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Vitamin D

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Sep.12.2023

Vitamin D

Indications/Dosage

Labeled

  • familial hypocholesterolemia
  • hypoparathyroidism
  • nutritional supplementation
  • osteoporosis
  • osteoporosis prophylaxis
  • rickets
  • vitamin D deficiency
  • vitamin D-dependent rickets

General dosing information

  • For dosing conversion, 1 mcg vitamin D = 40 International Units.

Off-Label

  • hyperparathyroidism
  • premenstrual syndrome (PMS)
  • renal osteodystrophy
† Off-label indication

For nutritional supplementation

NOTE: Persons with increased risk for deficiency of vitamin D (e.g., chronic fat malabsorption disorders, persons with chronic kidney disease, persons living with HIV, or persons taking certain enzyme-inducing medications, etc.) may require higher supplemental doses than those recommended for healthy persons to maintain normal vitamin D status.[36895] [52900] [59376] In such persons, 25(OH)D concentrations can be used to guide adequate dietary supplementation.

Oral dosage

Adults older than 70 years

20 mcg/day (800 International Units/day) PO is the RDA.[52900]

Adult 18 to 70 years

15 mcg/day (600 International Units/day) PO is the RDA.[52900]

Adolescents

15 mcg/day (600 International Units/day) PO is the RDA.[52900] 10 mcg/day (400 International Units/day) PO is recommended if the adolescent is not obtaining at least 10 mcg (400 International Units) through dietary sources. All dietary sources of vitamin D (e.g., fortified milk, eggs, other food) may be included in determining the daily intake.[36895]

Children

15 mcg/day (600 International Units/day) PO is the RDA.[52900] 10 mcg/day (400 International Units/day) PO is recommended if the child is consuming less than 1 L/day of vitamin D-fortified milk.[36895]

Infants

10 mcg/day (400 International Units/day) PO is the recommended Adequate Intake based on dietary intake of breast milk, formula, or other food sources. No RDA has been established.[52900] Infants that are exclusively breast-fed without vitamin D supplements are at increased risk for deficiency. Because most exclusively formula-fed infants ingest nearly 1 L/day of formula after the first month of life, they will achieve a vitamin D intake of 10 mcg/day (400 International Units/day). Infants who receive a mixture of human milk and formula should get a vitamin D supplement of 10 mcg/day (400 International Units/day) to ensure the AI value. As infants are weaned from human milk and/or formula, intake of vitamin D-fortified milk should be encouraged to provide at least 10 mcg/day (400 International Units/day) of vitamin D. Vitamin D supplementation should continue until the infant consumes at least 1 L/day (1 quart/day) of vitamin D-fortified milk (Whole milk (cow's milk) is not recommended until after 12 months of age).[36895]

Neonates

10 mcg/day (400 International Units/day) PO is the recommended Adequate Intake based on dietary intake of breast milk, formula, or other food sources. No RDA has been established.[52900] Infants that are exclusively breast-fed without vitamin D supplements are at increased risk for deficiency. Because most exclusively formula-fed infants ingest nearly 1 L/day of formula after the first month of life, they will achieve a vitamin D intake of 10 mcg/day (400 International Units/day). Infants who receive a mixture of human milk and formula should get a vitamin D supplement of 10 mcg/day (400 International Units/day) to ensure the AI value. As infants are weaned from human milk and/or formula, intake of vitamin D-fortified milk should be encouraged to provide at least 10 mcg/day (400 International Units/day) of vitamin D. Vitamin D supplementation should continue until the infant consumes at least 1 L/day (1 quart/day) of vitamin D-fortified milk (Whole milk (cow's milk) is not recommended until after 12 months of age).[36895]

Premature Neonates weighing 1.5 kg or more

10 mcg/day (400 International Units/day) PO.[52900] [54484]

Premature Neonates weighing less than 1.5 kg

5 to 10 mcg/day (200 to 400 International Units/day) PO. If the infant is receiving less than 10 mcg/day (400 International Units/day), increase the dosage to 10 mcg/day (400 International Units/day) when a weight of more than 1.5 kg is reached and full enteral nutrition is tolerated.[54484]

for nutritional supplementation in persons with cystic fibrosis

Oral dosage

Adults

20 to 50 mcg (800 to 2,000 International Units) PO once daily. Adjust dosage to maintain serum 25-hydroxyvitamin D concentrations of 30 ng/mL or more. Max: 250 mcg/day (10,000 International Units/day).[66596]

Children and Adolescents 11 to 17 years

20 to 50 mcg (800 to 2,000 International Units) PO once daily. Adjust dosage to maintain serum 25-hydroxyvitamin D concentrations of 30 ng/mL or more. Max: 250 mcg/day (10,000 International Units/day).[66596]

Children 1 to 10 years

20 to 25 mcg (800 to 1,000 International Units) PO once daily. Adjust dosage to maintain serum 25-hydroxyvitamin D concentrations of 30 ng/mL or more. Max: 100 mcg/day (4,000 International Units/day).[66596]

Infants

10 to 12.5 mcg (400 to 500 International Units) PO once daily. Adjust dosage to maintain serum 25-hydroxyvitamin D concentrations of 30 ng/mL or more. Max: 50 mcg/day (2,000 International Units/day).[66596]

Neonates

10 to 12.5 mcg (400 to 500 International Units) PO once daily. Adjust dosage to maintain serum 25-hydroxyvitamin D concentrations of 30 ng/mL or more. Max: 50 mcg/day (2,000 International Units/day).[66596]

for nutritional supplementation in persons with thalassemia

Oral dosage

Adults

50 mcg (2,000 International Units) PO once daily.[69099]

Children and Adolescents

50 mcg (2,000 International Units) PO once daily.[69099]

for nutritional supplementation after bariatric surgery

Oral dosage

Adults

75 mcg (3,000 International Units) PO once daily until serum vitamin D concentration is more than 30 ng/mL.[69358]

For the treatment of vitamin D deficiency

NOTE: In adults, the Institute of Medicine (IOM) defines vitamin D deficiency as 25(OH)D concentrations of 30 nmol/L or less (12 ng/mL or less) and vitamin D insufficiency as 25(OH)D concentrations of 30 to 50 nmol/L (12 to less than 20 ng/mL). Generally all persons are sufficient at levels of 50 nmol/L or more (20 ng/mL or more).[31730] [52900] In pediatric patients, the American Academy of Pediatrics (AAP) and the IOM define vitamin D deficiency as 25(OH)D concentrations of 37.5 nmol/L or less (15 ng/mL or less) and vitamin D insufficiency as 25(OH)D concentrations of 50 nmol/L or less (20 ng/mL or less).[36919] [52900] [59376] In contrast, the Endocrine Society guidelines for adults and pediatric patients define vitamin D insufficiency as 25(OH)D concentrations less than 75 nmol/L (less than 30 ng/mL) and vitamin D deficiency as 25(OH)D concentrations less than 50 nmol/L (less than 20 ng/mL).[62269]

for the treatment of vitamin D deficiency in the general population

Oral dosage

Adults

7,000 to 10,000 mcg (280,000 to 400,000 International Units) PO loading dose divided in daily or weekly doses over 6 to 10 weeks to achieve a serum vitamin D concentration more than 30 ng/mL, then 20 to 100 mcg (800 to 4,000 International Units) PO once daily or given intermittently at higher equivalent dose starting 1 month after loading. Example loading dose regimens include: 100 mcg (4,000 International Units) PO once daily for 10 weeks; 150 mcg (6,000 International Units) PO once daily for 8 weeks; 1,000 mcg (40,000 International Units) once weekly for 7 weeks; or 1,250 mcg (50,000 International Units) PO once weekly for 6 to 8 weeks. Individualize dose based on serum vitamin D concentrations.[62269] [62274] [69357]

Children and Adolescents

50 to 125 mcg (2,000 to 5,000 International Units) PO once daily or 350 to 1,250 mcg (14,000 to 50,000 International Units) PO once weekly for at least 6 weeks to achieve a serum vitamin D concentration more than 30 ng/mL, then 15 to 25 mcg (600 to 1,000 International Units) PO once daily.[36919] [62269] [62270] [66854] [66855] Maintenance doses of 1,250 mcg (50,000 International Units) PO once monthly have also been used.[68414] Individualize dose based on serum vitamin D concentrations.

