Forceval Soluble, Effervescent Multivitamin Tablets, 24 Vitamins and Minerals including Vitamin C, B Vitamins, Iron and Zinc. Suitable for Vegetarians. Pack of 30

Product Information

Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry. Iron ....................................... Iron forms part of red blood cells which carry oxygen round the body

Indications: As a therapeutic nutritional adjunct in conditions where the intake or absorption of vitamins and minerals is suboptimal, in convalescence from illness or surgery or for patients on special or restricted diets, where food intolerances exist or as an adjunct in synthetic diets. As a therapeutic nutritional adjunct in convalescence from surgery, e.g. where nutritional intake continues to be inadequate.

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Thiamine is absorbed from the gastro-intestinal tract and is widely distributed to most body tissues. Amounts in excess of the body's requirements are not stored but excreted in the urine as unchanged thiamine or its metabolites. Evidence from Randomised Control Trials suggests that high doses (20-30 mg/day) b-carotene intake may increase the risk of lung cancer in current smokers and those previously exposed to asbestos. This high-risk population should consider the potential risks and benefits of Forceval Capsules, which contain 4.5mg per recommended daily dose, before use. Malnourished individuals are usually depleted in whole body potassium, magnesium and phosphate, while simultaneously overloaded in whole body sodium and water. They also have reduced renal capacity to excrete a sodium and water load. This leads to vulnerability to re-feeding syndrome and iatrogenic sodium and water overload. 14,15 Pantothenic acid Pantothenic acid plays a vital role in the process of releasing energy from foods, the role of fat metabolism and the provision of the immune system with antibodies Mechanisms by which malnutrition predisposes to certain clinical problems and delays their resolution Adverse effect

For adults, the decision to initiate intravenous nutrition should NOT be taken outside of normal working hours whilst, for neonates, the decision to initiate intravenous nutrition outside of normal working hours MUST be in line with Trust policy and procedures. Whilst taking Forceval Capsules both protein and energy are also required to provide complete nutrition in the daily diet. No other vitamins, minerals or supplements with or without vitamin A should be taken with this preparation except under medical supervision.Some multivitamin supplements may not contain sufficient amounts of certain vitamins, minerals and trace elements to counteract the effects of bariatric surgery. Patients who have undergone gastric bypass or sleeve gastrectomy require a complete multivitamin and mineral supplement including iron, selenium, copper (2mg minimum) and zinc (ratio of 8-15mg zinc for each 1mg copper). Forceval is the only formulary product which is suitable for patients who have undergone bariatric surgery. See specific recommendations for patients who are planning pregnancy or who are pregnant.

Zinc is poorly absorbed from the gastro-intestinal tract. It is widely distributed throughout the body. It is excreted in the faeces with traces appearing in the urine. Swindon and Wiltshire- those who have a diagnosis of Coeliac disease, Dermatitis Herpetiformis or steatorrhea due to gluten sensitivity

For any patient with medically diagnosed vit B12 deficiency (diet- or non-diet-related) or malabsorption of vit B12 where it is not possible to administer IM hydroxocobalamin, 1mg oral cyanocobalamin (Orobalin®) tablets are a prescription only medicine (POM) and can be issued on FP10. See SPC and BSW treatment pathway below for more information. Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.

Vitamin B 1 (Thiamin) Is involved in the proper functioning of the heart muscles and for the release of energy from protein, fat and carbohydrate, needed for growth, normal appetite and digestion. Thiamin has also been shown to play a vital role in the normal functioning of the nervous system Menadiol sodium phosphate is water soluble and is included for use where patients have fat malabsorption.The gastric bypass impacts on the absorption of iron, vitamin B12, calcium and vitamin D. The longer term impact of the sleeve gastrectomy on nutrition is less well known but there are reports of low vitamin B12 levels and iron deficiency anaemia. Colecalciferol with Calcium carbonate tablets (chewable), 22 micrograms (880 units) + 2.5g (equivalent to 1g calcium) Vitamin A plays an important role in the visual process. It is isomerised to the 11-cis isomer and subsequently bound to the opsin to form the photoreceptor for vision under subdued light. One of the earliest symptoms of deficiency is night blindness which may develop into the more serious condition xerophthalmia. Vitamin A also participates in the formation and maintenance of the integrity of epithelial tissues and mucous membranes. Deficiency may cause skin changes resulting in a dry rough skin with lowered resistance to minor skin infections. Deficiency of Vitamin A, usually accompanied by protein-energy malnutrition, is linked with a frequency of infection and with defective immunological defence mechanisms. Iodine Involved in functioning of the thyroid gland which regulates many of the metabolic processes in the body RCPCH and NPPG joint position statement - using standardised strengths of unlicensed liquid medicines