Medicines Q&As
Q&A 355.4
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
Date prepared: 28 August 2012
Background
Vegetarians do not eat meat, poultry, game, fish, shellfish, crustacean or animal products such as
gelatine. There are three main types of vegetarian:
 Lacto-ovo-vegetarian who eat both dairy products and eggs
 Lacto-vegetarians who eat dairy 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 state that one unit of vitamin D is contained in 25 nanograms of colecalciferol or
ergocalciferol (2). The BP 2012 states 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
UKMi Q&A 35.7 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.
Licensed products
Suitability for vegetarians and vegans:
Accrete D3
Unsuitable for vegetarians and vegans: Contains gelatin
(8)
Adcal D3 Caplets
Suitable for vegetarians but not vegans: Gelatin free
(9)
Adcal D3 Lemon Chewable
Tablets
Unsuitable for vegetarians and vegans: Contains gelatin
(10)
Adcal-D3 Dissolve 1500mg/400IU
Effervescent Tablets
Unsuitable for vegetarians and vegans: Contains gelatin
(11)
Cacit D3 Effervescent Granules
500mg/440IU
Unsuitable for vegetarians and vegans: Contains gelatin
(12)
Calceos
Unsuitable for vegetarians and vegans: Contains gelatin
(13)
From the NHS Evidence website www.evidence.nhs.uk
Ref:
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Medicines Q&As
Calcichew D3 *
Suitable for vegetarians: Gelatin free
(14)
Calcichew D3 Forte *
Suitable for vegetarians: Gelatin free
(14)
Calcichew-D3 500mg/400IU
Caplets
Unsuitable for vegetarians and vegans: Contains gelatin
(15)
Calfovit D3
Unsuitable for vegetarians and vegans: Contains gelatin
(16)
Kalcipos-D 500mg/800IU
Chewable Tablets
Unsuitable for vegetarians and vegans: Contains gelatin
(17)
Natecal D3 Chewable Tablets
Unsuitable for vegetarians and vegans: Contains gelatin
and lactose
(18)
Sandocal+D 600 Effervescent
Tablets
Unsuitable for vegetarians and vegans: Contains bovine
gelatin
(19)
Sandocal +D 1200 Effervescent
Tablets
Unsuitable for vegetarians and vegans: Contains bovine
gelatin
(20)
* Gelatin was removed from these products in 2011. Check the PIL to ensure product has the new
formulation and is gelatin free (14).
Unlicensed calcium and vitamin D3 (colecalciferol) tablets are available: e.g.
Unlicensed Product:
Manufacturer:
Suitability for vegetarians and vegans:
Ref:
Calcium and Vitamin D3
Chewable Tablets
Zanza Laboratories
Ltd
Suitable for vegetarians but not vegans:
Gelatin free
(21)
Other preparations may be available.
Calcium and ergocalciferol:
Calcium and ergocalciferol tablets are available from generic pharmaceutical manufacturers. The list
below is not exhaustive. Other calcium and ergocalciferol tablets should be checked on an individual
basis with the manufacturer.
Table 1: Examples of generic calcium and ergocalciferol tablets
Manufacturer:
Suitability for vegetarians and vegans:
Ref:
Almus
Pharmaceuticals
Unsuitable for vegetarians and vegans. Contains porcine gelatin
and lactose
(22)
Crescent Pharma
Unsuitable for vegetarians and vegans. Contains porcine gelatin
and lactose
(23)
Table 2: Examples of unlicensed calcium and ergocalciferol tablets
Manufacturer:
Suitability for vegetarians and vegans:
Ref:
Chanelle Medical UK
Suitable for vegetarians and vegans
(24)
Zanza Labs
Suitable for vegetarians and vegans
(21)
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).
From the NHS Evidence website www.evidence.nhs.uk
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Medicines Q&As
Limitations
Manufacturers may change their formulation or the suppliers of their excipients. Current status of the
origins of the tablet ingredients should therefore be obtained from the manufacturer if appropriate.
The list of generic manufacturers of calcium and vitamin D tablets is not exhaustive.
Disclaimer
 Medicines Q&As are intended for healthcare professionals and reflect UK practice.
 Each Q&A relates only to the clinical scenario described.
 Q&As are believed to accurately reflect the medical literature at the time of writing.
 The authors of Medicines Q&As are not responsible for the content of external websites and
links are made available solely to indicate their potential usefulness to users of NeLM. You
must use your judgement to determine the accuracy and relevance of the information they
contain.
 This document is intended for use by NHS healthcare professionals and cannot be used for
commercial or marketing purposes.
 See www.ukmi.nhs.uk/activities/medicinesQAs/default.asp for full disclaimer.
References
1. NHS Choices Accessed online via
http://www.nhs.uk/Livewell/Vegetarianhealth/Pages/Goingvegetarian.aspx 24/7/2012
2. Sweetman S. Martindale: The Complete Drug Reference Accessed online
via:www.Medicinescomplete.com 24/7/2012