Infants

25 to 125 mcg (1,000 to 5,000 International Units) PO once daily or 1,250 mcg (50,000 International Units) PO once weekly for at least 6 weeks to achieve a serum vitamin D concentration more than 30 ng/mL, then 10 to 25 mcg (400 to 1,000 International Units) PO once daily. Individualize dose based on serum vitamin D concentrations.[36919] [62269] [62270]

Neonates

25 to 50 mcg (1,000 to 2,000 International Units) PO once daily or 1,250 mcg (50,000 International Units) PO once weekly for at least 6 weeks to achieve a serum vitamin D concentration more than 30 ng/mL, then 10 to 25 mcg (400 to 1,000 International Units) PO once daily. Individualize dose based on serum vitamin D concentrations.[36919] [62269] [62270]

for the treatment of vitamin D deficiency in persons with cystic fibrosis

Oral dosage

Adults

40 to 150 mcg (1,600 to 6,000 International Units) PO once daily, initially. May increase the dose to a maximum of 250 mcg (10,000 International Units) PO once daily to maintain a serum vitamin D concentration of at least 30 ng/mL (75 mmol/L).[66596]

Children and Adolescents 11 to 17 years

40 to 150 mcg (1,600 to 6,000 International Units) PO once daily, initially. May increase the dose to a maximum of 250 mcg (10,000 International Units) PO once daily to maintain a serum vitamin D concentration of at least 30 ng/mL (75 mmol/L).[66596]

Children 1 to 10 years

40 to 75 mcg (1,600 to 3,000 International Units) PO once daily, initially. May increase the dose to a maximum of 100 mcg (4,000 International Units) PO once daily to maintain a serum vitamin D concentration of at least 30 ng/mL (75 mmol/L).[66596]

Infants

20 to 25 mcg (800 to 1,000 International Units) PO once daily, initially. May increase the dose to a maximum of 50 mcg (2,000 International Units) PO once daily to maintain a serum vitamin D concentration of at least 30 ng/mL (75 mmol/L).[66596]

Neonates

20 to 25 mcg (800 to 1,000 International Units) PO once daily, initially. May increase the dose to a maximum of 50 mcg (2,000 International Units) PO once daily to maintain a serum vitamin D concentration of at least 30 ng/mL (75 mmol/L).[66596]

for the treatment of vitamin D deficiency in persons with obesity or malabsorption syndromes (i.e., inflammatory bowel disease) and persons receiving concomitant medications affecting vitamin D metabolism (i.e., anticonvulsants, HIV medications)

Oral dosage

Adults

75 to 250 mcg (3,000 to 10,000 International Units) PO once daily or 1,250 mcg (50,000 International Units) PO 1 to 3 times weekly to achieve a serum vitamin D concentration more than 30 ng/mL, then 75 to 150 mcg (3,000 to 6,000 International Units) PO once daily.[62269] [69358]

Children and Adolescents

150 to 250 mcg (6,000 to 10,000 International Units) PO once daily (2 to 3 times the usual recommended dose) to achieve a serum vitamin D concentration more than 30 ng/mL, then 30 to 75 mcg (1,200 to 3,000 International Units) PO once daily.[62269]

Infants

150 to 250 mcg (6,000 to 10,000 International Units) PO once daily (2 to 3 times the usual recommended dose) to achieve a serum vitamin D concentration more than 30 ng/mL, then 20 to 75 mcg (800 to 3,000 International Units) PO once daily.[62269]

Neonates

100 to 150 mcg (4,000 to 6,000 International Units) PO once daily (2 to 3 times the usual recommended dose) to achieve a serum vitamin D concentration more than 30 ng/mL, then 20 to 75 mcg (800 to 3,000 International Units) PO once daily.[62269]

For the treatment of nutritional rickets

Oral dosage

Children and Adolescents

50 to 500 mcg (2,000 to 20,000 International Units) PO daily for 4 to 8 weeks, with the duration of treatment determined by evidence of radiologic healing. Thereafter, supplement with the RDA to prevent further deficiency.[52884] [52946] Alternatively, at least 125 mcg (5,000 International Units) PO once daily has also been recommended for initial treatment; weekly regimens (e.g., high doses, such as 1,250 mcg [50,000 International Units] PO once weekly) or a single higher-dose course over 1 to 5 days may be considered if compliance is an issue that prevents adequate repletion.[36919] [53381] Large single dose regimens (5,000 to 15,000 mcg [200,000 to 600,000 International Units] PO divided into 2 to 4 doses administered over 1 day) have been used when compliance is a concern, but are sometimes controversial due to a purported risk for hypercalcemia. It is important to ensure adequate dietary intake of calcium and phosphorus.[52884] [52946] Active treatment may continue for 2 to 3 months to replete deficient stores, followed by maintenance dosing with the RDA.[36919] Individualize dose based upon 25(OH)D concentrations.[52884]

Infants

25 to 125 mcg (1,000 to 5,000 International Units) PO once daily has been recommended. Radiologic evidence of healing is usually observed in 2 to 4 weeks, and the active treatment duration is usually 2 to 3 months, after which the supplementation may be reduced to maintenance dosing in accordance with RDAs to prevent further deficiency. Supplementation with calcium is necessary due to the risk of hypocalcemia during bone remineralization.[36919] It is important to ensure adequate dietary intake of calcium and phosphorus.[52884] [52946] Weekly regimens (e.g., high doses, such as 1,250 mcg [50,000 International Units] PO once weekly) have been considered in older infants if compliance is an issue that prevents adequate repletion.[36919] [53381] Individualize dose based upon 25(OH)D concentrations.[52884]

Neonates

25 mcg (1,000 International Units) PO once daily has been recommended. Radiologic evidence of healing is usually observed in 2 to 4 weeks, and the active treatment duration is usually 2 to 3 months, after which the supplementation may be reduced to maintenance dosing in accordance with RDAs to prevent further deficiency. Supplementation with calcium is necessary due to the risk of hypocalcemia during bone remineralization.[36919] It is important to ensure adequate dietary intake of calcium and phosphorus.[52884] [52946] Individualize dose based upon 25(OH)D concentrations.[52884]

For the treatment of vitamin D-dependent rickets type 2 (hereditary vitamin D resistant rickets)

Oral dosage

Children and Adolescents

Treatment for HVDRR is not standardized. Despite significant improvements in vitamin D concentrations following high-dose ergocalciferol (or use of a vitamin D analog like calcitriol) alone, patients may remain hypocalcemic and hypophosphatemic. High doses of ergocalciferol (vitamin D2) have been used in these patients. The following regimens have been used with variable results: 100 to 1,000 mcg/day (4,000 to 40,000 International Units/day) PO or 5 to 7 mcg/kg/day (200 to 280 International Units/kg/day) PO. However, doses as high as 5,000 mcg/day (200,000 International Units/day) PO have not been effective in improving the disease in other patients. Patients should receive a 3 to 6 month trial of high dose vitamin D along with high-dose calcium therapy. Patients without alopecia appear more likely to respond.[52884] [52947] The FDA-approved dose is 300 to 12,500 mcg (12,000 to 500,000 International Units) PO daily. Calcium intake should be adequate. Blood calcium and phosphorus determinations are recommended every 2 weeks or more frequently if clinically indicated. X-rays of the bones are recommended every month until condition is corrected and stabilized.[30166] Individualize dose based upon 25(OH)D concentrations.[52884]

For osteoporosis prophylaxis and treatment in conjunction with calcium supplementation

Oral dosage

Adults 50 years and older

20 to 25 mcg (800 to 1,000 international units) PO daily is recommended by the National Osteoporosis Foundation. Supplementation regimen should include calcium for greatest benefit.[67144]

for osteoporosis prevention in patients receiving corticosteroids

Oral dosage

Adults

20 mcg (800 International Units) PO daily; different doses may be recommended dependent on concomitant pharmacological treatment or prevention. The American College of Rheumatology recommends supplementation of vitamin D and calcium in all patients receiving corticosteroid therapy, especially if treatment duration will exceed 3 months.[44888]

Children and Adolescents

20 mcg (800 International Units) PO daily. The American College of Rheumatology recommends supplementation of vitamin D and calcium in all patients receiving corticosteroid therapy, especially if treatment duration will exceed 3 months.[44888]

For the prevention of premenstrual syndrome (PMS)†

Oral dosage

Adult females

A total dose of 17.5 mcg (700 International Units) PO daily from a combination of dietary and non-dietary sources. In a population-based study of 3,025 females, the daily vitamin D and calcium intake was followed to determine if vitamin D or calcium had an impact on the risk of developing PMS. Women with the highest intake of vitamin D from both dietary sources and supplements (median 17.7 mcg [706 International Units daily]) had a reduced risk of developing PMS compared with those women with the lowest intake of vitamin D of 2.8 mcg (112 International Units) daily (RR of 0.59, 95% CI 0.4 to 0.86, p = 0.01 for the trend).[31641]

For the treatment of hypoparathyroidism with calcium supplementation

Oral Dosage

Adults

1,250 to 5,000 mcg (50,000 to 200,000 International Units) PO once daily along with calcium supplements.[30166]

Children and Adolescents

1,250 to 5,000 mcg (50,000 to 200,000 International Units) PO once daily along with calcium supplements.[30166]

For the prevention and treatment of vitamin D deficiency and secondary hyperparathyroidism and resultant bone disease (renal osteodystrophy†) in patients with CKD

Oral dosage

Adults

1,250 mcg (50,000 International Units) PO once weekly or monthly until target serum total hydroxyvitamin D concentrations are achieved.[66587] [66568] [66589] [66590] Cholecalciferol is more effective at raising serum total 25-hydroxyvitamin D concentrations in non-dialysis-dependent CKD patients (CKD G3a-5) compared with ergocalciferol and may be preferable in these patients.[66568] [66589] [66590]

For the treatment of familial hypocholesterolemia (e.g., abetalipoproteinemia, hypobetalipoproteinemia, and chylomicron retention disease, CRD)

