Vitamin A (Systemic)


VA CLASSIFICATION
Primary: VT050

Commonly used brand name(s): Aquasol A.

Another commonly used name is
retinol .
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Nutritional supplement (vitamin)—
Note: Vitamin A is a fat-soluble vitamin.



Indications

Accepted

Vitamin A deficiency (prophylaxis and treatment){01}—Vitamin A is indicated only for prevention or treatment of vitamin A deficiency states. Vitamin A deficiency may occur as a result of inadequate nutrition or intestinal malabsorption but does not occur in healthy individuals receiving an adequate balanced diet. For prophylaxis of vitamin A deficiency, dietary improvement, rather than supplementation, is advisable. For treatment of vitamin A deficiency, supplementation is preferred. {70}
—Deficiency of vitamin A may lead to keratomalacia, xerophthalmia, and nyctalopia (night blindness). {01}
—Recommended intakes may be increased and/or supplementation may be necessary in infants receiving unfortified formula or in individuals with the following conditions (based on documented vitamin A deficiency):

• Diarrhea {54} {55}


• Gastrectomy {19}


• Hyperthyroidism {19}


• Infections, chronic {19}


• Intestinal diseases—celiac, diarrhea, topical sprue, regional enteritis {17} {21}


• Malabsorption syndromes associated with pancreatic insufficiency—pancreatic disease, cystic fibrosis {19}


• Measles {28} {29} {59}


• Protein deficiency, severe {19}


• Stress, prolonged {19}


• Xerophthalmia {64}

—Vitamin A absorption will be impaired in any condition in which fat malabsorption (steatorrhea) occurs. {02} {07}
—Some studies have shown that vitamin A supplementation in the presence of vitamin A deficiency may reduce morbidity and mortality from certain diseases in children, {25} {26} {27} including diarrhea {54} {55} and measles. {28} {29} Vitamin A deficiency is more likely to be a problem where malnutrition is prevalent. {25} {26} {27} {28} {29}
—Some unusual diets (e.g., reducing diets that drastically restrict food selection, especially the fat-containing foods {55}) may not supply minimum daily recommended intakes of vitamin A. Supplementation is necessary in patients receiving total parenteral nutrition (TPN) or undergoing rapid weight loss or in those with malnutrition, because of inadequate dietary intake.
—Recommended intakes for most vitamins and minerals are increased during pregnancy. Many physicians recommend that pregnant women receive multivitamin and mineral supplements, especially those pregnant women who do not consume an adequate diet and those in high-risk categories (i.e., women carrying more than one fetus, heavy cigarette smokers, and alcohol and drug abusers). Taking excessive amounts of a multivitamin and mineral supplement may be harmful to the mother and/or fetus and should be avoided. {24}
—Recommended intakes for all vitamins and most minerals are increased during breast-feeding.
—Recommended intakes may be increased by the following medications: Cholestyramine, colestipol, mineral oil, and neomycin.

Acceptance not established
There are insufficient data to show that vitamin A may reduce the occurrence of certain types of cancer. {01} {19} {31}

Unaccepted
Vitamin A is not useful for treatment of dry or wrinkled skin, eye problems, or prevention or treatment of infections not related to vitamin A deficiency. {19} Large doses of vitamin A have been used for treatment of acne but, because of potential toxicity, this use is not recommended; topical retinoic acid (tretinoin) or isotretinoin, related compounds, are probably more useful. Vitamin A has not been proven effective for treatment of renal calculi, hyperthyroidism, anemia, degenerative conditions of the nervous system, sunburn, lung diseases, deafness, osteoarthritis, inflammatory bowel disease, or psoriasis. {07}


Pharmacology/Pharmacokinetics

Mechanism of action/Effect:

Vitamin A is essential for normal function of the retina. In the form of retinal, it combines with opsin (red pigment in the retina) to form rhodopsin (visual purple), which is necessary for visual adaptation to darkness. Other forms (retinol, retinoic acid) are necessary for growth of bone, testicular and ovarian function, and embryonic development, {02} and for regulation of growth and differentiation of epithelial tissues. Retinol and retinoic acid may act as cofactors in biochemical reactions. {19}

Absorption:

Vitamin A is readily absorbed from healthy gastrointestinal tract (duodenum and jejunum). Absorption of retinol requires presence of bile salts, pancreatic lipase, protein, and dietary fat. {01} {02} Excess, unabsorbed vitamin is excreted in feces. Water-miscible preparations are absorbed more readily than oil solutions.

