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Vitamin A

Medically reviewed by Drugs.com. Last updated on May 7, 2019.

Pronunciation

(VYE ta min aye)

Index Terms

  • Oleovitamin A
  • Vitamin A Acetate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

A-25: 25,000 units

Vitamin A Fish: 7500 units

Generic: 10,000 units

Capsule, Oral [preservative free]:

A-25: 25,000 units [dye free]

Generic: 8000 units

Cream, External:

AFirm 1X: 0.15% (30 g [DSC]) [fragrance free; contains benzyl alcohol, cetyl alcohol, disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanolamine)]

AFirm 2X: 0.3% (30 g [DSC]) [fragrance free; contains benzyl alcohol, cetyl alcohol, disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanolamine)]

AFirm 3X: 0.6% (30 g [DSC]) [fragrance free; contains benzyl alcohol, cetyl alcohol, disodium edta, methylparaben, peg-10 soya sterol, trolamine (triethanolamine)]

Gordons-Vite A: 100,000 units/g (75 g, 120 g, 480 g, 2400 g)

Lotion, External:

Gordons-Vite A: 100,000 units (120 mL, 3840 mL)

Solution, Intramuscular:

Aquasol A: 50,000 units/mL (2 mL) [contains chlorobutanol (chlorobutol)]

Tablet, Oral:

Generic: 10,000 units, 15,000 units, Vitamin A 10000 units and beta carotene 1000 units [DSC]

Brand Names: U.S.

  • A-25 [OTC]
  • AFirm 1X [OTC] [DSC]
  • AFirm 2X [OTC] [DSC]
  • AFirm 3X [OTC] [DSC]
  • Aquasol A
  • Gordons-Vite A [OTC]
  • Vitamin A Fish [OTC]

Pharmacologic Category

  • Vitamin, Fat Soluble

Pharmacology

Vitamin A is a fat soluble vitamin needed for visual adaptation to darkness, maintenance of epithelial cells, immune function and embryonic development.

Absorption

Vitamin A in dosages not exceeding physiologic replacement is well absorbed in the small intestine after oral administration; water miscible preparations are absorbed more rapidly than oil preparations; large oral doses, conditions of fat malabsorption, low protein intake, or hepatic or pancreatic disease reduces oral absorption

Distribution

Large amounts concentrate for storage in the liver

Metabolism

Converted in the small intestine to retinol and further metabolized in the liver; conjugated with glucuronide; undergoes enterohepatic recirculation

Excretion

Feces; urine

Use: Labeled Indications

Treatment and prevention of vitamin A deficiency; parenteral (IM) route is indicated when oral administration is not feasible or when absorption is insufficient (malabsorption syndrome); dietary supplement (OTC)

Off Label Uses

Xerophthalmia caused by vitamin A deficiency

Based on the World Health Organization (WHO) Model Formulary, vitamin A given for the treatment of xerophthalmia caused by vitamin A deficiency is effective and recommended in the management of this condition.

Contraindications

Hypersensitivity to vitamin A or any component of the formulation; hypervitaminosis A; pregnancy (dose exceeding RDA); intravenous administration of Aquasol A

Dosing: Adult

Note: Oral OTC supplements containing vitamin A may express the amount as mcg (retinol activity equivalents [RAE]) instead of (or in addition to) units; 1 unit = 0.3 mcg (RAE) = 0.3 mcg retinol (ASPEN [Vanek 2012]; IOM 2001).

Deficiency (manufacturer recommendation): IM: Note: IM route is indicated when oral administration is not feasible or when absorption is insufficient (malabsorption syndrome): 100,000 units (30,000 mcg)/day for 3 days, followed by 50,000 units (15,000 mcg)/day for 2 weeks

Note: Follow-up therapy with an oral therapeutic multivitamin (containing additional vitamin A) is recommended: Oral: 10,000 to 20,000 units (3,000 to 6,000 mcg)/day for 2 months

Deficiency (high-dose supplementation in patients at high risk for deficiency) (off-label dose) (eg, persons living in developing areas of the world where deficiency is a public health problem, especially persons with severe infectious disease or malnutrition): Oral:

Adults: 200,000 units (60,000 mcg)/dose every 6 months (WHO 2008)

