No

Vitamin D Analog

Treatment and management of metabolic bone disease associated with chronic renal failure or hypocalcemia in patients on chronic renal dialysis

C (per manufacturer); A/D (if dose exceeds RDA recommendation)(per expert analysis)

Hypercalcemia; known hypersensitivity to calcifediol; malabsorption syndrome; hypervitaminosis D; significantly decreased renal function

Adequate (supplemental) dietary calcium is necessary for clinical response to vitamin D; calcium-phosphate product (serum calcium times phosphorus) must not exceed 70; avoid hypercalcemia

Percentage unknown: Hypotension, cardiac arrhythmias, hypertension, irritability, headache, somnolence, seizures (rare), pruritus, hypercalcemia, polydipsia, hypermagnesemia, nausea, vomiting, constipation, anorexia, pancreatitis, metallic taste, xerostomia, polyuria, elevated LFTs, myalgia, bone pain, conjunctivitis, photophobia

Rarely toxicity occurs from acute overdose. Symptoms of chronic overdose include hypercalcemia, hypercalciuria with weakness, altered mental status, GI upset, renal tubular injury, and occasionally cardiac arrhythmias.

Following withdrawal of the drug, treatment consists of bed rest, liberal intake of fluids, reduced calcium intake, and cathartic administration. Severe hypercalcemia requires I.V. hydration and forced diuresis. I.V. saline may increase excretion of calcium. Calcitonin, cholestyramine, prednisone, sodium EDTA, biphosphonates, and mithramycin have all been used successfully to treat the more resistant cases of vitamin D-induced hypercalcemia.

Decreased effect: Cholestyramine, colestipol

Increased effect: Thiazide diuretics

Additive effect: Antacids (magnesium)

Store in light-resistant container

Vitamin D analog that (along with calcitonin and parathyroid hormone) regulates serum calcium homeostasis by promoting absorption of calcium and phosphorus in the small intestine; promotes renal tubule resorption of phosphate; increases rate of accretion and resorption in bone minerals

Absorption: Rapid from the small intestines

Distribution: Activated in the kidneys; stored in liver and fat depots

Half-life: 12-22 days

Time to peak: Within 4 hours (oral)

Elimination: In bile and feces

Oral: Hepatic osteodystrophy:

Children and Adults: Usual dose: 20-100 mcg/day or 20-200 mcg every other day; titrate to obtain normal serum calcium/phosphate levels; increase dose at 4-week intervals; initial dose: 300-350 mcg/week, administered daily or on alternate days

calcium (S), cholesterol (S), magnesium, BUN, AST, ALT; alk phos

May cause sedation or irritability

None reported

No information available to require special precautions

No effects or complications reported

Take exact dose as prescribed; do not increase dose. Maintain recommended diet and calcium supplementation. Avoid taking magnesium-containing antacids. You may experience nausea, vomiting, or metallic taste (frequent small meals, frequent mouth care, chewing gum, or sucking lozenges may help) or hypotension (use caution when rising from sitting or lying position or when climbing stairs or bending over). Report chest pain or palpitations, acute headache, skin rash, change in vision or eye irritation, CNS changes, weakness or lethargy.

Monitor calcium and phosphate levels closely; monitor symptoms of hypercalcemia

Capsule: 20 mcg, 50 mcg

Letsou AP and Price LS, "Health Aging and Nutrition: An Overview," Clin Geriatr Med, 1987, 3(2):253-60.

Myrianthopoulos M, "Dietary Treatment of Hyperlipidemia in the Elderly," Clin Geriatr Med, 1987, 3(2):343-59.

Riggs BL and Melton LJ, "The Prevention and Treatment of Osteoporosis," N Engl J Med, 1992, 327(9):620-7.