Protein binding:

Less than 5% of circulating vitamin A is bound to {48} lipoproteins in blood (normal), but may be up to 65% when hepatic stores are saturated because of excessive intake. The amount of vitamin A bound to lipoproteins may be increased in hyperlipoproteinemia. {41} {48} When released from liver, vitamin A is bound to retinol-binding protein (RBP). {15} Most vitamin A circulates in the form of retinol bound to RBP. {48}


Storage

Hepatic (approximately 2 years' adult requirements), with {19} small amounts stored in kidney and lung tissues. Zinc is required for mobilization of vitamin A reserves in the liver. {31} {32} {33}

Biotransformation:

Hepatic.

Elimination:
    Fecal/renal. {02}


Precautions to Consider

Pregnancy/Reproduction

Pregnancy—
Problems in humans have not been documented with intake of normal daily recommended amounts. Vitamin A crosses the placenta to only a limited extent. Fetal abnormalities (including urinary tract malformations), growth retardation, and early epiphyseal closure have been reported in children whose mothers took excessive amounts during pregnancy. {19} {23} Daily amounts from supplements exceeding 1800 RE (6000 Units) are not recommended because of potential fetotoxicity. {01}

Maternal overdosage in animals has been reported to result in central nervous system (CNS) malformations, as well as malformations of the spinal column, rib cage, heart, eye, palate, and genitourinary tract of the fetus. {01} {05} {06}

FDA Pregnancy Category X (parenteral vitamin A). {01}

Breast-feeding

Vitamin A is distributed into breast milk; however, problems in humans have not been documented with intake of normal daily recommended amounts. {01} {02}

Pediatrics

Problems in pediatrics have not been documented with intake of normal daily recommended amounts. However, caution is recommended in young children, who are more likely to develop toxicity from higher-than-recommended doses and/or prolonged use of vitamin A. {23}


Geriatrics


Problems in geriatrics have not been documented with intake of normal daily recommended amounts. However, long-term vitamin A use in the elderly may increase the risk of vitamin A overload due to delayed retinyl ester clearance. {34} {35}


Dental

High doses and/or prolonged use of vitamin A may cause bleeding from the gums; dry or sore mouth; or drying, cracking, or peeling of the lips. {12} {14} {16} {23}

Drug interactions and/or related problems
The following drug/dietary supplement interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):
Note: Combinations containing any of the following medications or dietary supplements, depending on the amount present, may also interact with vitamin A supplements.


Calcium supplements    (excessive intake [more than 7500 RE or 25,000 Units per day] of vitamin A may stimulate bone loss and counteract the effects of calcium supplementation and may cause hypercalcemia {19} {20})


Cholestyramine or{08}
Colestipol or{09}
Mineral oil or{10}
Neomycin, oral{11}    (concurrent use may interfere with absorption of vitamin A; recommended intakes for vitamin A may be increased or a water-miscible form of vitamin A may be needed in patients receiving these medications)


Contraceptives, oral{01}    (concurrent use may increase plasma vitamin A concentrations {19})


» Etretinate or{68}
» Isotretinoin    (concurrent use with vitamin A may result in additive toxic effects {53})


Tetracycline    (concurrent use with vitamin A 50,000 Units a day and higher has been reported to cause benign intracranial hypertension {44} {45} {47})


Vitamin E{02}{56}    (concurrent use of vitamin E may facilitate absorption, hepatic storage, and utilization of vitamin A, and reduce toxicity; excessive doses may deplete vitamin A stores {19})



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With physiology/laboratory test values
Blood urea nitrogen (BUN) and{14}{16}
Calcium, serum and{14}{16}
Cholesterol and triglyceride, serum{12}    (concentrations may be increased in chronic toxicity)


Erythrocyte counts and
Leukocyte counts{01}    (may be decreased by high doses)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, vitamin A supplements should not be used when the following medical problem exists:
» Hypervitaminosis A{01}
Risk-benefit should be considered when the following medical problems exist
Alcoholism, chronic or{19}{22}
Cirrhosis or{23}{37}
Hepatic disease or{23}{38}
Viral hepatitis{23}{36}    (use of vitamin A in these conditions may potentiate hepatotoxicity; however, this may not apply in cases of chronic cholestatic liver disease with accompanying vitamin A malabsorption {02} {58})


