VITAMIND AND RELATED COMPOUNDS (Systemic)
Some commonly used brand names are:
In the U.S.?
- Calciferol 6
- Calciferol Drops 6
- Calcijex 3
- Calderol 2
- DHT 4
- DHT Intensol 4
- Drisdol 6
- Drisdol Drops 6
- Hectorol 5
- Hytakerol 4
- Rocaltrol 3
- Zemplar 7
In Canada?
- Calciferol 6
- Calcijex 3
- Drisdol 6
- Hytakerol 4
- One-Alpha 1
- Ostoforte 6
- Radiostol Forte 6
- Rocaltrol 3
Note: | For quick reference, the following vitamin D and related compoundsare numbered to match the corresponding brand names. |
Category
- Antihypocalcemic
- Antihypoparathyroid
- Nutritionalsupplement, vitamin
Description
Vitamins ((VYE-ta-mins)) are compoundsthat you must have for growth and health. Theyare needed in small amounts only and are available in the foods that you eat.Vitamin D is necessary for strong bones and teeth.
Lack of vitamin D may lead to a condition called rickets, especially inchildren, in which bones and teeth are weak. In adults it may cause a conditioncalled osteomalacia, in which calcium is lost from bones so that they becomeweak. Your doctor may treat these problems by prescribing vitamin D for you.Vitamin D is also sometimes used to treat other diseases in which calciumis not used properly by the body.
Ergocalciferol is the form of vitamin D used in vitamin supplements.
Some conditions may increase your need for vitamin D. These include:
- Alcoholism
- Intestine diseases
- Kidney disease
- Liver disease
- Overactivity of the parathyroid glands with kidney failure
- Pancreas disease
- Surgical removal of stomach
In addition, individuals and breast-fed infants who lack exposure to sunlight,as well as dark-skinned individuals, may be more likely to have a vitaminD deficiency. Increased need for vitamin D should be determined by your healthcare professional.
Alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are formsof vitamin D used to treat hypocalcemia (not enough calcium in the blood).Alfacalcidol, calcifediol, and calcitriol are also used to treat certain typesof bone disease that may occur with kidney disease in patients who are undergoingkidney dialysis.
Claims that vitamin D is effective for treatment of arthritis and preventionof nearsightedness or nerve problems have not been proven. Some psoriasispatients may benefit from vitamin D supplements; however, controlled studieshave not been performed.
Injectable vitamin D is given by or under the supervision of a health careprofessional. Some strengths of ergocalciferol and all strengths of alfacalcidol,calcifediol, calcitriol, and dihydrotachysterol are available only with yourdoctor's prescription. Other strengths of ergocalciferol are available withouta prescription. However, it may be a good idea to check with your health careprofessional before taking vitamin D on your own. Takinglarge amounts over long periods may cause serious unwanted effects.
Vitamin D and related compounds are available in the following dosage forms:
Oral- Alfacalcidol
- Capsules (Canada)
- Oral solution (Canada)
- Oral drops (Canada)
- Calcifediol
- Calcitriol
- Capsules (U.S. and Canada)
- Oral solution (Canada)
- Dihydrotachysterol
- Capsules (U.S. and Canada)
- Oral solution (U.S.)
- Tablets (U.S.)
- Doxercalciferol
- Ergocalciferol
- Capsules (U.S. and Canada)
- Oral solution (U.S. and Canada)
- Tablets (U.S. and Canada)
- Paricalcitol
Parenteral- Alfacalcidol
- Calcitriol
- Injection (U.S. and Canada)
- Ergocalciferol
- Injection (U.S. and Canada)
- Paricalcitol
Importance of Diet
For good health, it is importantthat you eat a balanced and varied diet. Follow carefully any diet programyour health care professional may recommend. For your specific dietary vitaminand/or mineral needs, ask your health care professional for a list of appropriatefoods. If you think that you are not getting enough vitamins and/or mineralsin your diet, you may choose to take a dietary supplement.Vitamin D is found naturally only in fish and fish-liver oils. However,it is also found in milk (vitamin D-fortified). Cooking does not affectthe vitamin D in foods. Vitamin D is sometimes called the ''sunshine vitamin''since it is made in your skin when you are exposed to sunlight. If you eata balanced diet and get outside in the sunshine at least 1.5 to 2 hours aweek, you should be getting all the vitamin D you need.