Oral dosage

Children and Adolescents 6 to 17 years

20 to 30 mcg (800 to 1,200 International Units) PO once daily has been recommended. Alternative regimen is 15,000 mcg (600,000 International Units) PO once every 2 months. If vitamin D supplementation is started early, it prevents development of osteopenia in these patients.[53313]

Infants and Children 1 to 5 years

20 to 30 mcg (800 to 1,200 International Units) PO once daily has been recommended. Alternative regimen is 2,500 mcg (100,000 International Units) PO once every 2 months. If vitamin D supplementation is started early, it prevents development of osteopenia in these patients.[53313]

Therapeutic Drug Monitoring

Serum 25(OH)D concentrations are recommended for monitoring vitamin D status because it is reflective of both sources of vitamin D, sunlight and dietary. It is not, however, reflective of vitamin D body stores.[52900] Circulating 1,25(OH)2D is not a good indicator of vitamin D status due to its shorter half-life and its tight regulation by parathyroid hormone, calcium, and phosphorus. Levels of 1,25(OH)2D do not usually decrease until severe vitamin D deficiency.[52879]

 

The Institute of Medicine recommends the following regarding the interpretation of 25(OH)D concentrations and vitamin D status for normal healthy persons:[52900]

  • less than 30 nmol/L (less than 12 ng/mL): Vitamin D deficiency; in pediatric patients, a level of 37.5 nmol/L or less (15 ng/mL or less) is considered deficiency.[36919]
  • 30 to 50 nmol/L (12 to 20 ng/mL): Vitamin D insufficiency; concentrations may be inadequate in some persons for bone and overall health. In pediatric patients, a level of 40 to 50 nmol/L (16 to 20 ng/mL) is considered insufficiency.[36919]
  • 50 nmol/L or more (20 ng/mL or more): Generally considered adequate for bone and overall health.
  • 75 nmol/L or more (30 ng/mL or more): No consistent evidence of increased benefit.
  • more than 125 nmol/L (more than 50 ng/mL): Evidence supports a risk of adverse effects, especially at those concentrations more than 150 nmol/L (more than 60 ng/mL). Vitamin D toxicity has been associated with 25(OH)D concentrations of 500 to 600 nmol/L (200 to 240 ng/mL).

Maximum Dosage Limits

  • Adults

    Maintenance Tolerable Upper Intake Level (UL) is 100 mcg/day (4,000 International Units/day) PO.

  • Geriatric

    Maintenance Tolerable Upper Intake Level (UL) is 100 mcg/day (4,000 International Units/day) PO.

  • Adolescents

    Maintenance Tolerable Upper Intake Level (UL) is 100 mcg/day (4,000 International Units/day) PO.

  • Children

    Children 9 to 12 years: Maintenance Tolerable Upper Intake Level (UL) is 100 mcg/day (4,000 International Units/day) PO.

    Children 4 to 8 years: Maintenance Tolerable Upper Intake Level (UL) is 75 mcg/day (3,000 International Units/day) PO.

    Children 1 to 3 years: Maintenance Tolerable Upper Intake Level (UL) is 62.5 mcg/day (2,500 International Units/day) PO.

  • Infants

    Infants 7 to 12 months: Maintenance Tolerable Upper Intake Level (UL) is 37.5 mcg/day (1,500 International Units/day) PO.

    Infants 1 to 6 months: Maintenance Tolerable Upper Intake Level (UL) is 25 mcg/day (1,000 International Units/day) PO.

  • Neonates

    Maintenance Tolerable Upper Intake Level (UL) is 25 mcg/day (1,000 International Units/day) PO.

Patients with Hepatic Impairment Dosing

Specific guidelines for dosage adjustments in hepatic impairment are not available; higher doses may be needed to compensate for reductions in intestinal absorption.

Patients with Renal Impairment Dosing

Specific guidelines for dosage adjustments in renal impairment are not available. However, vitamin D is activated in the kidney; close monitoring is required to ensure the appropriate dose.

† Off-label indication
Revision Date: 09/12/2023, 12:15:08 PM

References

30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.31641 - Bertone-Johnson ER, Hankinson SE, Bendich A, et al. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med 2005;165:1246-1252.31730 - National Institute of Health Clinical Center and The Office of Dietary Supplements. Dietary Supplement Fact Sheet: Vitamin D. Retrieved December 1, 2005. Available on the World Wide Web at http://ods.od.nih.gov/factsheets/vitamind.asp36895 - Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and Vitamin D deficiency in Infants, Children, and Adolescents. Pediatrics 2008;112:1142-1152.36919 - Misra M, Pacaud D, Collett-Solberg PF, et al. Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics 2008;122:398-417.44888 - Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis. Arthritis and Rheumatology 2017;69:1521-1537.52879 - Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008;88(suppl):582S-6S.52884 - Greenbaum LA. Rickets and Hypervitaminosis D. In: Kliegman RM, Stanton BF, St. Geme JW, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Elsevier;2011:200-209.52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.52946 - Pettifor JM. Nutritional Rickets. In: Glorieux FH, Pettifor JM, Juppner H eds. Pediatric Bone: Biology and Diseases. 2nd ed. Philadelphia: Elsevier;2012:625-654.52947 - Portale AA, Perwad F, Miller WL. Rickets Due to Hereditary Abnormalities of Vitamin D Synthesis or Action. In: Glorieux FH, Pettifor JM, Juppner H, eds. Pediatric Bone: Biology and Diseases. 2nd ed. Philadelphia: Elsevier;2012:679-698.53313 - Peretti N, Sassolas A, Roy CC, et al. Guidelines for the diagnosis and management of chylomicron retention disease based on review of the literature and experience of two centers. Orphanet J Rare Dis 2010;5:24.53381 - Gordon CM, Williams AL, Feldman HA, et al. Treatment of hypovitaminosis D in infants and toddlers. J Clin Endocrinol Metab. 2008;93:2716-2721.54484 - Abrams SA and the Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics 2013; Apr 29 [Epub ahead of print]59376 - Lee JY, So TY, Thackray J. A review on vitamin D deficiency treatment in pediatric patients. J Pediatr Pharmacol Ther 2013;18:277-291.62269 - Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-1930.62270 - Khadilkar A, Khadilkar V, Chinnappa J, et al. Prevention and treatment of vitamin D and calcium deficiency in children and adolescents: Indian Academy of Pediatrics (IAP) Guidelines. Indian Pediatr 2017;54:567-573.62274 - Pludowski P, Karczmarewicz E, Bayer M, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol 2013;64:319-327.66568 - Gruskin AB, Sarnaik A. Hyponatremia: pathophysiology and treatment, a pediatric perspective. Pediatr Nephrol 1992;6:280-286.66587 - Uhlig K, Berns JS, Kestenbaum B, et al. KDOQI US Commentary on the 2009 KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of CKD–Mineral and Bone Disorder (CKD-MBD). Am J Kidney Dis 2010;55:773-799.66589 - Melamed ML, Chonchol M, Gutierrez OM, et al. The role of vitamin D in CKD Stages 3 to 4: Report of a Scientific Workshop sponsored by the National Kidney Foundation. Am J Kidney Dis 2018;72:834-845.66590 - Jean G, Souberbielle JC, Chazot C. Vitamin D in chronic kidney disease and dialysis patients. Nutrients 2017;9:328;doi: 10.3390/nu9040328.66596 - Tangpricha V, Kelly A, Stephenson A, et al. An update on the screening, diagnosis, management, and treatment of vitamin d deficiency in individuals with cystic fibrosis: Evidence-based recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab 2012;97:1082-1093.66854 - Replesta (cholecalciferol) chewable wafers package insert. St. Louis, MO: Everidis Health Sciences. Available on the world wide web at: https://www.replesta.com/ReplestaProductDirections.aspx; Accessed Aug 4, 2021.66855 - Children's Replesta (cholecalciferol) chewable wafers package insert. St. Louis, MO: Everidis Health Sciences. Available on the world wide web at: https://www.replesta.com/ReplestaChildrensDirections.aspx; Accessed Aug 4, 2021.67144 - Cosman F, de Beur SJ, LeBoff MS, et al.; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014;25:2359-2381.68414 - Carbonare LD, Valenti MT, del Forno F, et al. Vitamin D: Daily vs. Monthly Use in Children and Elderly—What Is Going On? Nutrients 2017;9:652.69099 - Thalassaemia Internation Federation. 2021 guidelines for the management of transfusion dependent thalassaemia (TDT). Accessed June 19, 2023. Available on the World Wide Web at . Accessed November 29, 2021. Available on the World Wide Web at https://www.thalassemia.org/wp-content/uploads/2021/06/TIF-2021-Guidelines-for-Mgmt-of-TDT.pdf69357 - Royal Osteoporosis Society: Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management. Published 2018. Last reviewed February 2020. Accessed August 25, 2023. Available on the World Wide Web at https://strwebprdmedia.blob.core.windows.net/media/ef2ideu2/ros-vitamin-d-and-bone-health-in-adults-february-2020.pdf.69358 - Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update. Endocr Pract 2019;25:1346-1359.

