and/or malnutrition.
- Calcium and vitamin D preparations.
Click here to visit the All Wales Medicines Strategy Group Guidance
The Northern Ireland Department of Health (DoH) does not support prescribing of products on the Health Service where there is insufficient evidence of effectiveness. This document provides information on products that should not be prescribed and those that should be prescribed in approved circumstances.
Recommendation – The Northern Ireland Department of Health (NI DoH), and the Health and Social Care Board (HSCB) allow prescribing of some vitamins, including Forceval® Capsules, to prevent or treat deficiency but NOT as dietary supplements.
Medicines on the Limited Evidence List should be reviewed to ensure that they are used only in the approved circumstances.
Click here to visit the Northern Ireland HSC Guidance
These European guidelines on micronutrients provide information for clinical practice regarding assessment, monitoring, and prescription of micronutrients – addressing the specific needs of patients where standard dietary allowances may not be sufficient.
Within the guidelines, a set of recommendations were created and then graded using evidence-based results within clinical settings. A ‘strong consensus’ rating required >90% of the votes from the expert panel, comprising of representatives from European medical and educational institutions.
Multivitamin specific content:
Recommendation 1
Adequate amounts of all essential trace elements and vitamins shall be supplied to all patients receiving medical nutrition from the beginning of the period of nutritional support.
(Grade of recommendation – Strong consensus 100%)
Recommendation 2
Micronutrient supplements shall be provided orally or enterally if this can be done safely and effectively.
(Grade of recommendation – Strong consensus 100%)
Click here to view the full guideline
ESPEN European Society for Clinical Nutrition and Metabolism.
How to manage malnutrition
Learn more about ‘Food First’ and other strategies to manage malnutrition.
- Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. NICE Clinical guideline 32. Published 22 February 2006.
- Nutrition support in adults. NICE Quality Standard 24. Published 30 November 2012.
- BOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery. Available at: https://bomss.org/wp-content/uploads/2021/06/BOMSS-guidelines-Final-version1Oct14.pdf
- BOMSS Post-Bariatric Surgery Nutritional Guidance for GPs. Available at: https://bomss.org/bomss-post-bariatric-surgery-nutritional-guidance-for-gps/
- Policy guidance: conditions for which over the counter items should not be routinely prescribed in primary care, NHS England, 2024. Available at: https://www.england.nhs.uk/long-read/policy-guidance-conditions-for-which-over-the-counter-items-should-not-be-routinely-prescribed-in-primary-care/
- All Wales Medicines Strategy Group. Items Identified as Low Value for Prescribing in NHS Wales – Paper 3, February 2020. Available at: https://awttc.nhs.wales/files/guidelines-and-pils/items-identified-as-low-value-for-prescribing-in-nhs-wales-paper-3-v4-pdf/
- Northern Ireland Department of Health (NI DoH) and Health and Social Care Board (HSCB). Deprescribing: Limited Evidence List and Stop List. April 2024v2. Available at: https://niformulary.hscni.net/deprescribing/prescribing-stop-list/
- Berger, M et al. ESPEN micronutrient guideline. Clinical Nutrition. 2022;41:1357-1424.
Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk or by searching for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Pharmacovigilance at Alliance Pharmaceuticals Ltd, Tel: 01249 466966, email: pharmacovigilance@alliancepharma.co.uk.
Please consult the Summary of Product Characteristics for a full listing of contraindications, precautions, and adverse events before prescribing this medicine. Rash, nausea, vomiting and abdominal pain have been reported (frequency not known). Should not be given to individuals with allergies to peanut or soya, hypercalcaemia, haemochromatosis, other iron storage disorders, hypersensitivity to the active substance(s) or to any of the excipients.