Vitamins alone will not take the place of a good diet and will not provideenergy. Your body also needs other substances found in food such as protein,minerals, carbohydrates, and fat. Vitamins themselves often cannot work withoutthe presence of other foods. For example, fat is needed so that vitamin Dcan be absorbed into the body.
The daily amount of vitamin D needed is defined in several different ways.
For U.S.?- Recommended Dietary Allowances (RDAs) are the amount of vitaminsand minerals needed to provide for adequate nutrition in most healthy persons.RDAs for a given nutrient may vary depending on a person's age, sex, and physicalcondition (e.g., pregnancy).
- Daily Values (DVs) are used on food and dietary supplement labelsto indicate the percent of the recommended daily amount of each nutrient thata serving provides. DV replaces the previous designation of United StatesRecommended Daily Allowances (USRDAs).
For Canada?- Recommended Nutrient Intakes (RNIs) are used to determine the amountsof vitamins, minerals, and protein needed to provide adequate nutrition andlessen the risk of chronic disease.
In the past, the RDA and RNI for vitamin D have been expressed in Units(U). This term has been replaced by micrograms (mcg) of vitamin D.
Normal daily recommended intakes in mcg and Units are generally definedas follows:
| U.S. | Canada |
| Persons | (mcg) | Units | (mcg) | Units |
Infantsand children
Birth to 3 years of age | 7.5-10 | 300-400 | 5-10 | 200-400 |
| 4 to 6 years of age | 10 | 400 | 5 | 200 |
| 7 to 10 years of age | 10 | 400 | 2.5-5 | 100-200 |
| Adolescents and adults | 5-10 | 200-400 | 2.5-5 | 100-200 |
Pregnant and breast-
feeding females | 10 | 400 | 5-7.5 | 200-300 |
Remember:
- The total amount of each vitamin that you get every day includeswhat you get from the foods that you eat and whatyou may take as a supplement.
- Your total amount should not be greater than the RDA or RNI, unlessordered by your doctor. Taking too much vitamin D overa period of time may cause harmful effects.
Before Using This Dietary Supplement
If you are taking this dietary supplement without a prescription, carefullyread and follow any precautions on the label. For vitamin D and related compounds,the following should be considered:
Allergies?Tell your health care professional if you have everhad any unusual or allergic reaction to alfacalcidol, calcifediol, calcitriol,dihydrotachysterol, doxercalciferol, ergocalciferol, or paricalcitol. Also,tell your health care professional if you are allergic to any other substances,such as foods, preservatives, or dyes.
Pregnancy?It is especially important that you are receivingenough vitamin D when you become pregnant and that you continue to receivethe right amounts of vitamins throughout your pregnancy. The healthy growthand development of the fetus depend on a steady supply of nutrients from themother.
You may need vitamin D supplements if you are a strict vegetarian (vegan-vegetarian)and/or have little exposure to sunlight and do not drink vitamin D-fortifiedmilk.
Taking too much alfacalcidol, calcifediol, calcitriol, dihydrotachysterol,or ergocalciferol can also be harmful to the fetus. Taking more than yourhealth care professional has recommended can cause your baby to be more sensitivethan usual to its effects, can cause problems with a gland called the parathyroid,and can cause a defect in the baby's heart.
Doxercalciferol or paricalcitol have not been studied in pregnant women.However, studies in animals have shown that paricalcitol causes problems innewborns. Before taking this medicine, make sure your doctor knows if youare pregnant or if you may become pregnant.
Breast-feeding?It is especially important that you receive theright amounts of vitamins so that your baby will also get the vitamins neededto grow properly. Infants who are totally breast-fed and have little exposureto the sun may require vitamin D supplementation. However, taking large amountsof a dietary supplement while breast-feeding may be harmful to the motherand/or baby and should be avoided.
Only small amounts of alfacalcidol, calcifediol, calcitriol, or dihydrotachysterolpass into breast milk and these amounts have not been reported to cause problemsin nursing babies.
It is not known whether doxercalciferol or paricalcitol passes into breastmilk. Be sure you have discussed the risks and benefits of the supplementwith your doctor.