How Supplied

Vitamin D (Cholecalciferol) Chewable tablet

GNP Vitamin D3 400units Chewable Tablet (null) (AmerisourceBergen Corporation) null

Vitamin D (Cholecalciferol) Chewable tablet

Today's Health Vitamin D3 400units Chewable Tablet (null) (Today's Health, Inc.) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D 400units Chewable Tablet (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3 400units Chewable Tablet (Vanilla) (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3-400units Chewable Tablet (Orange) (null) (21st Century HealthCare, Inc.) null

Vitamin D (Cholecalciferol) Chewable tablet

Fiber with D3 Adult Gummies Soft Chew (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Chewable tablet

CVS Vitamin D3 1000units Chewable Tablet (Creamy Vanilla) (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Chewable tablet

Premier Value Vitamin D 1000units Chewable Tablet (Vanilla) (68016-0446) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D 1000units Chewable Tablet (Peach Vanilla) (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3 1000units Chewable Tablet (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Chewable tablet

Walgreens Vitamin D3 2000units Gummies Soft Chew (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3 2000units Chewable Tablet (null) (Natures Way Brands) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3 2000units Chewable Tablet (Vanilla) (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Chewable tablet

D5000 Fast Meltz Chewable Tablet (Fruity) (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Chewable tablet

Vitamin D3 125mcg (5000units) Chewable Tablet(Chocolate) (null) (Integrative Therapeutics, LLC) null

Vitamin D (Cholecalciferol) Chewable tablet

Replesta Children's Chewable Wafer (null) (Everidis Health Sciences) null

Vitamin D (Cholecalciferol) Chewable tablet

Replesta Chewable Wafer (null) (Everidis Health Sciences) nullReplesta Chewable Wafer package photo

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 1,000units (25mcg) Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

D3-5 5000units Capsule (53191-0244) (Bio-Tech Pharmacal, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule

Dialyvite Vitamin D 5000unit (125mcg) Capsule (null) (Hillestad Pharmaceuticals Inc USA) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D 125mcg Capsule (null) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 125mcg (5,000IU) Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 5000IU Capsule (00904-5986) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 5000IU Capsule (00904-5986) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 5000units (125mcg) Capsule (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Vitamin D (Cholecalciferol) Oral capsule

MAXIMUM D3 10000units Capsule (66594-0999) (Pro Pharma LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Optimal D3M 14,000IU Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Optimal D3M Pack 14,000IU Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

D3-50 50,000units Capsule (53191-0362) (Bio-Tech Pharmacal, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule

Optimal D3 50,000units Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Optimal D3 Pack 50,000IU Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 1250mcg (50,000IU) Capsule (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 50,000unit Capsule (75834-0020) (Nivagen Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 50,000units (1,250mcg) Capsule (null) (RV Nutritional LLC) null

Vitamin D (Cholecalciferol) Oral capsule

Vitamin D3 50000unit (1250mcg) Capsule (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) nullVitamin D3 50000unit (1250mcg) Capsule package photo

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 10mcg (400units) Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 400units Softgel (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Premier Value Vitamin D3 400units Softgel (68016-0647) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Natural Vitamin D 400units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 1000units Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 25mcg (1,000units) Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

D3 25mcg (1000units) Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

GNP Vitamin D3 25mcg (1,000units) Softgel (null) (AmerisourceBergen Corporation) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Happy Sunshine Vitamin D3 25mcg (1000IU) Softgel (null) (Basic Organics) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Leader Rapid Release Vitamin D3 25mcg (1,000units) Softgel (null) (Cardinal Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Leader Vitamin D3 25mcg Softgel (null) (Cardinal Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Nutressa Vitamin D3 1000unit Softgel (null) (WynnPharm Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Premier Value Vitamin D3 1000units Softgel (68016-0619) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Radiance Platinum Vitamin D3 1000units Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Spring Valley Vitamin D3 25mcg (1,000units) Softgel (null) (Wal-Mart Stores, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Today's Health Vitamin D 1000unit Softgel (null) (Today's Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D 1000units Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 1000units Softgel (null) (National Vitamin Company Inc) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 1000units Softgel (null) (National Vitamin Company Inc) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 1000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 1000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 25mcg (1000IU) Softgel (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 25mcg (1000IU) Softgel (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 25mcg (1000units) Softgel (null) (Mason Vitamins) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 25mcg (1000units) Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 25mcg (1000units) Softgel (null) (Piping Rock Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3-1000units High Potency Softgel (null) (21st Century HealthCare, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3-1000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Natural Vitamin D 1000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Nutrition Vitamin D3 25mcg (1000IU) Softgel (11917-0220) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Nutrition Vitamin D3 25mcg Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 25mcg (1,000IU) Softgel (11917-0136) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 25mcg (1,000IU) Softgel (null) (Walgreens Co) nullWalgreens Vitamin D3 25mcg (1,000IU) Softgel package photo

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 Bone Health 1000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Satin Collection Vitamin D3 2000units Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D 2000IU Softgel (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D 2000IU Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 2000units Softgel (null) (CVS Health) (off market)CVS Vitamin D3 2000units Softgel package photo

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 50mcg (2000units) Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Leader Vitamin D3 50mcg Softgel (null) (Cardinal Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Leader Vitamin D3 50mcg Softgel (null) (Cardinal Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Premier Value Vitamin D3 2000units Softgel (68016-0597) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Radiance Vitamin D3 2000units Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Sunmark Vitamin D3 2000units Softgel (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Sunmark Vitamin D3 50mcg (2000units) Softgel (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Today's Health Vitamin D 2000unit Softgel (null) (Today's Health, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D 2000unit Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D 2000units Softgel (00536-3790) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Capsule (43063-0705) (PD-Rx Pharmaceuticals, Inc.) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Easy-To-Swallow Super Strength Softgel (50268-0867) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Easy-To-Swallow Super Strength Softgel (54629-0909) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (57896-0890) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (69618-0009) (Reliable 1 Laboratories LLC ) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Softgel (null) (Xymogen, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 2000units Super Potency Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 50mcg (2,000 IU) Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 50mcg (2,000units) Softgel (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 50mcg (2,000units) Softgel (00536-1353) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3-2000units Super Strength Softgel (null) (21st Century HealthCare, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Nutrition Vitamin D3 50mcg (2,000units) Softgel (11917-0220) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 2000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 Bone Health 2000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 Bone Health 50mcg (2,000units) Softgel (11917-0198) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Sunmark Vitamin D3 4000units Softgel (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 5000units Softgel (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 5000units Softgel (null) (CVS Health) (off market)CVS Vitamin D3  5000units Softgel package photo

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 5000units Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS Vitamin D3 125mcg Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D3 5000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D-3 5000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

RITE AID Vitamin D-3 5000units Softgel (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Spring Valley Vitamin D3 5000units (125mcg) Extra Strength Softgel (null) (Wal-Mart Stores, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Spring Valley Vitamin D3 5000units Maximum Strength Softgel (null) (Wal-Mart Stores, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Sunmark Vitamin D3 Maximum Strength 125mcg (5000units) Softgel (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Super Happy SUNSHINE Vitamin D3 125mcg (5000IU) Softgel (null) (Basic Brands Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D Advanced 5000units Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 125mcg (5,000 IU) Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 125mcg (5000units) Softgel (69618-0042) (Reliable 1 Laboratories LLC ) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 5000units Easy-To-Swallow Ultra Strength Softgel (50268-0868) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 5000units Easy-To-Swallow Ultra Strength Softgel (54629-0909) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 5000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 5000units Softgel (null) (Xymogen, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3-5000units Maximum Strength Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3-5000units Maximum Strength Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Nutrition Vitamin D3 5000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 125mcg (5,000IU) Softgel (11917-0021) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Vitamin D3 Bone Health 5000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS D3 10,000units Softgel (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

CVS D3 250mcg (10,000units) Softgel (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D 10,000units Softgel (null) (Mason Vitamins) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Vitamin D3 250mcg (10,000IU) Softgel (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

Walgreens Finest Nutrition Vitamin D3 10,000units Softgel (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral capsule, liquid filled

DECARA 25,000units Vegicap (67112-0901) (Medecor Pharma LLC) null

Vitamin D (Cholecalciferol) Oral disintegrating tablet

CVS Vitamin D3 1000units Instant Dissolving Tablet (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral disintegrating tablet

Natrol Vitamin D3 Bone & Joint Heath 2000IU Fast Dissolve Tablet (Strawberry) (null) (Natrol LLC., a Vytalogy Wellness Company) null

Vitamin D (Cholecalciferol) Oral disintegrating tablet

Natrol Vitamin D3 Bone & Joint Heath 5000IU Fast Dissolve Tablet (Strawberry) (null) (Natrol LLC., a Vytalogy Wellness Company) null

Vitamin D (Cholecalciferol) Oral disintegrating tablet

Walgreens Finest Nutrition D3 Quick Dissolve Tablet (Strawberry) (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral drops, solution

CVS Infants' Vitamin D3 400IU/0.028mL Liquid Drops (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

D-Vita 400IU/mL Drops (00904-6273) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Enfamil D-Vi-Sol Vitamin D 400IU/mL Drops (00087-0866) (Mead Johnson Nutrition) null