Pregnant females: Maximum 10,000 units (3,000 mcg)/day or 25,000 units (7,500 mcg) once weekly. Administer for a minimum of 12 weeks during pregnancy or until delivery (WHO 2008; WHO 2011c)

Postpartum females: 200,000 units (60,000 mcg) at delivery or within 8 weeks of delivery (WHO 2008)

Xerophthalmia, treatment (off-label use): Oral:

Adults (except females of reproductive age): 200,000 units (60,000 mcg) once daily for 2 days; repeat with single dose after 2 weeks (WHO 2008)

Females of reproductive age (WHO 1997; WHO 2008):

With night blindness or Bitot's spots (less severe xerophthalmia): 5,000 to 10,000 units (1,500 to 3,000 mcg)/day (maximum 10,000 units [3,000 mcg]/day) or ≤25,000 units (≤7,500 mcg) once weekly for ≥4 weeks

Severe xerophthalmia: Refer to adult dosing.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Adequate Intake (AI): Presented as retinol activity equivalent (RAE) (IOM 2000):

1 to 6 months: 400 mcg/day

6 to 12 months: 500 mcg/day

Recommended Daily Allowance (RDA): Presented as retinol activity equivalent (RAE) (IOM 2000):

1 to 3 years: 300 mcg/day

4 to 8 years: 400 mcg/day

9 to 13 years: 600 mcg/day

>13 years: Female: 700 mcg/day; Male: 900 mcg/day

Cystic fibrosis supplementation: Note: Typically administered as part of a fixed dosage product with other fat-soluble vitamins (eg, ADEK); however, some patients may require higher doses based on condition (CF liver disease [Debray 2011]); doses presented are in addition to usual RDA for age.

Infants: Oral: 1,500 units/day (Borowitz 2002; Borowitz 2009)

Children 1 to 3 years: Oral: 5,000 units/day (Borowitz 2002; Lahiri 2016)

Children 4 to 8 years: Oral: 5,000 to 10,000 units/day (Borowitz 2002; Lahiri 2016)

Children ≥9 years and Adolescents: Oral: 10,000 units/day (Borowitz 2002); some data suggest that dose should be individualized based on patient serum concentrations. Based on current US recommendations, some available multivitamin products may be excessive based on patient's needs, particularly in preadolescent patients (Bonifant 2014; Brei 2013; Graham-Maar 2006)

Malabsorption (eg, cholestasis, biliary atresia); supplementation: Limited data available: Children and Adolescents: Note: Specific dose should be based on serum markers and clinical condition; dose should be individualized: Oral: 5,000 to 15,000 units/day of water miscible product (eg, Aquasol A); begin at low end of the range for younger patients (Kelly 2007; Kliegman 2016)

Measles infection, supplementation: Limited data available (WHO 2004; WHO 2010):

Infants <6 months: Oral: 50,000 units daily for 2 days

Infants 6 to 11 months: Oral: 100,000 units daily for 2 days

Infants ≥12 months and Children ≤5 years: Oral: 200,000 units daily for 2 days

Note: If severe malnutrition or ophthalmologic evidence of vitamin A deficiency is present, repeat a single dose 2 to 4 weeks after the second dose.

Vitamin A deficiency; prevention for geographical at-risk populations: Note: Supplementation recommended in areas where vitamin A deficiency is a public health problem, including local prevalence of nightblindness ≥1% in ages 24 to 59 months or prevalence of serum retinol ≤0.7 mmol/L is ≥20% in ages 6 to 59 months (WHO 2011)

Infants ≥6 months: Oral: 100,000 units once

Children <5 years: Oral: 200,000 units; administer as a single dose every 4 to 6 months

Vitamin A deficiency, treatment: Note: After completion of an IM course to correct deficiency, patient should continue on an oral supplementation for 2 months with a multivitamin preparation that contains: Infants and children <8 years: 5,000 to 10,000 units/day; and children ≥8 years and Adolescents: 10,000 to 20,000 units/day

Infants: IM: 7,500 to 15,000 units once daily for 10 days followed by oral supplementation

Children 1 to 8 years: IM: 17,500 to 35,000 units once daily for 10 days followed by oral supplementation