» Renal failure, chronic    (serum vitamin A concentrations are increased {03})


Sensitivity to vitamin A

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Carotene determinations, plasma and{32}
» Vitamin A determinations, plasma{32}    (recommended to confirm deficiency; plasma vitamin A concentrations are not necessarily indicative of vitamin A nutritional status because of significant hepatic storage, although low concentrations correlate with deficiency {19})


Dark adaptation tests{32}


Overdose
For more information on the management of overdose or unintentional ingestion contact a Poison Control Center (see Poison Control Center Listing) .

Clinical effects of overdose
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Note: Ingestion of excessive doses of vitamin A acutely (greater than 450,000 RE [1,500,000 Units] {51} in adults and 22,500 RE [75,000 Units] {57} to 105,100 RE [350,000 Units] {51} in children, depending on age) or over prolonged periods (greater than 7500 RE [25,000 Units] {51} a day for eight months in adults and 5400 RE [18,000 Units] {57} to 15,000 RE [50,000 Units] {51} a day for several months in children, depending on age) can result in severe toxicity and even death. Daily doses higher than 1800 RE (6000 Units) in pregnant women are not recommended because of potential fetotoxicity. {01}

Acute effects
    
Bleeding from gums or sore mouth
    
bulging soft spot on head —in babies{17}
    
confusion or unusual excitement
    
diarrhea
    
dizziness or drowsiness{12}{17}
    
double vision {21}
    
severe headache {01}{12}{17}
    
severe irritability {14}{17}
    
peeling of skin, especially on lips and palms {14}{16}
    
severe vomiting{01}{16}

Note: Toxicity usually occurs about 6 hours after ingestion of acute overdoses of vitamin A. Acute overdose also results in hydrocephalus in infants and increased intracranial pressure (pseudotumor cerebri) {18} in older children and adults. Acute toxicity is reversible on withdrawal of vitamin A.


Chronic effects
    
Bone or joint pain {13}{16}
    
drying or cracking of skin or lips {12}{16}
    
dry mouth {23}{67}
    
fever
    
general feeling of discomfort or illness or weakness {01}{23}
    
headache {16}{23}
    
increased sensitivity of skin to sunlight
    
increase in frequency of urination, especially at night, or in amount of urine
    
irritability {01}{23}
    
loss of appetite {01}{23}
    
loss of hair {01}{23}
    
seizures {41}
    
stomach pain {01}
    
unusual tiredness {23}
    
vomiting {23}
    
yellow-orange patches on soles of feet, palms of hands, or skin around nose and lips{01}

Note: Chronic overdose may also result in any of the following: hepatotoxicity, {23} papilledema, {23} intracranial hypertension, {23} hypomenorrhea, {01} portal hypertension, hemolysis and anemia, radiographic bone changes, {23} and, in children, premature closure of epiphyses. {17} Chronic toxicity is slowly reversible on withdrawal of vitamin A, but may persist for several weeks.



Treatment of overdose
Hypervitaminosis A is treated by withdrawing vitamin A and instituting symptomatic and supportive treatment. {01} Some signs and symptoms disappear within 1 week, while others may persist for several weeks to months. {19}

For female patients of childbearing potential, it is recommended that a pregnancy test be performed and a blood sample collected for the determination of vitamin A concentrations at the time of overdose and at one complete menstrual cycle after the overdose. Effective contraception should be used for at least one complete menstrual cycle after the overdose and continued if necessary until vitamin A concentrations are no longer measurable in the blood. Patients with a positive pregnancy test should be counseled on the risk of fetotoxicity. {60} {61}


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Vitamin A (Systemic).
In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Description of use
Description should include function in the body, signs of deficiency, and unproven uses


Importance of diet
Importance of proper nutrition; supplement may be needed because of inadequate dietary intake

Food sources of vitamin A; difference between retinols and beta-carotene; effects of processing

Not using vitamins as substitute for balanced diet

Recommended daily intake for vitamin A

Before using this dietary supplement
»   Conditions affecting use, especially:
Sensitivity to vitamin A