Vitamin D (Cholecalciferol) Oral drops, solution

Infant and Toddler Vitamin D 400IU/mL Drops (Cherry) (00536-1343) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null

Vitamin D (Cholecalciferol) Oral drops, solution

Infants Aqueous Vitamin D 400IU/mL Drops (54838-0006) (Silarx Pharmaceuticals Inc) nullInfants Aqueous Vitamin D 400IU/mL Drops package photo

Vitamin D (Cholecalciferol) Oral drops, solution

Leader Infant Vitamin D 400IU/mL Drops (Cherry) (null) (Cardinal Health, Inc.) null

Vitamin D (Cholecalciferol) Oral drops, solution

Pedia D-Vite 400IU/mL Drops (76518-0050) (Bayshore Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral drops, solution

Pediatric D-Vite 400IU/mL Drops (71399-7401) (Akron Pharma Inc.) null

Vitamin D (Cholecalciferol) Oral drops, solution

UpSpring Baby Vitamin D 400IU/0.2mL D3 Drops (null) (UpSpring, Ltd.) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

UpSpring Baby Vitamin D3 10mcg (400IU)/0.025mL Liquid Drops (null) (UpSpring, LLC) null

Vitamin D (Cholecalciferol) Oral drops, solution

UpSpring Baby Vitamin D3 400IU/0.025mL Drops (null) (UpSpring, Ltd.) null

Vitamin D (Cholecalciferol) Oral drops, solution

UpSpring Baby Vitamin D3 400IU/0.2mL Drops (null) (UpSpring, Ltd.) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D Infant 400IU/mL Liquid Drops (69618-0019) (Reliable 1 Laboratories LLC ) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D Supplement 400IU/mL Drops (50383-0917) (Hi-Tech Pharmacal, a subsidiary of Akorn) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 400IU/mL Drops (54629-0772) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 400IU/mL Liquid Drops (00536-8400) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 400IU/mL Liquid Drops (00536-8400) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 400IU/mL Liquid Drops (00536-1156) (Rugby Laboratories a Division of The Harvard Drug Group, LLC ) (off market)

Vitamin D (Cholecalciferol) Oral drops, solution

Walgreens Baby Vitamin D3 400IU/0.028mL Liquid Drops (null) (Walgreens Co) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 1000IU(25mcg)/0.0394mL Liquid Drops (null) (Xymogen, Inc.) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 125mcg (5000IU)/mL Ultra Strength Drops (Lemon) (54629-0772) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 Maximum Strength 5000IU/mL Drops (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral drops, solution

Vitamin D3 Ultra Strength 5000IU/mL Drops (Lemon) (54629-0772) (National Vitamin Company Inc) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Equaline Vitamin D 400units Tablet (null) (Albertson's, Inc) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Premier Value Vitamin D 400units Tablet (68016-0313) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Sunmark Vitamin D 400units Tablet (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 400units Tablet (57896-0874) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 400units Tablet (null) (Leiner Health Products, a subsidiary of Nature's Bounty) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 400units Tablet (00904-5823) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 10mcg (400IU) Tablet (00761-0058) (Basic Drugs Inc,) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 10mcg (400IU) Tablet (null) (Basic Drugs Inc,) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 10mcg (400IU) Tablet (77333-0948) (GenDose Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 10mcg Tablet (68094-0114) (Precision Dose, Inc.) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 400units Tablet (50268-0863) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 400units Tablet (54629-0011) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D-400 Tablet (null) (Windmill Health Products, LLC) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D-400units Tablet (null) (Natures Bounty, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Oral tablet

Natural Vitamin D-3 1000units Tablet (null) (Basic Drugs Inc,) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Premier Value Vitamin D 1000unit Tablet (68016-0371) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral tablet

Premier Value Vitamin D 1000units Tablet (68016-0328) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral tablet

RITE AID Vitamin D-3 1000units Tablet (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral tablet

RITE AID Vitamin D-3 1000units Tablet (null) (Rite Aid Corp) null

Vitamin D (Cholecalciferol) Oral tablet

Sunmark Vitamin D 1000units Tablet (49348-0874) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral tablet

Sunmark Vitamin D3 1000units Tablet (null) (McKesson Corporation) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1000units Tablet (57896-0876) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1000units Tablet (00904-5824) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1000units Tablet (00904-5824) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1000units Tablet (00904-5824) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1000units Tablet (00536-3334) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 1000 IU Tablet (57896-0876) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 1000units Tablet (null) (Freeda Vitamins, Inc.) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 1000units Tablet (54629-0050) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 1000units Tablet (54629-0502) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 25mcg (1000IU) Tablet (null) (Basic Drugs Inc,) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 25mcg (1000IU) Tablet (10135-0749) (Marlex Pharmaceuticals) nullVitamin D3 25mcg (1000IU) Tablet package photo

Vitamin D (Cholecalciferol) Oral tablet

Premier Value Vitamin D 2000units Tablet (68016-0329) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral tablet

THERA-D 2000 Tablet (null) (Theralogix, LLC) null

Vitamin D (Cholecalciferol) Oral tablet

THERA-D Rapid Repletion Tablet (null) (Theralogix, LLC) null

Vitamin D (Cholecalciferol) Oral tablet

THERA-D SPORT 2000units Tablet (null) (Theralogix, LLC) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 2000units Tablet (00904-6157) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 2000units Super Strength Tablet (50268-0865) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 2000units Tablet (54629-0411) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 50mcg (2000IU) Tablet (null) (Basic Drugs Inc,) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 50mcg (2000IU) Tablet (10135-0750) (Marlex Pharmaceuticals) nullVitamin D3 50mcg (2000IU) Tablet package photo

Vitamin D (Cholecalciferol) Oral tablet

Thera-D 4000 Tablet (null) (Theralogix, LLC) null

Vitamin D (Cholecalciferol) Oral tablet

Premier Value Vitamin D 5000units Tablet (68016-0335) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) null

Vitamin D (Cholecalciferol) Oral tablet

Radiance Platinum Vitamin D3 5000units Tablet (null) (CVS Health) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 5000units Tablet (00761-0178) (Basic Vitamins) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 5000units Ultra Strength Tablet (50268-0866) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 5000units Ultra Strength Tablet (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Oral tablet

Dialyvite Vitamin D3 Max 1,250mcg (50,000units) Tablet (10542-1000) (Hillestad Pharmaceuticals Inc USA) nullDialyvite Vitamin D3 Max 1,250mcg (50,000units)  Tablet package photo

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D 1,250mcg (50,000units) High Potency Tablet (57896-0815) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Oral tablet

Vitamin D3 50,000units Ultra Potency Caplet (57896-0815) (Geri-Care Pharmaceuticals) null

Vitamin D (Cholecalciferol) Soft chew

CVS Vitamin D3 800units Gummies Soft Chew (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Soft chew

Fiber with Vitamin D3 Gummies Gluten-Free 5g Soft Chew (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) null

Vitamin D (Cholecalciferol) Soft chew

CVS Children's Vitamin D Gummies Soft Chew (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Soft chew

CVS Vitamin D3 1000units Soft Chew (Chocolate) (null) (CVS Health) (off market)CVS Vitamin D3 1000units Soft Chew (Chocolate) package photo

Vitamin D (Cholecalciferol) Soft chew

CVS Vitamin D3 2000units Gummies (null) (CVS Health) (off market)

Vitamin D (Cholecalciferol) Soft chew

CVS Vitamin D3 2000units Gummies (null) (CVS Health) null

Vitamin D (Cholecalciferol) Soft chew

CVS Vitamin D3 50mcg Gummies (Orange, Strawberry & Lemon) (null) (CVS Health) null

Vitamin D (Cholecalciferol) Soft chew

GNP Vitamin D3 2000units Gummies (null) (AmerisourceBergen Corporation) null

Vitamin D (Cholecalciferol) Soft chew

Leader Vitamin D3 50mcg Gummies (Peach & Berry) (null) (Cardinal Health, Inc.) nullLeader Vitamin D3 50mcg Gummies (Peach & Berry) package photo

Vitamin D (Cholecalciferol) Soft chew

Vitamin D3 2000units Gummies Soft Chew (Peach Mango Strawberry) (null) (National Vitamin Company Inc) null

Vitamin D (Cholecalciferol) Soft chew

Vitamin D3 2000units Gummies Soft Chew (Strawberry Orange Lemon) (null) (Rexall Sundown, Inc.) null

Vitamin D (Cholecalciferol) Soft chew

YumVs Kids ZERO Vitamin D3 25mcg (1000units) Gummies (Berry) (null) (Teelahvit, LLC) null

Vitamin D (Cholecalciferol) Soft chew

YumVs Vitamin D3 50mcg (2000units) Gummies (Berry) (null) (Teelahvit, LLC) null

Vitamin D (Cholecalciferol) Soft chew

YumVs Vitamin D3 50mcg (2000units) Gummies (Berry) (null) (Teelahvit, LLC) null

Vitamin D (Cholecalciferol) Soft chew

YumVs ZERO Vitamin D3 50mcg (2000units) Gummies (Strawberry) (null) (Teelahvit, LLC) null

