cholecalciferol

Contraindicated in:

Hypersensitivity;
Hypercalcemia;
Vitamin D toxicity;
Concurrent use of magnesium-containing antacids or other vitamin D supplements;
Malabsorption problems.

Use Cautiously in:

OB: Safety not established.

Adv. Reactions/Side Effects ⬆ ⬇

Seen primarily as manifestations of toxicity (hypercalcemia)

CV: arrhythmias, hypertension

Derm: pruritus

EENT: conjunctivitis, photophobia

F and E: hypercalcemia

GI: ↑liver enzymes, anorexia, constipation, dry mouth, metallic taste, nausea, PANCREATITIS, polydipsia, vomiting, weight loss

GU: albuminuria, azotemia, polyuria

MS: bone pain, muscle pain

Neuro: headache, irritability, somnolence, weakness

Interactions ⬆ ⬇

Drug-drug:

Cholestyramine, colestipol, or mineral oil↓ absorption of vitamin D analogues.
Use with thiazide diuretics may result in hypercalcemia.
Corticosteroids↓ effectiveness of vitamin D analogues.
Concurrent use of magnesium-containing drugs may lead to hypermagnesemia.
Calcium-containing drugs may ↑ risk of hypercalcemia.
Concurrent use of other vitamin D supplements (↑ risk of hypercalcemia).

Drug-Food:

Ingestion of foods high in calcium content (see Food Sources for Specific Nutrients) may lead to hypercalcemia.

Availability ⬆ ⬇

(Generic available)

Tablets: 400 IU^OTC; 1000 IU^OTC
Oral solution: 400 IU/drop^OTC
In combination with: alendronate (Fosamax Plus D); See Appendix [not included in this PDA edition].

Route/Dosage ⬆ ⬇

PO (Adults ): 400–1000 IU daily.
PO (Infants ): Exclusively or partially-breastfed- 400 IU daily.

US Brand Names ⬆ ⬇

vitamin D₃ (inactive)

Action ⬆ ⬇

Requires activation in the liver and kidneys to create the active form of vitamin D₃ (calcitriol).
Promotes the intestinal absorption of dietary calcium.

Therapeutic effects:

Treatment and prevention of deficiency states, particularly bone manifestations.

Classifications ⬆ ⬇

Therapeutic Classification: vitamins

Pharmacologic Classification: fat soluble vitamins

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Extensively protein bound.

Metabolism/Excretion: Undergoes activation in liver and kidneys to form calcitriol (active form of vitamin D₃).

Half-Life: 14 hr.

Time/Action Profile ⬆ ⬇

(effects on serum calcium)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown

Patient/Family Teaching ⬆ ⬇

Advise patient to take medication as directed. Take missed doses as soon as remembered that day, unless almost time for next dose; do not double up on doses. Advise parents to use calibrated measuring device or dropper with oral solution.
Review diet modifications with patient. See Food Sources for Specific Nutrients for foods high in calcium and vitamin D.
Encourage patient to comply with dietary recommendations of health care professional. Explain that the best source of vitamins is a well-balanced diet with foods from the 4 basic food groups and the importance of sunlight exposure.
Patients self-medicating with vitamin supplements should be cautioned not to exceed RDA. The effectiveness of megadoses for treatment of various medical conditions is unproved and may cause side effects.
Advise patient to avoid concurrent use of antacids containing magnesium.
Review symptoms of overdose and instruct patient to report these promptly to health care professional.
Emphasize the importance of follow-up exams to evaluate progress.

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Indications ⬇

Contraind./Precautions ⬆ ⬇