Pregnancy—Fetal abnormalities, growth retardation, early epiphyseal closure reported in children of mothers taking excessive amounts during pregnancy; daily doses above 1800 retinol equivalents (RE) (6000 Units) not recommended





Use in children—Children may be more sensitive to effects of high doses and/or prolonged use





Use in the elderly—— Use of high doses may cause vitamin A overload





Dental—High doses and/or prolonged use of vitamin A may cause bleeding from the gums; dry or sore mouth; or drying, cracking, or peeling of the lips
Other medications, especially etretinate and isotretinoin
Other medical problems, especially hypervitaminosis A or chronic renal failure

Proper use of this dietary supplement

» Proper dosing
Missed dose: No cause for concern because of length of time necessary for depletion; remembering to take as directed
Proper administration of oral solution dosage form: Taking by mouth even though it comes in dropper bottle; may be dropped directly into the mouth or mixed with cereal, fruit juice, or other food

» Proper storage

Precautions while using this dietary supplement
Risk of toxicity with chronic overdose; upper limits for chronic and acute vitamin A toxicity; upper limits for use in pregnancy


General Dosing Information

For oral dosage forms only
When oral absorption or storage of vitamin A is impaired, higher doses or parenteral administration may be required.

Water-miscible preparations may be useful for prevention of vitamin A deficiency in individuals with fat malabsorption, {41} although if bile acid depletion is present, high doses may still be necessary.

For parenteral dosage forms only
Parenteral administration is indicated when oral administration is not acceptable (for example, in nausea, vomiting, preoperative and postoperative conditions) or possible, or when ocular damage is severe.

The administration of intravenous vitamin A is restricted to special intravenous preparations. {43}

Diet/Nutrition
Recommended dietary intakes for vitamin A are defined differently worldwide.



For U.S.:
The Recommended Dietary Allowances (RDAs) for vitamins and minerals are determined by the Food and Nutrition Board of the National Research Council and are intended to provide adequate nutrition in most healthy persons under usual environmental stresses. In addition, a different designation may be used by the FDA for food labeling purposes, as with Daily Value (DV). DVs replace the previous labeling terminology United States Recommended Daily Allowances (USRDAs). {02} {63}



For Canada:
Recommended Nutrient Intakes (RNIs) for vitamins, minerals, and protein are determined by Health and Welfare Canada and provide recommended amounts of a specific nutrient while minimizing the risk of chronic diseases. {52}

The expression of vitamin A activity has changed from Units to retinol equivalents (RE) or micrograms (mcg) of retinol, with 1 RE equal to 1 mcg of retinol. One RE of vitamin A is equal to 3.33 Units of retinol and 10 Units of vitamin A activity as beta-carotene. {21} {23} This conversion was made because the term Units did not take into account the poor absorption and bioavailability of carotenoids. {02} {04} Most commercially available vitamin A products continue to be labeled in Units.

Daily recommended dietary intakes for vitamin A are generally defined according to age or condition and form of vitamin A as follows {02} {51} {69}


For the U.S.—


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Infants and children
     
Birth to 3 years
375–400
1250–1330
1875–2000
4 to 6 years
500
1665
2500
7 to 10 years
700
2330
3500
Adolescent and adult
males
1000
3330
5000
Adolescent and adult
females
800
2665
4000
Pregnant females
800
2665
4000
Breast-feeding females
1200–1300
4000–4330
6000–6500
* Based on 1980 Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene. {69}



For Canada—


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Infants and children
     
Birth to 3 years
400
1330
2000
4 to 6 years
500
1665
2500
7 to 10 years
700–800
2330–2665
3500
Adolescent and adult
males
1000
3330
5000
Adolescent and adult
females
800
2665
4000
Pregnant females
900
2665–3000
4000–4500
Breast-feeding females
1200
4000
6000
* Based on 1980 U.S. Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene. {69}


The above recommended dietary intakes are usually provided by nutritionally adequate diets.

Best dietary sources of vitamin A activity {39} include yellow-orange fruits and vegetables; dark green, leafy vegetables; vitamin A-fortified milk; liver; and margarine. {02} Approximately 20% {50} of beta-carotene, which is found in green and yellow vegetables, is converted to retinol after absorption from the gastrointestinal tract. Ordinary cooking does not destroy vitamin A activity in vegetables {40}, but frozen foods lose 5 to 10% during storage for 12 months at -23 °C.