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 35.7 What are the excipients in calcium supplements?
http://www.nelm.nhs.uk/en/NeLM-Area/Evidence/Medicines-Q--A/What-are-the-excipients-incalcium-supplements2/
7. Martin J (editor). British National Formulary online. Accessed via:
www.medicinescomplete.com on 24/7/2012
8. Summary of Product Characteristics – Accrete D3. Internis Pharmaceuticals Ltd. Accessed
via http://www.medicines.org.uk/EMC/medicine/25530/SPC/Accrete+D3/ on 24/07/2012 [date
of revision of the text 19/01/2011]
9. Personal Communication with Medicines Information ProStrakan Pharmaceuticals
09/08/2012
10. Summary of Product Characteristics – Adcal D3 lemon Chewable Tablets. ProStrakan.
Accessed via
http://www.medicines.org.uk/EMC/medicine/20117/SPC/Adcal+D3+Lemon+Chewable+Tablet
s/ on 24/07/2012 [date of revision of the text 20/05/2009]
11. Summary of Product Characteristics – Adcal D3 Dissolve 1500mg/400IU Effervescent
Tablets. ProStrakan. Accessed via
http://www.medicines.org.uk/EMC/medicine/20519/SPC/AdcalD3+Dissolve+1500mg+400IU+Effervescent+Tablets/ on 24/07/2012 [date of revision of the
text 20/05/2009]
12. Summary of Product Characteristics – Cacit D3 Effervescent Granules 500mg/440IU. Warner
Chilcott UK Ltd Accessed via
http://www.medicines.org.uk/EMC/medicine/10717/SPC/Cacit+D3+Effervescent+Granules+5
00+mg+440+IU/ on 24/07/2012 [date of revision of the text 01/05/2010]
13. Summary of Product Characteristics – Calceos.Galen Ltd Accessed via
http://www.medicines.org.uk/EMC/medicine/448/SPC/Calceos/ on 17/08/2012 [date of
revision of the text 31/07/2012]
14. Personal Communication with Medicines Information, Shire Pharmaceuticals 08/08/2012
15. Summary of Product Characteristics – Calcichew-D3 500mg/400IU Caplets. Shire
Pharmaceuticals Ltd Accessed via
http://www.medicines.org.uk/EMC/medicine/23703/SPC/CalcichewD3+500+mg+400IU+Caplets/ on 24/07/2012 [date of revision of the text Nov 2011]
From the NHS Evidence website www.evidence.nhs.uk
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Medicines Q&As
16. Summary of Product Characteristics – Calfovit D3. A.Menarini Pharma U.K. S.R.L. Accessed
via http://www.medicines.org.uk/EMC/medicine/19326/SPC/Calfovit+D3/ on 24/07/2012 [date
of revision of the text 23/09/2009]
17. Summary of Product Characteristics – Kalcipos-D 500mg/800IU Chewable Tablets. Meda
Pharmaceuticals. Accessed via
http://www.medicines.org.uk/EMC/medicine/24306/SPC/KalciposD+500+mg++800+IU+chewable+tablets/ [date of revision of the text 12/08/2010]
18. Summary of Product Characteristics – Natecal D3 Chewable Tablets. Chiesi Ltd. Accessed
via http://www.medicines.org.uk/EMC/medicine/20993/SPC/Natecal+D3+Chewable+Tablets/
[date of revision of the text 22/09/2011]
19. Summary of Product Characteristics – Sandocal+D 600 Effervescent Tablets. Novartis
Consumer Health. Accessed via
http://www.medicines.org.uk/EMC/medicine/21663/SPC/Sandocal%2bD+600+Effervescent+t
ablets/ [date of revision of the text 03/06/2011]
20. Summary of Product Characteristics – Sandocal+D 1200 Effervescent Tablets. Novartis
Consumer Health. Accessed via
http://www.medicines.org.uk/EMC/medicine/22238/SPC/Sandocal+%2b+D+1200+Effervesce
nt+Tablets/ [date of revision of the text 03/06/2011]
21. Personal Communication with Zanza Laboratories 10/08/2012
22. Personal Communication with Almus Pharmaceuticals 16/08/2012
23. Personal Communication with Customer Service Crescent Pharma on 14/08/2012
24. Personal Communication with Chanelle Medical UK – 24/08/2012
Quality Assurance
Prepared by
Gill Lewis, South West Medicines Information and Training, University Hospitals Bristol NHS
Foundation Trust
Date Prepared
28 August 2012
Checked by
Julia Kuczynska, South West Medicines Information and Training, University Hospitals Bristol NHS
Foundation Trust
Date of check
31st August 2012
Search strategy


In-house database/ resources
Manufacturer
 ProStraken Pharmaceuticals email 09/08/2012
 Shire Pharmaceuticals email 09/08/2012
 Crescent Pharma email 14/08/2012
 Kent Pharmaceuticals email 10/08/2012
 Almus Pharmaceuticals email 16/08/2012
 Chanelle Medical UK Ltd email 24/08/2012
 Zanza Laboratories email 10/08/2012
From the NHS Evidence website www.evidence.nhs.uk
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Medicines Q&As

Internet Search
 BNF on line “calcium “vitamin D””
 Electronic Medicines Compendium “calcium”
 Dictionary of Medicines and Devices Browser “ergocalciferol”, “colecalciferol”
 Medicines Complete (Martindale and AHFS) “colecalciferol/cholecalciferol”, “ ergocalciferol
 Google Scholar “"vitamin D" "wool fat"”
 Google “vegetarians uk nhs”

Societies
 The Vegan Society email 06.07.2010
 The Vegetarian Society email 12.07.2010
From the NHS Evidence website www.evidence.nhs.uk
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