Is There a Calcium and Vitamin D Preparation Which Is Suitable for a Vegetarian Or Vegan?

Q&A 355.6

Is there a calcium and vitamin D preparation which is suitable for a vegetarian or vegan?

Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals

Before using this Q&A, read the disclaimer at

Date prepared: 22nd September 2016

Background

Vegetarians do not eat meat, poultry, game, fish, shellfish, crustacean or animal by-products such as gelatine. There are three main types of vegetarian:

• Lacto-ovo-vegetarians who eat both dairy products and eggs
• Lacto-vegetarians who eat dairy products but not eggs
• Vegans who do not eat dairy products, eggs or any other animal products (1).
  

Around 2% of the UK population is vegetarian (1). With a large number of people avoiding some or all animal products for reasons of faith, ethics or allergy, information on the origins of active ingredients and excipients in medicines is often requested.

Proprietary calcium and vitamin D preparations contain calcium and colecalciferol or calcium and ergocalciferol. Colecalciferol and ergocalciferol are traditionally considered equal in potency. Pharmacopoeias consider that one unit of vitamin D is contained in 25 nanograms of colecalciferol or ergocalciferol (2). The BP 2016 directs that when calciferol or vitamin D is prescribed, colecalciferol or ergocalciferol should be dispensed (2). However some authors have suggested that colecalciferol is used as the preferred form of vitamin D as colecalciferol has been reported to raise serum vitamin D concentrations more effectively than ergocalciferol (2). Colecalciferol (vitamin D3) is produced in the skin after sun exposure. Colecalciferol is synthesised commercially from a precursor obtained from an animal source such as wool fat (3). Ergocalciferol (vitamin D2) has a different side chain than colecalciferol and is commercially made by irradiating and then purifying the ergosterol extracted from yeast (3). Wool fat derived products are unacceptable to vegans and would only be approved by the Vegetarian Society if the sheep’s wool had been pressed and not derived from slaughter (4). Yeast derived products are acceptable to vegetarians and vegans (5).

For information on suitable calcium tablets for vegetarians and vegans please see Medicines Q&A 35.8 What are the excipients in calcium supplements? (6).

Answer

Calcium and colecalciferol:

There are a number of branded calcium and vitamin D preparations listed in the British National Formulary (7). These all contain colecalciferol as the vitamin D component.

The table below gives information from the manufacturers or Summary of Product Characteristics regarding the suitability of these products for use by vegetarians or vegans.

Unlicensed products are also available. Confirm with the manufacturer regarding suitability for vegetarians or vegans.

Calcium and ergocalciferol:

Calcium and ergocalciferol tablets are available from generic pharmaceutical manufacturers. An example of generic calcium and ergocalciferol tablets is given below. Other calcium and ergocalciferol tablets should be checked on an individual basis with the manufacturer.

Example of generic calcium and ergocalciferol tablets:

Whilst a specific excipient may be listed as “not present” in a particular product, it cannot be guaranteed that the product has not been in contact with the listed excipients (or e.g. milk-derived or animal-derived products) during the manufacturing process. Further information on the manufacturing process should therefore be obtained from the manufacturer if appropriate (6).

Limitations

 Manufacturers may change the formulations of their products or the suppliers of their excipients. Current status of the origins of the product ingredients should therefore be obtained from the manufacturer if appropriate.

 The list of manufacturers of calcium and vitamin D products is not exhaustive.

References

1. NHS Choices Accessed online via on 2/8/2016
2. Sweetman S. Martindale: The Complete Drug Reference Accessed online via: 4/8/2016
3. Holick MF. The influence of vitamin D on bone health across the life cycle. J.Nutr 2005;135:2739S-2748S
4. Personal communication Vegetarian Society 13.07.10
5. Personal communication The Vegan Society 03.08.10
6. UKMi Q&A 35.8 What are the excipients in calcium supplements? Accessed via on 4/8/2016
7. Baxter K (BNF Director). British National Formulary online. Accessed via: on 5/8/2016
8. Internis Pharmaceuticals Ltd. Summary of Product Characteristics – Accrete D3 film-coated tablets. [Date of revision of text 25/07/2015] Accessed via on 4/8/2016
9. Personal Communication with Medicines Information Kyowa Kirin Ltd on 25/7/2016
10. Warner Chilcott UK Ltd. Summary of Product Characteristics: Cacit D3 Effervescent Granules 500mg/440IU. [Date of revision of text 01/05/2010] Accessed via on 4/8/2016
11. Galen Ltd. Summary of Product Characteristics: Calceos 500mg/400IU Chewable Tablets. [Date of revision of text 31/3/2015] Accessed via on 4/8/2016
12. Personal Communication with Medicines Information, Takeda UK Ltd 22/7/2016 and 18/8/2016
13. Personal Communication with Medical Information Consilient Health Ltd 22/9/2016
14. A.Menarini Farmaceutica Internazionale S.R.L. Summary of Product Characteristics: Calfovit D3. [Date of revision of text 23/09/2009] Accessed via on 4/8/2016
15. Personal Communication with Medicines Information, Teva UK Ltd on 22/7/2016
16. Personal communication with Medicines Information, Meda on 29/7/2016
17. Chiesi Ltd. Summary of Product Characteristics: Natecal D3 Chewable Tablets. [Date of revision of text 10/2015] Accessed via on 4/8/2016
18. Personal communication with Medicines Information, Stirling Anglian Pharmaceuticals Ltd on 21/7/2016
19. Personal Communication with Technical Manager Almus Pharmaceuticals on 22/7/2016 and 17/8/2016

Quality Assurance

Prepared by

Gill Lewis, South West Medicines Information and Training, Bristol

Date Prepared

21th September 2016

Checked by
Julia Kuczynska, South West Medicines Information and Training, Bristol

Date of check

5th October 2016

Search strategy

• In-house database/ resources
  

• Manufacturer

• Internis Pharmaceuticals Ltd email 21/7/2016
• Kyowa Kirin Ltd email 25/7/2016
• Galen Ltd email 22/7/2016
• Takeda UK Ltd email 22/7/2016
• Warner Chilcott UK Ltd email 22/7/2016
• Teva UK Ltd email 21/7/2016
• Meda Pharmaceuticals 21/7/2016
• Chiesi Ltd email 21/7/2016
• Consilient Health Ltd email 21/7/2016
• Stirling Anglian Pharmaceuticals Ltd email 21/7/2016
• Sanofi email 21/7/2016
• Almus Pharmaceuticals email 22/7/2016

• Internet Search
• British National Formulary Accessed via (colecalciferol with calcium carbonate, ergocalciferol with calcium lactate and calcium phosphate) on 18/7/2016
• Electronic Medicines Compendium [ Search term: calcium, colecalciferol, ergocalciferol
• Medicines Complete (Martindale) “colecalciferol/cholecalciferol”, “ ergocalciferol

• Societies

• The Vegan Society email 06.07.2010
• The Vegetarian Society email 12.07.2010

1

Available through NICE Evidence Search at