Oral Dosage Forms

VITAMIN A CAPSULES USP

Usual adult and adolescent dose
Deficiency (prophylaxis)
Oral, amount based on normal daily recommended intakes: {02} {52}


For the U.S.:


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Adolescent and adult
males
1000
3330
5000
Adolescent and adult
females
800
2665
4000
Pregnant females
800
2665
4000
Breast-feeding
females
1200–1300
4000–4330
6000–6500
* Based on 1980 Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene.



For Canada:


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Adolescent and adult
males
1000
3330
5000
Adolescent and adult
females
800
2665
4000
Pregnant females
900
2665–3000
4000–4500
Breast-feeding
females
1200
4000
6000
* Based on 1980 U.S. Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene.


Deficiency (treatment)
Treatment dose is individualized by prescriber based on severity of deficiency. The following dosage has been established:


Xerophthalmia:
Oral, 7500 to 15,000 RE (25,000 to 50,000 Units) a day. {07}


Note: Acute toxicity has been reported at a single dose of 450,000 RE (1,500,000 Units). {51} Chronic toxicity has been reported at doses of 7500 RE (25,000 Units) a day for eight months. {51} However, individuals with compromised liver function may develop toxicity at lower doses.



Usual pediatric dose
Deficiency (prophylaxis)
Oral, amount based on intake of normal daily recommended intakes: {02} {52}


For the U.S.—:


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Infants and children
     
Birth to 3 years
375–400
1250–1330
1875–2000
4 to 6 years
500
1665
2500
7 to 10 years
700
2330
3500
* Based on 1980 Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene.



For Canada—:


Age or
Condition
Form of Vitamin A
RE or mcg
of Retinol
Amount in
Units as
Retinol
Amount in
Units as a
Combination
of Retinol and
Beta-carotene *
Infants and children
     
Birth to 3 years
400
1330
2000
4 to 6 years
500
1665
2500
7 to 10 years
700–800
2330–2665
3500
* Based on 1980 U.S. Recommended Dietary Allowances (RDAs) for vitamin A in the diet that is a combination of retinol and beta-carotene.


Deficiency (treatment)
Treatment dose is individualized by prescriber based on severity of deficiency. The following dosages have been established:


Measles {64}:
Children 6 months to 1 year of age: Oral, 30,000 RE (100,000 Units) as a single dose when measles are diagnosed. {66}

Children 1 year of age and older: Oral, 60,000 RE (200,000 Units) as a single dose when measles are diagnosed. {66}



Xerophthalmia {64}:
Children 6 months to 1 year of age: Oral, 30,000 RE (100,000 Units) as a single dose, repeated the next day, and again at 4 weeks.

Children 1 year of age and older: Oral, 60,000 RE (200,000 Units) as a single dose, repeated the next day, and again at 4 weeks.


Note: The vitamin A doses recommended for measles and xerophthalmia are based on World Health Organization (WHO) guidelines and are used when vitamin A deficiency may be a problem, such as in malnutrition or selected disease states. {64}
Acute toxicity has been reported at a single dose of 22,500 to 105,100 RE (75,000 to 350,000 Units), depending on age. {51} Chronic toxicity has been reported at doses of 5400 to 15,000 RE (18,000 to 50,000 Units) a day for several months. {51} However, individuals with compromised liver function may develop toxicity at lower doses.



Strength(s) usually available
U.S.—


10,000 Units (3000 RE) (Rx/OTC)[Generic]


25,000 Units (7500 RE) [Aquasol A (Rx)][Generic]


50,000 Units (15,000 RE) (Rx) [Aquasol A][Generic]

Canada—


10,000 Units (3000 RE) (Rx/OTC)[Generic]


25,000 Units (7500 RE) (Rx) [Aquasol A][Generic]


50,000 Units (15,000 RE) (Rx) [Aquasol A][Generic]

Note: A water-miscible product is available.
Some strengths of these vitamin A preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs. {46}


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight, light-resistant container. Protect from light.


VITAMIN A ORAL SOLUTION

Usual adult and adolescent dose
See Vitamin A Capsules USP.

Usual pediatric dose
See Vitamin A Capsules USP.

Strength(s) usually available
U.S.—


5000 Units (1500 RE) per 0.1 mL (Rx) [Aquasol A]

Canada—
Not commercially available.

