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

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Licensed for the treatment and prevention of magnesium deficiency, where clinically indicated in adults, adolescents and children aged 2 years and older. Riboflavine is absorbed from the gastro-intestinal tract and in the circulation is bound to plasma proteins. It is widely distributed. Little is stored and excess amounts are excreted in the urine. In the body riboflavine is converted to flavine mononucleotide (FMN) and then to flavine adenine dinucleotide (FAD). Contains both fat and water-soluble vitamins and minerals. The resulting solution may therefore be cloudy, this is perfectly normal. As an adjunct to specific therapy for osteoporosis in patients with vitamin D deficiency or at risk of vitamin D insufficiency

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations. Colecalciferol with Calcium carbonate caplets, 5 micrograms (200 units) + 750mg (equivalent to 300mg calcium)Micronutrients are only required in very small amounts daily (milligram or microgram amounts). However, micronutrients are vitally important to the successful functioning of the body. The following colecalciferol (vitamin D3) plus calcium products are included in the formulary (see 9.6.4 Vitamin D). It is accepted that patients post bariatric surgery may require non-formulary products and/or off-label doses. Specialists should be consulted for further advice Vitamin C .............................. Vitamin C is an essential vitamin that plays an important role in Effervescent tablets each containing P otassiumchloride 600mg / Potassiumbicarbonate 400mg (total potassium12mmol) per tablet As a therapeutic nutritional adjunct in convalescence from surgery, e.g. where nutritional intake continues to be inadequate.

In children, THORENS can be mixed with a small amount of children's foods, yogurt, milk, cheese or other dairy products. The parents should be warned not to mix THORENS into a bottle of milk or container of soft foods in case the child does not consume the whole portion, and does not receive the full dose. In children who are not breast-fed, the prescribed dose should be administered with a meal. Although it has been established that chromium is essential to human life, little information is available on its function and metabolism. These products may be used twice a day for a specified short period of time on the advice of a clinical Dietitian for severe inflammatory states or other conditions that incur higher than normal vitamin / trace element requirements e.g. burns patients. Women with a BMI ≥30 wishing to become pregnant should be advised to take 5mg folic acid supplementation daily, starting at least one month before conception and continuing during the first trimester of pregnancy. ( RCOG) No cases of overdosage due to Forceval therapy have been reported. Any symptoms which may be observed due to the ingestion of large quantities of Forceval capsules will be due to the fat soluble vitamin content. If iron overdosage is suspected, symptoms may include nausea, vomiting, diarrhoea, abdominal pain, haematemesis, rectal bleeding, lethargy and circulatory collapse. Hyperglycaemia and metabolic acidosis may also occur. Treatment should be implemented immediately. In severe cases, after a latent phase, relapse may occur after 24 - 48 hours, manifest by hypotension coma and hepatocellular necrosis and renal failure.

Please note that parcels weighing over 2kg may be sent via courier due to Royal Mail weight restrictions. The gastric balloon and gastric band have no direct impact on absorption of nutrients though they help patients to eat less resulting in reduced nutrient intake. Patients may experience vomiting or regurgitation and develop food intolerances. A complete multivitamins supplement with minerals and trace elements (containing iron, selenium, zinc and copper) is recommended after all bariatric procedures. Some multivitamin supplements may not contain sufficient amounts of certain vitamins, minerals and trace elements to counteract the effects of bariatric surgery. Forceval is the only formulary multivitamin preparation which is suitable for patients who have undergone bariatric surgery. See specific recommendations for patients who are planning pregnancy or who are pregnant. As a therapeutic nutritional adjunct where the intake of vitamins and minerals is suboptimal, e.g. in the presence of organic disease such as malignancy and immune deficiency syndromes, such as AIDS. Where medicines are included in the BSWformulary (for any indication) and are in the BNF for Children (BNF-C) they can be prescribed for a licensed indication within the manufacturer's recommendations using any licensed formulation.

NICE CG32: Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition BOMSS recommend treatment and adjustment of vitamin D supplementation in line with National Society of Osteoporosis Guideline: Vitamin D and Bone Health (see Management of Vitamin D deficiency). As a therapeutic nutritional adjunct in conditions where the absorption of vitamins and minerals is suboptimal, e.g. malabsorption, inflammatory bowel disease and fistulae, short bowel syndrome and Crohn's disease, and where concurrent medication decreases vitamin and mineral absorption.Manganese Manganese helps the body to utilise calcium and potassium and maintain the structure of cells Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review. Thiamine (as the coenzyme, thiamine pyrophosphate) is associated with carbohydrate metabolism. Thiamine pyrophosphate also acts as a co-enzyme in the direct oxidative pathway of glucose metabolism. In thiamine deficiency, pyruvic and lactic acids accumulate in the tissues. The pyruvate ion is involved in the biosynthesis of acetylcholine via its conversion to acetyl co-enzyme A through a thiamine-dependent process. In thiamine deficiency, therefore, there are effects on the central nervous system due either to the effect on acetylcholine synthesis or to the lactate and pyruvate accumulation. Deficiency of thiamine results in fatigue, anorexia, gastro-intestinal disturbances, tachycardia, irritability and neurological symptoms. Gross deficiency of thiamine (and other Vitamin B group factors) leads to the condition beri-beri. For initiation and follow-on prescribing by an Endocrinology Specialist for the treatment of complex primary hyperparathyroidism

Ascorbic acid is readily absorbed from the gastro-intestinal tract and is widely distributed in the body tissues. Ascorbic acid in excess of the body's needs is rapidly eliminated in the urine and this elimination is usually accompanied by a mild diuresis. Total parenteral nutrition (TPN) should only be prescribed by appropriately trained, healthcare professionals, in line with Trust policy. Except when liver function is impaired, Vitamin A is readily absorbed. β-carotene (as in Forceval Capsules) is Provitamin A and is the biological precursor to Vitamin A. It is converted to Vitamin A (Retinol) in the liver; retinol is emulsified by bile salts and phospholipids and absorbed in a micellar form. Part is conjugated with glucuronic acid in the kidney and part is metabolised in the liver and kidney, leaving 30 to 50% of the dose for storage in the liver. It is bound to a globulin in the blood. Metabolites of Vitamin A are excreted in the faeces and the urine. Calcium................................. Calcium is necessary for the formation of bones and teeth and plays a Over-the-counter "complete" vitamin and mineral supplements recommended by patient's specialist or BOMSS, take two tablets dailyCopper .................................. Is required for growth and forms part of enzymes involved in blood Potassium salts are absorbed from the gastro-intestinal tract. Potassium is excreted in the urine, the faeces and in perspiration. Urinary excretion of potassium continues even when intake is low. 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.