ADEK as a ready-made product, individual prescription or individually from the drugstore?

Question

Does it still correspond to the medical consensus in Germany that cystic fibrosis patients (including those undergoing ETI-CFTR modulator therapy) should receive individually prescribed ADEK vitamin preparations from the pharmacy and have their vitamin levels checked annually – or are commercially available single preparations (e.g., from drugstores) now considered an equivalent alternative by doctors?

Answer

Hello,

Due to the clinically apparent digestive insufficiency in most cystic fibrosis patients, vitamin absorption is often impaired. The fat-soluble vitamins A, D, E, and K are particularly affected by this disorder. To address this problem, one can attempt to compensate for the deficiency through oral or parenteral administration of the vitamins.

While there was an approved finished medicinal product called ADEK 25 years ago, corresponding preparations have since disappeared from the market due to a lack of evidence of clinical efficacy and lack of profitability. What remains are finished medicinal products for vitamins D, E, and K. For several months now, there has been no approved finished medicinal product for vitamin A.

Therefore, comprehensive supplementation of all four vitamins together can only be achieved through compounding or dietary supplements. For an extended period, a company from Munich/Germany produced capsules and solutions for patients with cystic fibrosis. These products were reimbursable as prescription drugs. Unfortunately, the company recently ceased operations, either temporarily or permanently. Compounding them as oily drops remains an option, but these drops only maintain sufficient stability when refrigerated. Some pharmacies specialize in this and can be found with a quick internet search.

Other products, such as the DEKA products you mentioned, are medical food products or dietary supplements. These are generally excluded from reimbursement by statutory health insurance (in Germany). The supplier of DEKA products, the Dutch company Alveolus Biomedical BV, mentions a "clinically tested absorption technology" on its website and refers, among other things, to a pilot study with an American preparation called CF-1. Based on this data, I cannot assess whether these preparations are actually superior to other multivitamin preparations (dietary supplements) available in Germany, such as A-Z Complex, Centrum, Eunova, etc., because no comparative studies exist.


Other products, such as DEKA products, are not covered by health insurance. Meanwhile, a French research group (Munck A et al. Children 2025, 12, 1149. https://doi.org/10.3390/children12091149) has published a study comparing DEKA's Plus Liquid (DPL) with individual vitamin supplements. Median serum concentrations of vitamins A, D, E, and K were slightly higher with DPL (except for vitamin K), although interindividual variability was very high.

However, DEKA's products are significantly more expensive than the sum of several individual supplements and are only available through the company's website or, according to a company employee, also through the Alte Apotheke pharmacy in Stuttgart-Feuerbach (https://www.aa-s.de/).

Therefore, it is certainly advisable to consider taking a higher quantity of the multivitamin supplements available in Germany or to switch to the administration of pharmaceutically approved individual vitamins. As mentioned previously, vitamins D, E, and K are conditionally prescribable and reimbursable. These preparations can also be stored at room temperature. Dietary supplements available in pharmacies or drugstores are not pharmaceutically tested for their content. However, it can be assumed that they meet sufficient food-grade standards.

A prerequisite for targeted use is the determination of serum levels in the individual patient. As already indicated in the question, many patients have achieved a normal weight and nutritional status through therapy with CFTR modulators. Therefore, supplementation with fat-soluble vitamins may not even be necessary. Nevertheless, vitamin status should be checked during routine examinations, and supplementation should be initiated if a deficiency is found.

If a dietary supplement has been chosen, the costs should be documented. If purchased through a public pharmacy, they can issue a consolidated invoice at the end of the year for the products purchased, which may be tax-deductible as extraordinary expenses.

Sincerely,
Dr. M. Hug

01.02.2026