Note: Product is water-miscible.
The strength of this vitamin A preparation may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs. {46}


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. Protect from light. Protect from freezing.


VITAMIN A TABLETS

Usual adult and adolescent dose
See Vitamin A Capsules USP.

Usual pediatric dose
See Vitamin A Capsules USP.

Strength(s) usually available
U.S.—


10,000 Units (3000 RE) (Rx/OTC)[Generic]


25,000 Units (7500 RE) (Rx/OTC)[Generic]


50,000 Units (15,000 RE) (Rx)[Generic]

Canada—
Not commercially available.

Note: Some strengths of these vitamin A preparations may exceed the dosage range recommended by USP DI Advisory Panels based on the amount necessary to meet normal nutritional needs. {46}


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. Protect from light.



Parenteral Dosage Forms

VITAMIN A INJECTION

Usual adult and adolescent dose
Deficiency (prophylaxis or treatment)
Intravenous infusion, as part of total parenteral nutrition solutions, the specific amount determined by individual patient need. {42}

Intramuscular, 15,000 to 30,000 RE (50,000 to 100,000 Units) a day for three days, followed by 15,000 RE (50,000 Units) a day for two weeks. {01}


Usual pediatric dose
Deficiency (prophylaxis or treatment)


Children up to 1 year of age:
Intramuscular, 1500 to 3000 RE (5000 to 10,000 Units) a day for ten days. {01}

In severe deficiency—Intramuscular, 2250 to 4500 RE (7500 to 15,000 Units) a day for ten days. {01}



Children 1 to 8 years of age:
Intramuscular, 1500 to 4500 RE (5000 to 15,000 Units) a day for ten days. {01}

In severe deficiency—Intramuscular, 5250 to 10,500 RE (17,500 to 35,000 Units) a day for ten days.



Children 8 years of age and over:
See Usual adult and adolescent dose.



Strength(s) usually available
U.S.—


50,000 Units (15,000 RE) per mL (Rx) [Aquasol A]

Canada—
Not commercially available.

Note: Product is water-miscible.


Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing.

Stability:
Vitamin A has been found to adsorb to PVC containers and tubing. {42} Exposure to light causes degradation of vitamin A; therefore, total parenteral solutions that contain vitamin A should be protected from light. {42} {62} {65} Total parenteral nutrition solutions containing vitamin A should be used within 24 hours of admixture. {49}