Children?Problems in children have not been reported withintake of normal daily recommended amounts. Some studies have shown that infantswho are totally breast-fed, especially with dark-skinned mothers, and havelittle exposure to sunlight may be at risk of vitamin D deficiency. Your healthcare professional may prescribe a vitamin/mineral supplement that containsvitamin D. Some infants may be sensitive to even small amounts of alfacalcidol,calcifediol, calcitriol, dihydrotachysterol, or ergocalciferol. Also, childrenmay show slowed growth when receiving large doses of alfacalcidol, calcifediol,calcitriol, dihydrotachysterol, or ergocalciferol for a long time.
Studies on doxercalciferol or paricalcitol have been done only in adultpatients, and there is no specific information comparing the use of doxercalciferolor paricalcitol in children with use in other age groups.
Older adults?Problems in older adults have not been reported withintake of normal daily recommended amounts. Studies have shown that olderadults may have lower blood levels of vitamin D than younger adults, especiallythose who have little exposure to sunlight. Your health care professionalmay recommend that you take a vitamin supplement that contains vitamin D.
Medicines or other dietary supplements?Although certain medicines or dietary supplements should not be used togetherat all, in other cases they may be used together even if an interaction mightoccur. In these cases, your health care professional may want to change thedose, or other precautions may be necessary. When you are taking vitamin Dand related compounds, it is especially important that your health care professionalknow if you are taking any of the following:
- Antacids containing magnesium?Use of these products with anyvitamin D-related compound may result in high blood levels of magnesium,especially in patients with kidney disease
- Calcium-containing preparations or
- Thiazide diuretics (water pills)?Use of these preparationswith vitamin D may cause high blood levels of calcium and increase the chanceof side effects
- Vitamin D and related compounds, other?Use of vitamin D witha related compound may cause high blood levels of vitamin D and increase thechance of side effects.
Other medical problems?The presence of other medicalproblems may affect the use of vitamin D and related compounds. Make sureyou tell your health care professional if you have any other medical problems,especially:
- Heart or blood vessel disease?Alfacalcidol, calcifediol, calcitriol,or dihydrotachysterol may cause hypercalcemia (high blood levels of calcium),which may make these conditions worse
- Kidney disease?High blood levels of alfacalcidol, calcifediol,calcitriol, dihydrotachysterol, or ergocalciferol may result, which may increasethe chance of side effects
- Sarcoidosis?May increase sensitivity to alfacalcidol, calcifediol,calcitriol, dihydrotachysterol, or ergocalciferol and increase the chanceof side effects
Proper Use of This Dietary Supplement
For use as a dietary supplement:
- Do not take more than the recommended daily amount. Vitamin D is stored in the body, and taking too much over a periodof time can cause poisoning and even death.
If you have any questions about this, check with your health care professional.
For individuals taking the oral liquid formof this dietary supplement:
- This preparation should be taken by mouth even though it comes ina dropper bottle.
- This dietary supplement may be dropped directly into the mouth ormixed with cereal, fruit juice, or other food.
While you are taking alfacalcidol, calcifediol, calcitriol, dihydrotachysterol, doxercalciferol or paricalcitol , your healthcare professional may want you to follow a special diet or take a calciumsupplement. Be sure to follow instructions carefully. If you are already takinga calcium supplement or any medicine containing calcium, make sure your healthcare professional knows.
Dosing?The dose of these vitamin D and related compoundswill be different for different patients. Follow yourdoctor's orders or the directions on the label. The following informationincludes only the average doses of these medicines. If your dose is different, do not change it unless your health careprofessional tells you to do so.
The number of milliliters (mL) of solution that you take, or the numberof capsules or tablets you take, depends on the strength of the medicine.Also, the number of doses you take each day, the timeallowed between doses, and the length of time you take the medicine dependon the medical problem for which you are taking the combination medicine.
For alfacalcidol- To treat bone disease in kidney patients undergoing kidney dialysis:
- For oral dosage form (capsules):
- Adults and teenagers?At first, 1 microgram (mcg) a day. Yourdoctor may change your dose if needed. However, most people will take notmore than 3 mcg a day.
- For oral dosage form (drops):
- Adults and teenagers?At first, 1 microgram (mcg) a day. Yourdoctor may change your dose if needed. However, most people will take notmore than 3 mcg a day.