Children >8 years and Adolescents: IM: 100,000 units once daily for 3 days; then 50,000 units once daily for 14 days followed by oral supplementation

Xerophthalmia: Limited data available (WHO 1997; WHO 2010):

Infants <6 months: Oral: 50,000 units administered as a single dose; repeat the next day and again after at least 2 weeks for a total of 3 doses

Infants 6 to 12 months: Oral: 100,000 units administered as a single dose; repeat the next day and again after at least 2 weeks for a total of 3 doses

Children and Adolescents: Oral: 200,000 units administered as a single dose; repeat the next day and again after at least 2 weeks for a total of 3 doses

Administration

May be administered orally or IM. Note: IV administration is contraindicated.

Dietary Considerations

Dairy products, fish, and liver are common dietary sources of vitamin A; broccoli, cantaloupe, carrots, peas, spinach, and squash are sources of beta-carotene (which is converted to vitamin A) (IOM 2000)

Dietary reference Intake (presented as retinol activity equivalent [RAE]) (IOM 2001):

1 to 6 months: Adequate intake: 400 mcg/day (1,330 units/day)

7 to 12 months: Adequate intake: 500 mcg/day (1,670 units/day)

1 to 3 years: RDA: 300 mcg/day (1,000 units/day)

4 to 8 years: RDA: 400 mcg/day (1,330 units/day)

9 to 13 years: RDA: 600 mcg/day (2,000 units/day)

>13 years: RDA: Females: 700 mcg/day (2,330 units/day); Males: 900 mcg/day (3,000 units/day)

Pregnancy: RDA: 14 to 18 years: 750 mcg/day (2,500 units/day); ≥19 years: 770 mcg/day (2,560 units/day)

Lactation: RDA: 14 to 18 years: 1,200 mcg/day (4,000 units/day); ≥19 years: 1,300 mcg/day (4,330 units/day)

Storage

Injection: Store at 2°C to 8°C (36°F to 46°F); do not freeze. Protect from light. Extended storage information at room temperature may be available; contact product manufacturer to obtain current recommendations.

Drug Interactions

Bexarotene (Topical): Vitamin A may enhance the adverse/toxic effect of Bexarotene (Topical). Management: Limit doses of vitamin A to 5,000 units per day if combined with topical bexarotene. Consider therapy modification

Orlistat: May decrease the serum concentration of Vitamins (Fat Soluble). Management: Administer oral fat soluble vitamins at least 2 hours before or after the administration of orlistat. Similar precautions do not apply to parenterally administered fat soluble vitamins. Consider therapy modification

Retinoic Acid Derivatives: Vitamin A may enhance the adverse/toxic effect of Retinoic Acid Derivatives. Exceptions: Adapalene; Alitretinoin (Topical); Bexarotene (Topical); Tretinoin (Topical). Avoid combination

Adverse Reactions

Frequency not defined: Hypersensitivity: Anaphylactic shock (following IV administration), hypersensitivity reaction (rare)

Warnings/Precautions

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

• Parenteral vitamin A: In low birth weight infants, polysorbates have been associated with thrombocytopenia, renal dysfunction, hepatomegaly, cholestasis, ascites, hypotension, and metabolic acidosis (E-Ferol syndrome).

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Other warnings/precautions:

• Appropriate use: Evaluate other sources of vitamin A while receiving this product; patients receiving >25,000 units/day should be closely monitored for toxicity.

Monitoring Parameters

Serum retinol

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies. In humans, the critical period of exposure is the first trimester of pregnancy. Excess vitamin A during pregnancy may cause craniofacial malformations, as well as CNS, heart, and thymus abnormalities. Maternal vitamin A deficiency also causes adverse effects in the fetus, and vitamin A requirements are increased in pregnant women (IOM 2000). The manufacturer notes that the safety of doses >6,000 units/day in pregnant women has not been established and doses greater than the RDA are contraindicated in pregnant women or those who may become pregnant. High doses are used in some areas of the world for supplementation where deficiency is a public health problem (eg, to prevent night blindness); however, single doses >25,000 units should be avoided within 60 days of conception. High-dose supplementation is otherwise not recommended as part of routine antenatal care (WHO 2011c).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Other brands: Aquasol A

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