Revised: 05/26/1995



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  1. Finkel AJ, editor. CMIT. Current medical information and terminology. 5th ed. Chicago: American Medical Association, 1981: 333.
  1. Paige DM, editor. Manual of clinical nutrition. 1st ed. Pleasantville, NJ: Nutrition Publications, Inc., 1983: 22.8-22.1, 33.2-33.5.
  1. Gilman AG, Goodman LS, Rall TW, Murad F, editors. Goodman and Gilman's the pharmocological basis of therapeutics. 7th ed. New York: Macmillan, 1985.
  1. Panelist comment
  1. Olson J. Recommended dietary intakes (RDI)of vitamin A in humans. Am J Clin Nutr 1987; 45: 704-16.
  1. Lieber C. Alcohol, liver, and nutrition. J Am Coll Nutr 1990; 9(5): 545.
  1. Hathcock J, Hattan D, Jenkins M, McDonald J, Sundaresan P, Wilkening V. Evaluation of vitamin A toxicity. Am J Clin Nutr 1990; 52: 183-202.
  1. Committee on Nutritional Status during Pregnancy, National Academy of Sciences. Washington, DC: National Academy Press, 1990: 19-22.
  1. West K, Pokhrel R, Katz J, et al. Efficacy of vitamin A in reducing preschool child mortality in Nepal. Lancet 1991; 338(8759): 67-71.
  1. Rahmathullah L, Underwood B, Thulasiraj R, et al. N Eng J Med 1990; 323(14): 929-35.
  1. Sommer A, Djunaidi E, Loeden A, Tarwotjo I, West K, Tilden R. Impact of vitamin A supplementation on childhood mortality. Lancet 1986 May 24: 1169-73.
  1. Barclay A, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomized clinical trial. Br Med J 1987; 294: 294-6.
  1. Hussey G, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Eng J Med 1990; 323: 160-4.
  1. Panelist comment, 1990.
  1. Russell R. Vitamin A and zinc metabolism in alcoholism. Am J Clin Nutr 1980; 33: 2741-9.
  1. Panel consensus, 1990.
  1. Hustead V, Greger J, Gutcher G. Zinc supplementation and plasma concentration of vitamin A in preterm infants. Am J Clin Nutr 1988; 47: 1017-21.
  1. Krasinski S, Russell R, Otradovec C, et al. Relationship of vitamin A and vitamin E intake to fasting plasma retinol, retinol-binding protein, retinyl esters, carotene, alphatocopherol, and cholesterol among elderly people and young adults: increased plasma retinyl esters among vitamin A-supplement users. Am J Clin Nutr 1989; 49: 112-20.
  1. Krasinski S, Cohn J, Schaefer E, Russell R. Postprandial plasma retinyl ester response is greater in older subjects compared with younger subjects. J Clin Invest 1990; 85: 883-92.
  1. Hatoff D, Gertler S, Miyai K, Parker B, Weiss J. Hypervitaminosis A unmasked by acute viral hepatitis. Gastroenterology 1982; 82: 124-8.
  1. Babb R, Kieraldo J. Cirrhosis due to hypervitaminosis A. West J Med 1978; 128(3): 244-6.
  1. Jacques E, Buschmann R, Layden T. The histopathologic progression of vitamin A-induced hepatic injury. Gastroenterology 1979; 76: 599-602.
  1. Panelist comment, 1990.
  1. Burton D. Human nutrition, 3rd ed. New York: McGraw Hill, 1976: 87-91.
  1. Ellis J, Russell R, Makrauer F, Schaefer E. Increased risk for vitamin A toxicity in severe hypertriglyceridemia. Ann Intern Med 1986; 105(6): 877-9.
  1. Trissel LA. ASHP handbook on injectable drugs. 5th ed. Bethesda, MD: American Society of Hospital Pharmacists, 1988: 702-4.
  1. Panelist comment, 1991.
  1. Pearson M, Littlewood S, Bowden A. Tetracycline and benign intracranial hypertension. Br Med J 1981; 282: 568-9.
  1. Walters B, Gabbay S. Tetracycline and benign intracranial hypertension: report of five cases. Br Med J 1981; 282: 19-20.
  1. Panel consensus, 1993.
  1. Panel consensus, 1991.
  1. Panelist comment, 1991.
  1. Panelist comment, 1991.
  1. Panelist comment, 1991.
  1. Ellenhorn M, Barceloux D. Medical toxicology diagnosis and treatment of human poisoning. New York: Elsevier Press, 1988: 549-50.
  1. Health and Welfare Canada. Nutrition Recommendations, the report of the scientific review committee. Ottawa Canada: Canadian Government Publishing Centre, 1990: 11-12, 204.
  1. Accutane product information (Roche—US), Rec 7/91.
  1. Vitamin A supplements and childhood mortality: further encouraging evidence. WHO Drug Information 1992; 6(1): 11.
  1. Panelist comment, 1993.
  1. Tatro DS, editor. Drug interaction facts. St Louis: Facts and Comparisons, 1990: 764.
  1. Haddad L, Winchester J, editors. Clinical management of poisoning and drug overdose. Philadelphia: W.B. Saunders Co, 1983: 934.
  1. Panelist comment, 1993.
  1. Panelist comment, 1993.
  1. Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 27th ed. Ottawa: Canadian Pharmaceutical Association, 1992: 13.
  1. Pediatric Panel Meeting 11/93.
  1. Trissel LA. ASHP handbook on injectable drugs. 7th ed. Bethesda, MD: American Society of Hospital Pharmacists, 1988: 927-9.
  1. Willis JL, editor. Focus on food labeling. FDA Consum 1993 May: 40-5.
  1. Committee on Infectious Diseases. Vitamin A treatment of measles. Pediatrics 1993; 91(5): 1014-5.
  1. Panel consensus, 1994.
  1. Panelists comments, 1994.
  1. Panelist comment, 1994.
  1. Tegison product information (Roche—U.S.), Rec 1/87, Rev 1/87.
  1. National Research Council. Recommended dietary allowances. 9th ed. Washington, DC: National Academy Press, 1980: 56-9.
  1. Nutrition and Electrolytes Advisory Panel meeting, 1/95.
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