- For oral dosage form (solution):
- Adults and teenagers?At first, 1 mcg a day. Your doctor maychange your dose if needed. However, most people will take not more than 3mcg a day.
- For parenteral dosage form (injection):
- Adults and teenagers?At first, 1 mcg a day. Your doctor maychange your dose if needed. However, most people will take not more than 12mcg a week.
- To treat diseases in which calcium is not used properly by the body
- For oral dosage form (capsules):
- Adults and teenagers?At first, 0.25 microgram (mcg) a day.Your doctor may change your dose if needed. However, most people will takenot more than 1 mcg a day.
- For oral dosage form (drops):
- Adults and teenagers?At first, 0.25 microgram (mcg) a day.Your doctor may change your dose if needed. However, most people will takenot more than 1 mcg a day.
- For oral dosage form (solution):
- Adults and teenagers?At first, 0.25 mcg a day. Your doctormay change your dose if needed. However, most people will take not more than1 mcg a day.
For calcifediol- To treat diseases in which calcium is not used properly by the bodyor to treat bone disease in kidney patients undergoing kidney dialysis:
- For oral dosage form (capsules):
- Adults, teenagers, and children over 10 years of age?At first,300 to 350 micrograms (mcg) a week, taken in divided doses either once a dayor every other day. Your doctor may change your dose if needed.
- Children up to 2 years of age?20 to 50 mcg a day.
- Children 2 to 10 years of age?50 mcg a day.
For calcitriol- To treat diseases in which calcium is not used properly by the bodyor to treat bone disease in kidney patients undergoing kidney dialysis:
- For oral dosage form (capsules and solution):
- Adults, teenagers, and children?At first, 0.25 micrograms (mcg)a day. Your doctor may change your dose if needed.
- For injection dosage form:
- Adults and teenagers?At first, 0.5 mcg injected into a veinthree times a week. Your doctor may change your dose if needed.
- Children?Use and dose must be determined by your doctor.
For dihydrotachysterol- To treat diseases in which calcium is not used properly by the body:
- For oral dosage forms (capsules, solution,or tablets):
- Adults and teenagers?At first, 100 micrograms (mcg) to 2.5milligrams (mg) a day. Your doctor may change your dose if needed.
- Children?At first, 1 to 5 mg a day. Your doctor may changeyour dose if needed.
For doxercalciferol- To treat an overactive parathyroid gland in patients with kidneyfailure:
- For oral dosage form (capsules):
- Adults: 10 micrograms (mcg) three times weekly at dialysis. The doctormay change your dose if needed.
- Children: Use and dose must be determined by your doctor.
For ergocalciferol- For oral dosage forms (capsules, tablets,oral solution):
- The amount of vitamin D to meet normal daily recommended intakeswill be different for different individuals. The following information includesonly the average amounts of vitamin D.
- To prevent deficiency, the amount taken by mouth is based on normaldaily recommended intakes:
For the U.S.- Adults and teenagers: 5 to 10 micrograms (mcg) (200 to 400 Units)per day.
- Pregnant and breast-feeding females: 10 mcg (400 Units) per day.
- Children 4 to 10 years of age: 10 mcg (400 Units) per day.
- Children birth to 3 years of age: 7.5 to 10 mcg (300 to 400 Units)per day.
For Canada- Adults and teenagers: 2.5 to 5 mcg (100 to 200 Units) per day.
- Pregnant and breast-feeding females: 5 to 7.5 mcg (200 to 300 Units)per day.
- Children 7 to 10 years of age: 2.5 to 5 mcg (100 to 200 Units) perday.
- Children 4 to 6 years of age: 5 mcg (200 Units) per day.
- Children birth to 3 years of age: 5 to 10 mcg (200 to 400 Units)per day.
- To treat deficiency:
- Adults, teenagers, and children: Treatment dose is determined byprescriber for each individual based on severity of deficiency.
- To treat diseases in which calcium and phosphate are not used properlyby the body:
- Adults and teenagers: At first, 1000 to 500,000 Units a day. Thedoctor may change your dose if needed.
- Children: At first, 1000 to 200,000 Units a day. The doctor may changeyour dose if needed.
For paricalcitol- To treat an overactive parathyroid gland in patients with kidneyfailure:
- For oral dosage form (capsules):
- Adults: 1 to 2 micrograms (mcg) one time per day or 2 to 4 mcg threetimes a week (not more often than every other day). The doctor may changeyour dose if needed.