Vitamin D (Cholecalciferol) Soft chew

YumVs ZERO Vitamin D3 125mcg (5000units) Gummies (Strawberry) (null) (Teelahvit, LLC) null

Vitamin D (Cholecalciferol), Vitamin E (Alpha Tocopherol) Oral capsule, liquid filled

Vitamin D3 10,000units Softgel (63044-0401) (Nnodum Pharmaceuticals) null

Vitamin D (Ergocalciferol) Oral capsule

PureMark Naturals Vitamin D 2000IU Vegetarian Capsule (null) (21st Century HealthCare, Inc.) nullPureMark Naturals Vitamin D 2000IU Vegetarian Capsule package photo

Vitamin D (Ergocalciferol) Oral capsule

Deltalin 50000unit Capsule (00002-0000) (Eli Lilly and Co) (off market)

Vitamin D (Ergocalciferol) Oral capsule

Ergocalciferol 50000unit Capsule (00677-0765) (Sun Pharmaceutical Industries, Inc.) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Drisdol 1.25mg Capsule (00280-0392) (Bayer Corp Consumer Care Div) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Drisdol 1.25mg Capsule (00024-0393) (Sanofi U.S. LLC) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Drisdol 1.25mg Capsule (00024-0392) (Sanofi U.S. LLC) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Drisdol 1.25mg Capsule (30698-0493) (Validus Pharmaceuticals LLC) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergo D 50000unit Softgel (61298-0020) (Optimum Pharmaceuticals Inc) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (42291-0266) (AvKARE, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (50268-0297) (AvPAK; a Division of AvKARE Inc) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (00574-0194) (Paddock Laboratories Inc, a Perrigo Family) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (72789-0249) (PD-Rx Pharmaceuticals, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (64380-0737) (Strides Pharma., Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (50111-0990) (Teva Pharmaceuticals USA) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (00955-0250) (Winthrop U.S., a business of Sanofi-Aventis) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Ergocalciferol 1.25mg Capsule (00955-0251) (Winthrop U.S., a business of Sanofi-Aventis) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (62332-0464) (Alembic Pharmaceuticals, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (68084-0463) (American Health Packaging) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (60687-0500) (American Health Packaging) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (42291-0274) (AvKARE, Inc.) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (69387-0106) (Banner Life Sciences) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (69452-0151) (Bionpharma Inc) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (10544-0527) (Blenheim Pharmacal, Inc.) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (51991-0604) (Breckenridge Inc) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (62135-0439) (Chartwell RX LLC) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (42806-0547) (Epic Pharma LLC) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (51407-0143) (Golden State Medical Supply, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (60429-0245) (Golden State Medical Supply, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (00574-0194) (Paddock Laboratories Inc, a Perrigo Family) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (43063-0391) (PD-Rx Pharmaceuticals, Inc.) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (43063-0711) (PD-Rx Pharmaceuticals, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (43063-0290) (PD-Rx Pharmaceuticals, Inc.) (off market)

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (64980-0157) (Rising Pharmaceuticals Inc) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg Capsule (57664-0136) (Sun Pharmaceutical Industries, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D 1.25mg (50,000units) Capsule (23155-0809) (Avet Pharmaceuticals Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D2 50,000units (1250 mcg) Capsule (71335-0062) (Bryant Ranch Prepack, Inc.) null

Vitamin D (Ergocalciferol) Oral capsule, liquid filled

Vitamin D2 50,000units (1250mcg) Capsule (71335-0278) (Bryant Ranch Prepack, Inc.) null

Vitamin D (Ergocalciferol) Oral drops, solution

Drisdol 8000IU/mL Drops (00024-0391) (Sanofi U.S. LLC) (off market)

Vitamin D (Ergocalciferol) Oral drops, solution

Calcidol 8000IU/mL Drops (39328-0357) (Patrin Pharma Inc) (off market)

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol 200mcg (8000IU)/mL Drops (47781-0647) (Alvogen, Inc.) null

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol 200mcg (8000IU)/mL Drops (43199-0015) (County Line Pharmaceuticals a Div of Alvogen Group) (off market)

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol 200mcg (8000IU)/mL Drops (69367-0283) (Westminster Pharmaceuticals, LLC) null

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol Vitamin D Supplement 8000IU (0.2mg)/mL Drops (75834-0010) (Nivagen Pharmaceuticals) null

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol Vitamin D Supplement 8000IU (0.2mg)/mL Drops (69543-0234) (Virtus Pharmaceuticals) (off market)

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol Vitamin D Supplement 8000IU/mL (0.2mg)/mL Drops (76439-0234) (Virtus Pharmaceuticals) (off market)

Vitamin D (Ergocalciferol) Oral drops, solution

Ergocalciferol Vitamin D Supplement 8000IU/mL Drops (13811-0655) (Trigen Laboratories, Inc.) null

Vitamin D (Ergocalciferol) Oral drops, solution

Calcidol 200mcg (8000IU)/mL Drops (39328-0357) (Patrin Pharma Inc) null

Vitamin D (Ergocalciferol) Oral drops, solution

Vitamin D Supplement 8000IU/mL Drops (00091-4150) (UCB Pharma Inc) null

Description/Classification

Description

Vitamin D is a fat-soluble vitamin and has two primary forms: cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). The chemical structure differences between the two forms of vitamin D do not affect the metabolism or clinical responses once activated within the body. Although animal experiments have indicated a difference in toxicity between vitamin D3 and vitamin D2, human studies have been inconclusive. Vitamin D is available in dietary supplements as ergocalciferol or cholecalciferol and is also found in fortified milk and cereal products; liver, fish liver oils, fatty fish, and egg yolks from hens have also been supplemented with vitamin D. Vitamin D must undergo hydroxylation in the liver and kidney to its active form. Vitamin D is responsible for appropriate calcium and phosphate balance and is required for normal bone growth and mineralization. Vitamin D status is determined by monitoring 25-hydroxyvitamin D [25(OH)D] serum concentrations, which represent all sources of vitamin D (e.g., sunlight and dietary or from supplements). Although labeled for use in several disease states, the primary use is for vitamin D supplementation and the prevention and treatment of vitamin D deficiency and rickets.[52900]

Classifications

  • Vitamins, Minerals, and Dietary or Nutritional Supplements
    • Vitamin and Mineral Supplements
      • Vitamin D Supplements (new)
        • Cholecalciferol Supplements
        • Ergocalciferol Supplements
Revision Date: 07/23/2021, 11:18:57 AM

References

52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Administration Information

General Administration Information

For storage information, see the specific product information within the How Supplied section.

Route-Specific Administration

Oral Administration

  • While vitamin D may be taken without regard to food, it is better absorbed when taken with foods containing fat.[52900]

Oral Liquid Formulations

  • Some formulations of vitamin D oral solution/drops contain propylene glycol. When selecting oral liquid preparations for neonates, infants, and young children, ensure the correct formulation of vitamin D is chosen to avoid propylene glycol toxicity.[36919]
  • Administer using a calibrated measuring device to ensure dosage accuracy. Due to the risk of inadvertently administering an incorrect dose to infants, the FDA recommends using a product with a dropper that will measure no more than 10 mcg (400 International Units) per dose.[40946]
  • Administer directly into the mouth or mix with breast milk, formula, fruit juice, cereal, or other foods. If mixed, make sure the patient drinks or eats the entire portion to ensure they receive the total amount of the medication.
  • Storage: After opening, store away from direct light.

Clinical Pharmaceutics Information

From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database
Revision Date: 07/22/2021, 10:03:09 AMCopyright 2004-2023 by Lawrence A. Trissel. All Rights Reserved.

References

36919 - Misra M, Pacaud D, Collett-Solberg PF, et al. Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics 2008;122:398-417.40946 - Food and Drug Administration (US FDA) MedWatch. Vitamin D Supplement Products: Medication Use Error. Retrieved June 15, 2010. Available on the world wide web at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm215523.htm52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Adverse Reactions

Mild

  • anorexia
  • fatigue
  • headache
  • increased urinary frequency
  • irritability
  • nausea
  • polydipsia
  • polyuria
  • vomiting
  • weight loss

