Cholecalciferol Dosage

Usual Adult Dose for Vitamin D Insufficiency

400 to 1000 international units orally once a day.

Usual Adult Dose for Vitamin D Deficiency

1000 international units orally once a day.

Usual Adult Dose for Prevention of Falls

800 international units orally every day (with calcium).

Usual Geriatric Dose for Prevention of Fractures

For patients over 65 years of age:

100,000 international units orally every 4 months

Usual Pediatric Dose for Vitamin D Insufficiency

Neonates, infants and children: 200 international units orally once daily.

Alternate dosing:

Premature neonates: 400 to 800 international units orally once daily or 150 to 400 international units/kg/day.

Breastfed neonates and infants (fully or partially breastfed): 400 international units orally once daily beginning in the first few days of life. Continue supplementation until the infant is weaned to greater than or equal to 1000 ml/day or 1 qt/day of vitamin D fortified formula or whole milk (after 12 months of age).

Formula fed neonates and infants ingesting less than 1000 ml of vitamin D fortified formula: 400 international units orally once daily.

Children ingesting less than 1000 ml of vitamin D fortified milk: 400 international units orally once daily.

Adolescents without adequate intake: 400 international units orally once daily.

Children with increased risk of vitamin D deficiency (chronic fat malabsorption, maintained on chronic antiseizure medications): Higher doses may be required; use laboratory testing [25(OH)D, PTH, bone mineral status] to evaluate.

Usual Pediatric Dose for Vitamin D Deficiency

Treatment of Vitamin D deficiency and/or rickets:

Infants 1 to 12 months: 1000 to 5000 international units/day for 2 to 3 months; once radiologic evidence of healing is observed, dose should be decreased to 400 international units/day.

Children older than 12 months: 5000 to 10,000 international units/day for 2 to 3 months; once radiologic evidence of healing is observed, dose should be decreased to 400 international units/day.

Children with increased risk of vitamin D deficiency (chronic fat malabsorption, maintained on chronic antiseizure medications): Higher doses may be required; use laboratory testing [25(OH)D, PTH, bone mineral status] to evaluate.
Note: If poor compliance, single high dose may be used or repeated periodically.

Treatment of Vitamin D insufficiency or deficiency associated with CKD (stages 2 to 5, 5D): serum 25 hydroxyvitamin D [25(OH)D] level less than or equal to 30 ng/mL:

Serum 25(OH)D level 16 to 30 ng/mL: Children: 2000 international units/day for 3 months or 50,000 international units every month for 3 months.

Serum 25(OH)D level 5 to 15 ng/mL: Children: 4000 international units/day for 12 weeks or 50,000 international units every other week for 12 weeks.

Serum 25(OH)D level less than 5 ng/mL: Children: 8000 international units/day for 4 weeks then 4000 international units/day for 2 months for total therapy of 3 months or 50,000 international units/week for 4 weeks followed by 50,000 international units 2 times/month for a total therapy of 3 months.

Maintenance dose [once repletion accomplished; serum 25(OH)D level greater than 30 ng/mL]: 200 to 1000 international units/day.

Dosage adjustment: Monitor serum 25(OH)D, corrected total calcium and phosphorus levels 1 month following initiation of therapy, every 3 months during therapy and with any Vitamin D dose change.

Prevention and treatment of Vitamin D Deficiency in cystic fibrosis:

Recommended daily intake:

Infants less than 1 year: 400 international units/day.

Children older than 1 year: 400 to 800 international units/day.

Alternate dosing:

Infants less than 1 year: 8000 international units/week.

Children older than 1 year: 800 international units/day.

Note: If serum 25 hydroxyvitamin D [25(OH)D] level remains less than or equal to 30 ng/mL (75 nmol/L) and patient compliance established; then medium dose regimen may be used:

Medium Dose Regimen:

Patients less than 5 years: 12,000 international units/week for 12 weeks.

Patients 5 years or older: 50,000 international units/week for 12 weeks.

Note: If repeat 25 hydroxyvitamin D [25(OH)D] level remains less than or equal to 30 ng/mL (75 nmol/L) and patient compliance established; then high dose regimen may be used:

High Dose Regimen:

Patient less than 5 years: 12,000 international units twice weekly for 12 weeks.

Patient 5 years or older: 50,000 international units twice weekly for 12 weeks.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Dialysis

Vitamin D and its metabolites are not dialyzable.

Other Comments

25-hydroxyvitamin D, also referred to as 25OHD, is the major circulation metabolite of vitamin D. A serum level of 25OHD from 20 to 29 ng/mL is considered to be vitamin D insufficiency. A serum level of less than 20 ng/mL of is considered to be a deficiency.

Ergocalciferol is vitamin D2. Cholecalciferol is vitamin D3. One study has reported that cholecalciferol (vitamin D3) "raises and maintains 25OHD levels to a substantially greater degree than does ergocalciferol (vitamin D2), with a differential potency of at least 3-fold, and more likely closer to 10-fold." However, another study has reported that "vitamin D2 is equally as effective as vitamin D3 in maintaining 25-hydroxyvitamin D status.

See also...