Rationalising vitamin and mineral supplements in palliative care

Follow the principles of medication rationalisation when rationalising vitamin and mineral supplements in palliative care.

There is no evidence that vitamin and mineral supplements are beneficial in the absence of a deficiency; vitamin and mineral supplements used in this context can be stopped in patients with palliative care needsCurtin, 2021Macpherson, 2013.

Even if there is a potential deficiency in the last months of life (eg due to an unbalanced diet), vitamin and mineral supplements can be stopped in the last weeks of life because deficiencies take weeks to months to affect health.

Some supplements are required to prevent toxicity associated with specific therapies, and may require specialist advice before deprescribing. For example, folic acid is recommended with some anticancer drugs (eg pemetrexed, methotrexate), and should be continued for 3 weeks after the last dose of chemotherapy.

Many older patients take calcium and vitamin D to treat osteoporosis and prevent minimal-trauma fracture. As people approach the end of life, the benefit of these supplements becomes less important; calcium and vitamin D can be stopped in the last weeks of life. Patients treated with a bisphosphonate or denosumab should continue calcium and vitamin D supplementation until the bisphosphonate or denosumab is stopped—see Rationalising bisphosphonates and denosumab used for osteoporosis in palliative care.

For advice on rationalising vitamin and mineral supplements used for chronic kidney disease, see Rationalising supportive therapies for chronic kidney disease in palliative care.