Moderate

  • constipation
  • growth inhibition
  • hypercalcemia
  • hypercalciuria

Severe

  • hypervitaminosis D

In general, the use of supplemental vitamin D according to recommended dietary intakes is not associated with serious adverse reactions. Vitamin D may cause side effects in overdose, but such symptoms associated with hypervitaminosis D (and resultant hypercalcemia) are rarely reported. An excess of vitamin D causes abnormally high levels of calcium in the blood and is almost always caused by vitamin D analogs (e.g., calcitriol, doxercalciferol, paricalcitol), rather than vitamin D found in dietary supplements (e.g., cholecalciferol, ergocalciferol). However, patients taking higher doses of vitamin D supplements should report any of the following potential signs of high vitamin D/calcium concentrations: nausea/vomiting, constipation, loss of appetite, increased thirst (polydipsia), increased urinary frequency, mental/mood changes or irritability, headache, unusual fatigue or tiredness. These symptoms may require clinical evaluation. Anorexia, weight loss, polyuria, and arrhythmias may also be observed. In addition, hypercalcemia due to bone resorption leading to hypercalciuria may be observed in prolonged hypervitaminosis D. In early stages of vitamin D toxicity, hypercalcemia is mild and renal function remains normal. As vitamin D toxicity continues, continued bone resorption and increased calcium levels lead to suppression of parathyroid production. Calcification of the vasculature and other tissues has been associated with prolonged vitamin D toxicity. Data do not support that vitamin D toxicity is associated with kidney stones. Death due to vitamin D intoxication is likely due to renal and cardiovascular failure. Long-term doses of vitamin D of 250 to 1,000 mcg/day (10,000 to 40,000 International Units/day) and long-term serum 25(OH)D concentrations of 500 to 600 nmol/L (200 to 400 ng/mL) are associated with vitamin D toxicity. Symptoms of vitamin D toxicity can become apparent within 4 weeks of continual excessive ingestion. Due to the long half-life of vitamin D, symptoms of toxicity may be prolonged. Excessive sun exposure does not result in vitamin D toxicity.[52900] [30166]

Risk of growth inhibition in infants due to vitamin D supplements is based on a 1938 report of 35 infants up to 45 weeks of age where high-dose vitamin D supplementation (45 to 112.5 mcg/day [1,800 to 4,500 International Units/day] for 6 months) was associated with growth inhibition in comparison with lower dose vitamin D supplements (less than 8.5 mcg/day [340 International Units/day] for 6 months). In a subsequent but smaller study (n = 11) performed in 1966, no association between vitamin D supplements and growth inhibition was found. However, due to a possible association, no RDI for vitamin D has been set for infants.[52900] A large observational study from Finland in 2011 reported no association between growth inhibition later in life (as evaluated at 14 and 31 years of age) and the administration of vitamin D supplements (50 mcg/day [2,000 International Units/day]) during infancy.[52948]

Revision Date: 04/05/2022, 01:15:15 PM

References

30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.52948 - Hypponen E, Fararouei M, Sovio U, et al. High-dose vitamin D supplements are not associated with linear growth in a large Finnish cohort. J Nutr 2011;141:843-848.

Contraindications/Precautions

Absolute contraindications are italicized.

  • hypercalcemia
  • hypervitaminosis D
  • malabsorption syndrome
  • biliary tract disease
  • breast-feeding
  • children
  • Crohn's disease
  • cystic fibrosis
  • fat malabsorption
  • gallbladder disease
  • hepatic disease
  • infants
  • neonates
  • pregnancy
  • premature neonates
  • renal disease
  • renal failure
  • tartrazine dye hypersensitivity
 

Vitamin D is contraindicated in patients with hypercalcemia, hypervitaminosis D, and vitamin D hypersensitivity or hypersensitivity to any of the excipients in the formulation. Certain vitamin D formulations contain FD&C yellow dye No. 5 (tartrazine); these formulations should not be used in patients with tartrazine dye hypersensitivity. Hypersensitivity to vitamin D is one etiologic factor in infants with idiopathic hypercalcemia; in these patients, vitamin D intake must be seriously restricted.[30166] Some formulations of the oral solution contain propylene glycol. The clinician should be aware of the toxic potential for young children (e.g., neonates and premature neonates, infants, and children younger than 4 years) and ensure the correct formulation of vitamin D is chosen. Excessive propylene glycol can cause lactic acidosis, hyperosmolality, tachypnea, tachycardia, diaphoresis, and central nervous system toxicity (e.g., seizures, intraventricular hemorrhage).[36919]

Patients with renal disease, especially renal failure, may be at increased risk for vitamin D-induced hypercalcemia even with usual dosages. Close clinical monitoring is needed to ensure adequate supplementation and, in pediatric patients, proper growth. In patients with stage 3 or higher kidney disease, use of a vitamin D analog appears preferred, following recommendations of the National Kidney Foundation.[38437] [52900]

Vitamin D is contraindicated in patients with malabsorption syndrome.[30166] Patients with fat malabsorption due to cystic fibrosis, Crohn's disease, some forms of hepatic disease, gallbladder disease or biliary tract disease may require higher doses of vitamin D due to decreases in intestinal absorption. Some patients taking concurrent medications (e.g., certain anticonvulsants) may require higher doses as well. The prescription of active vitamin D analogs may be preferred in such cases.[52900]

Adverse effects have not been reported with the normal daily intake of Vitamin D within the recommended dietary daily intakes for a pregnant female. Animal reproduction studies have shown fetal abnormalities in several species associated with hypervitaminosis D; therefore, the use of vitamin D in excess of the recommended dietary allowance during normal pregnancy should be avoided unless, in the judgment of the physician, potential benefits outweigh the hazards involved.[30166] The RDA of vitamin D during pregnancy is 15 mcg/day (600 International Units/day) with a Tolerable Upper Intake Limit of 100 mcg/day (4,000 International Units/day).[52900]

The 25-hydroxyvitamin D metabolite of vitamin D is distributed into human breast milk at concentrations relative to the maternal serum concentration. Typical breast milk concentrations (without maternal supplementation) are not sufficient to prevent vitamin D deficiency in infants that are exclusively breast-fed and do not receive other vitamin D supplementation. Prolonged, exclusive breast-feeding of infants without recommended vitamin D supplementation is a significant cause of rickets in infants, especially in dark-skinned infants breast-fed by mothers who are not vitamin D replete.[52900] Use of vitamin D within the recommended daily dietary intake for lactating women is generally recognized as safe.[31028] The recommended maternal daily allowance of vitamin D during breast-feeding is 600 International Units/day with a Tolerable Upper Intake Limit of 4000 International Units/day.[52900] While high-dose vitamin D supplementation to nursing mothers has been shown to increase the concentration of vitamin D in breast milk and favorably increase 25(OH)D levels in infants, the results have not been validated and supplementation to infants is still recommended.[36895] Generally, the serum calcium concentrations of the infant should be monitored when a nursing mother is prescribed vitamin D in high doses, since hypercalcemia has been reported with high dose maternal use.[30166]

Revision Date: 07/22/2021, 11:31:33 AM

References

30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.31028 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine (IOM). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. The National Academy of Sciences Press, Washington DC; 199736895 - Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and Vitamin D deficiency in Infants, Children, and Adolescents. Pediatrics 2008;112:1142-1152.36919 - Misra M, Pacaud D, Collett-Solberg PF, et al. Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics 2008;122:398-417.38437 - Kidney Disease Improving Global Outcomes. KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD_MBD). 2009. https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2009-CKD-MBD-Guideline-English.pdf.52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Mechanism of Action

Both forms of vitamin D are metabolized to the active form, calcitriol (1,25-dihydroxyvitamin D); all vitamin D activity is due to this metabolite. Calcitriol promotes renal reabsorption of calcium, increases intestinal absorption of calcium and phosphorus, and increases calcium mobilization from bone to plasma. Calcitriol promotes intestinal absorption of calcium through binding to a specific receptor in the mucosal cytoplasm of the intestine. Subsequently, calcium is absorbed through formation of a calcium-binding protein. The synthesis of calcitriol is enhanced by elevated parathyroid hormone levels and low plasma phosphorus levels. Hypocalcemia causes release of parathyroid hormone, which stimulates the production of calcitriol.[52900]

The vitamin D receptor (VDR) is present in numerous tissues throughout the body; the exact action of calcitriol within these tissues is not completely understood. There is evidence that calcitriol plays a role in the immune system. Calcitriol has been shown to inhibit cancer growth and stimulate cell differentiation.[52900]

Revision Date: 07/15/2021, 03:09:51 PM

References

52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Pharmacokinetics

Vitamin D is administered orally. Maximal clinical effects of a given dosage are usually observed in 4 weeks. Dietary vitamin D is absorbed from the GI tract in the presence of bile salts and is initially bound to chylomicrons, then is slowly transferred to vitamin D binding protein (DBP) in the serum. The uptake by chylomicrons results in vitamin D update by adipose tissue and muscle; remaining vitamin D in circulation is then metabolized by the liver. The uptake by the liver and other tissues accounts results in a plasma half-life of 4 to 6 hours for supplemental vitamin D. However, studies have shown that the whole-body half-life is about 2 months due to the stores in these tissues.[52879]

 

Ergocalciferol and cholecalciferol are considered prohormones and are converted in the liver by a group of activating cytochrome P450 (CYP) enzymes, CYP2R1, CYO27A1, and CYP27B1, to 25-hydroxyvitamin D (25(OH)D, calcidiol), the predominant form of vitamin D in the blood. This metabolite has a half-life of about 15 days. Serum 25(OH)D concentrations increase in a non-linear fashion in response to increased vitamin D intake based on baseline concentrations and duration of supplementation. Increasing serum 25(OH)D levels to more than 50 nmol/L requires a greater amount of vitamin D than increasing baseline levels that are less than 50 nmol/L. The impact on serum 25(OH)D concentrations is less when doses are at least 25 mcg/day (1,000 International Units/day) compared to doses less than 25 mcg/day (1,000 International Units/day). For example, for vitamin D doses of at least 25 mcg/day (1,000 International Units/day), the increase in serum 25(OH)D concentrations is about 1 nmol/L for each 1 mcg (40 International Units) of vitamin D. Conversely, for vitamin D doses of 15 mcg (600 International Units) or less, the increase in 25(OH)D concentrations is about 2.3 nmol/L for each 1 mcg (40 International Units) of vitamin D.[52900] In the kidneys, 25-hydroxyvitamin D is further converted to its active, hormonal form, 1,25-dihydroxyvitamin D (1,25(OH)2D, calcitriol), which has a half-life of about 15 hours and accounts for only a small portion of the total body amount of vitamin D. Synthesis to this active form by renal CYP27B1 is tightly regulated by parathyroid hormone and serum phosphate levels.[52879] [52900] All metabolites of vitamin D are excreted through the bile into the feces; very little is excreted in the urine.

