Yes

Vitamin D Analog

Treatment of refractory rickets, hypophosphatemia, hypoparathyroidism

A/C (if dose exceeds RDA recommendation)

Hypercalcemia, hypersensitivity to ergocalciferol or any component; malabsorption syndrome; evidence of vitamin D toxicity

Administer with extreme caution in patients with impaired renal function, heart disease, renal stones, or arteriosclerosis; must administer concomitant calcium supplementation; maintain adequate fluid intake; avoid hypercalcemia; renal function impairment with secondary hyperparathyroidism

Generally well tolerated

Symptoms of chronic overdose include hypercalcemia, weakness, fatigue, lethargy, anorexia

Following withdrawal of the drug and oral decontamination, treatment consists of bedrest, liberal intake of fluids, reduced calcium intake, and cathartic administration. Severe hypercalcemia requires I.V. hydration and forced diuresis with I.V. furosemide. Urine output should be monitored and maintained at >3 mL/kg/hour. I.V. saline can quickly and significantly increase excretion of calcium into urine. Calcitonin, mithramycin, and biphosphonates have all been used successfully to treat the more resistant cases of vitamin D-induced hypercalcemia.

Decreased effect: Cholestyramine, colestipol, mineral oil may decrease oral absorption

Increased effect: Thiazide diuretics may increase vitamin D effects

Increased toxicity: Cardiac glycosides may increase toxicity

Protect from light

Stimulates calcium and phosphate absorption from the small intestine, promotes secretion of calcium from bone to blood; promotes renal tubule phosphate resorption

Peak effect: In ~1 month following daily doses

Absorption: Readily absorbed from GI tract; absorption requires intestinal presence of bile

Metabolism: Inactive until hydroxylated in the liver and the kidney to calcifediol and then to calcitriol (most active form)

Oral dosing is preferred; I.M. therapy required with GI, liver, or biliary disease associated with malabsorption

Premature infants: 10-20 mcg/day (400-800 units), up to 750 mcg/day (30,000 units)

Infants and healthy Children: 10 mcg/day (400 units)

Adults: 10 mcg/day (400 units)

Renal failure:

Children: 100-1000 mcg/day (4000-40,000 units)

Adults: 500 mcg/day (20,000 units)

Hypoparathyroidism:

Children: 1.25-5 mg/day (50,000-200,000 units) and calcium supplements

Adults: 625 mcg to 5 mg/day (25,000-200,000 units) and calcium supplements

Vitamin D-dependent rickets:

Children: 75-125 mcg/day (3000-5000 units); maximum: 1500 mcg/day

Adults: 250 mcg to 1.5 mg/day (10,000-60,000 units)

Nutritional rickets and osteomalacia:

Children and Adults (with normal absorption): 25-125 mcg/day (1000-5000 units)

Children with malabsorption: 250-625 mcg/day (10,000-25,000 units)

Adults with malabsorption: 250-7500 mcg (10,000-300,000 units)

Vitamin D-resistant rickets:

Children: Initial: 1000-2000 mcg/day (40,000-80,000 units) with phosphate supplements; daily dosage is increased at 3- to 4-month intervals in 250-500 mcg (10,000-20,000 units) increments

Adults: 250-1500 mcg/day (10,000-60,000 units) with phosphate supplements

Familial hypophosphatemia: 10,000-80,000 units daily plus 1-2 g/day elemental phosphorus

Osteoporosis prophylaxis: Adults:

51-70 years of age: 400 units/day

>70 years of age: 600 units/day

Maximum daily dose: 2000 units/day

Parenteral injection for I.M. use only

Measure serum calcium, BUN, and phosphorus every 1-2 weeks; x-ray bones monthly until stabilized

Serum calcium times phosphorus should not exceed 70 mg/dL to avoid ectopic calcification; ergocalciferol levels: 10-60 ng/mL; serum calcium: 9-10 mg/dL, phosphorus: 2.5-5 mg/dL

May cause irritability or drowsiness; may rarely cause psychosis

None reported

No information available to require special precautions

No effects or complications reported

Take exact dose prescribed; do not take more than recommended. Your prescriber may recommend a special diet; do not increase calcium intake without consulting prescriber. Avoid magnesium supplements or magnesium-containing antacids. You may experience nausea, vomiting, or metallic taste (frequent small meals, frequent mouth care, or sucking hard candy may help); hypotension (use caution when rising from sitting or lying position or when climbing stairs or bending over). Report chest pain or palpitations; acute headache, dizziness, or feeling of weakness; unresolved nausea or vomiting; persistent metallic taste; unrelieved muscle or bone pain; or CNS irritability.

Monitor serum calcium, phosphorus, and BUN every 2 weeks

Capsule (Drisdol®): 50,000 units [1.25 mg]

Injection (Calciferol™): 500,000 units/mL [12.5 mg/mL] (1 mL)

Liquid (Calciferol™, Drisdol®): 8000 units/mL [200 mcg/mL] (60 mL)

Tablet (Calciferol™): 50,000 units [1.25 mg]

Cardella CJ, Birkin BL, and Rapoport A, "Role of Dialysis in the Treatment of Severe Hypercalcemia: Report of Two Cases Successfully Treated With Hemodialysis and Review of the Literature," Clin Nephrol, 1979, 12(6):285-90.

Cetaruk EW and Aaron CK, "Hazards of Nonprescription Medications," Emerg Med Clin North Am, 1994, 12(2):483-510.

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.

Pettifor JM, Bikle DD, Cavaleros M, et al, "Serum Levels of Free 1,25-Dihydroxyvitamin D in Vitamin D Toxicity," Ann Intern Med, 1995, 122(7):511-3.

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

Thomas MK, Lloyd-Jones, DM, Thadhani RI, et al, "Hypovitaminosis D in Medical Inpatients," N Engl J Med, 1998, 338(12):777-83.