- Children: Use and dose must be determined by your doctor.
- For injection dosage form:
- Adults: 0.04 to 0.1 micrograms (mcg) per kg no more than every otherday during dialysis. The doctor may change your dose if needed.
- Children: Use and dose must be determined by your doctor.
Missed dose?
- For use as a dietary supplement: If youmiss taking a dietary supplement for one or more days there is no cause forconcern, since it takes some time for your body to become seriously low invitamins. However, if your health care professional has recommended that youtake this dietary supplement, try to remember to take it as directed everyday.
- If you are taking this medicine for a reason other than as a dietarysupplement and you miss a dose and your dosing schedule is:
- One dose every other day: Take the missed dose as soon as possibleif you remember it on the day it should be taken. However, if you do not rememberthe missed dose until the next day, take it at that time. Then skip a dayand start your dosing schedule again. Do not double doses.
- One dose a day: Take the missed dose as soon as possible. Then goback to your regular dosing schedule. However, if you do not remember themissed dose until the next day, skip the missed dose and go back to your regulardosing schedule. Do not double doses.
- More than one dose a day: Take the missed dose as soon as possible.Then go back to your regular dosing schedule. However, if it is almost timefor your next dose, skip the missed dose and go back to your regular dosingschedule. Do not double doses.
If you have any questions about this, check with your healthcare professional.Storage?To store this dietary supplement:
- Keep out of the reach of children.
- Store away from heat and direct light.
- Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the dietary supplement to break down.
- Keep the oral liquid form of the dietary supplement from freezing.
- Do not keep outdated dietary supplements or those no longer needed.Be sure that any discarded dietary supplement is out of the reach of children.
Precautions While Using This Dietary Supplement
For individuals taking vitamin D without a prescription:
- Vitamin D is stored in the body; therefore, when you take more thanthe body needs, it will build up in the body. This may lead to poisoning.Problems are more likely to occur in:
- Adults taking 20,000 to 80,000 Units a day and more for several weeksor months.
- Children taking 2,000 to 4,000 Units a day for several months.
- Remember that the total amount of vitamin D you get every day includeswhat you get from foods that you eat and what you take as a supplement.
If you are taking this medicine for a reason other than as a dietary supplement, your doctor should check your progress at regular visits to make sure that it does not cause unwanted effects.
Do not take any nonprescription (over-the-counter [OTC]) medicine or dietarysupplement that contains calcium, phosphorus, or vitamin D while you are takingany of these dietary supplements unless you have been told to do so by yourhealth care professional. The extra calcium, phosphorus, or vitamin D mayincrease the chance of side effects.
Do not take antacids or other medicines containingmagnesium while you are taking any of these medicines. Taking these medicinestogether may cause unwanted effects.
Side Effects of This Dietary Supplement
Along with its needed effects, a dietary supplement may cause some unwantedeffects. Alfacalcidol, calcifediol, calcitriol, dihydrotachysterol, and ergocalciferoldo not usually cause any side effects when taken as directed. However, taking large amounts over a period of time may cause some unwantedeffects that can be serious.
Check with your doctorimmediately if any of the following effects occur:
Late symptoms of severe overdose
Check with your health care professional as soon as possible if any ofthe following effects occur:
Early symptoms of overdose
Bone pain; constipation (especiallyin children or adolescents); diarrhea; drowsiness; dryness of mouth; headache (continuing); increased thirst; increase in frequency of urination, especiallyat night, or in amount of urine; irregular heartbeat; itching skin; loss ofappetite; metallic taste; muscle pain; nausea or vomiting (especially in childrenor adolescents); unusual tiredness or weakness
Late symptoms of overdose
Bone pain; calcium deposits (hard lumps)in tissues outside of the bone; cloudy urine; drowsiness; increased sensitivity ofeyes to light or irritation of eyes; itching of skin; loss of appetite; lossof sex drive; mood or mental changes; muscle pain; nausea or vomiting; protein in the urine; redness or dischargeof the eye, eyelid, or lining of the eyelid; runnynose; weight loss
Other side effects not listed above may also occur insome individuals. If you notice any other effects, check with your healthcare professional.
Revised: 07/13/2005