Route-Specific Pharmacokinetics

Oral Route

Vitamin D is well absorbed orally in most individuals without conditions associated with fat malabsorption. There is a time lag of 10 to 24 hours between the oral administration of vitamin D and the initiation of its action in the body due to the necessity of synthesis of the active metabolites in the liver and kidneys.[30166]

Special Populations

Hepatic Impairment

Vitamin D absorption can be decreased in patients with any hepatic disease associated with fat malabsorption.[62269]

Pediatrics

Of relevance to breastfed children, the 25-hydroxyvitamin D metabolite is distributed into maternal breast milk; however, the concentration in breast milk is dependent upon the maternal serum concentration. Typical breast milk concentrations of vitamin D without maternal vitamin D supplementation are less than 0.625 to 1.95 mcg/L (25 to 78 International Units/L); these levels of vitamin D will not be sufficient to prevent vitamin D deficiency in infants who are exclusively breastfed. Administration of high-dose vitamin D supplementation to nursing mothers has been shown to increase the concentration of vitamin D in breast milk and favorably increase 25(OH)D levels in infants; however, the results have not been validated and supplementation to infants is still recommended.[36895]

Obesity

Persons with body mass index (BMI) of 30 or more have lower 25(OH)D levels as compared to those with a lower BMI. In addition, people who are obese may require higher doses of vitamin D to achieve 25(OH)D levels comparable to non-obese people. The increased amounts of subcutaneous fat in these persons sequester more vitamin D and alter its release into the circulation. Also, obese patients who have undergone gastric bypass surgery will become vitamin D deficient over time without sufficient supplementation, since part of the small intestine where vitamin D is absorbed is bypassed and vitamin D mobilization from fat stores will not compensate over time.[52900]

Other

Biliary or GI Disease

Vitamin D absorption can be decreased in patients with any biliary or GI disease that results in fat malabsorption.[62269]

Revision Date: 07/23/2021, 11:20:55 AM

References

30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.36895 - Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and Vitamin D deficiency in Infants, Children, and Adolescents. Pediatrics 2008;112:1142-1152.52879 - Jones G. Pharmacokinetics of vitamin D toxicity. Am J Clin Nutr 2008;88(suppl):582S-6S.52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.62269 - Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of Vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-1930.

Pregnancy/Breast-feeding

pregnancy

Adverse effects have not been reported with the normal daily intake of Vitamin D within the recommended dietary daily intakes for a pregnant female. Animal reproduction studies have shown fetal abnormalities in several species associated with hypervitaminosis D; therefore, the use of vitamin D in excess of the recommended dietary allowance during normal pregnancy should be avoided unless, in the judgment of the physician, potential benefits outweigh the hazards involved.[30166] The RDA of vitamin D during pregnancy is 15 mcg/day (600 International Units/day) with a Tolerable Upper Intake Limit of 100 mcg/day (4,000 International Units/day).[52900]

breast-feeding

The 25-hydroxyvitamin D metabolite of vitamin D is distributed into human breast milk at concentrations relative to the maternal serum concentration. Typical breast milk concentrations (without maternal supplementation) are not sufficient to prevent vitamin D deficiency in infants that are exclusively breast-fed and do not receive other vitamin D supplementation. Prolonged, exclusive breast-feeding of infants without recommended vitamin D supplementation is a significant cause of rickets in infants, especially in dark-skinned infants breast-fed by mothers who are not vitamin D replete.[52900] Use of vitamin D within the recommended daily dietary intake for lactating women is generally recognized as safe.[31028] The recommended maternal daily allowance of vitamin D during breast-feeding is 600 International Units/day with a Tolerable Upper Intake Limit of 4000 International Units/day.[52900] While high-dose vitamin D supplementation to nursing mothers has been shown to increase the concentration of vitamin D in breast milk and favorably increase 25(OH)D levels in infants, the results have not been validated and supplementation to infants is still recommended.[36895] Generally, the serum calcium concentrations of the infant should be monitored when a nursing mother is prescribed vitamin D in high doses, since hypercalcemia has been reported with high dose maternal use.[30166]

Revision Date: 07/21/2021, 03:04:37 PM

References

30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.31028 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine (IOM). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. The National Academy of Sciences Press, Washington DC; 199736895 - Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and Vitamin D deficiency in Infants, Children, and Adolescents. Pediatrics 2008;112:1142-1152.52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

Interactions

Level 2 (Major)

  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Magnesium
  • Magnesium Citrate
  • Magnesium Hydroxide
  • Phosphorus
  • Tipranavir

Level 3 (Moderate)

  • Castor Oil
  • Cholestyramine
  • Colesevelam
  • Colestipol
  • Hydantoins
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Mineral Oil
  • Orlistat
  • Rifampin
  • Selumetinib
  • Thiazide diuretics
  • Warfarin
Aluminum Hydroxide; Magnesium Hydroxide: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Castor Oil: (Moderate) Absorption of fat-soluble vitamins may be decreased with coadministration of castor oil. [30408] [44272] Cholestyramine: (Moderate) Cholestyramine can decrease the intestinal absorption of fat and fat-soluble vitamins. If used concurrently, administration of the two agents should be staggered for the longest time interval possible. [28070] Colesevelam: (Moderate) It is not known if colesevelam can reduce the absorption of oral vitamin supplements including fat soluble vitamins A, D, E, and K. To minimize potential interactions, administer vitamins at least 4 hours before colesevelam. [7576] Colestipol: (Moderate) Separate administration of fat-soluble vitamins by 1 hour before or 4 hours after a colestipol dose to limit effects on oral absorption. Because it sequesters bile acids, colestipol may interfere with normal fat absorption and thus may reduce absorption of fat-soluble vitamins. [48282] Hydantoins: (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] (Moderate) Phenytoin and fosphenytoin can decrease the activity of vitamin D (e.g., cholecalciferol, ergocalciferol) by increasing its metabolism. In rare cases, this has caused anticonvulsant-induced rickets and osteomalacia. Vitamin D supplementation or dosage adjustments may be required in patients who are receiving chronic treatment with anticonvulsants. [30173] [30448] Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of ergocalciferol, Vitamin D2. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of ergocalciferol, Vitamin D2 may be required. [30314] Isoniazid, INH; Rifampin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of ergocalciferol, Vitamin D2. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of ergocalciferol, Vitamin D2 may be required. [30314] Magnesium Citrate: (Major) Avoid vitamin D coadministration with magnesium citrate in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Magnesium Hydroxide: (Major) Avoid vitamin D coadministration with magnesium hydroxide in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Magnesium: (Major) Avoid vitamin D coadministration with magnesium-containing products, such as antacids, in persons on chronic hemodialysis due to the risk for hypermagnesemia. [30153] [49493] Mineral Oil: (Moderate) Absorption of fat-soluble vitamins is reported to be decreased with prolonged oral administration of mineral oil. However, despite warnings in various texts, there is little direct evidence that the interaction is of practical/clinical importance with limited use as directed. It may be prudent for those taking dietary supplements of Vitamin A, D, E, or K to separate administration by 1 hour before or 4 hours after a mineral oil oral dosage to help limit absorption interactions. Theoretically, the effect on fat-soluble vitamin absorption may more likely occur with prolonged or chronic administration of mineral oil. [29362] [45899] Orlistat: (Moderate) Administer vitamin E at least 2 hours before or after the administration of orlistat to limit effects on oral absorption. Orlistat has been shown to inhibit the absorption of a vitamin E acetate supplement by 60%. [27971] (Moderate) Orlistat reduced the absorption of fat-soluble vitamins during clinical trials. The bioavailability of orally administered vitamin D may also be decreased. In patients receiving orally-administered vitamin D with orlistat, close monitoring is recommended. In addition, the manufacturer recommends that fat-soluble vitamins be administered at least 2 hours before or after the administration of orlistat to limit effects on oral absorption. [27971] Phosphorus: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. [27970] [30166] [60895] Rifampin: (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of cholecalciferol, Vitamin D3. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of cholecalciferol, Vitamin D3 may be required. [30314] (Moderate) Rifampin is a potent inducer of the cytochrome P450 hepatic enzyme system and can decrease the plasma concentrations and possibly the efficacy of ergocalciferol, Vitamin D2. In some cases, reduced concentrations of circulating vitamin D and 1,25-dihydoxy vitamin D have been accompanied by decreased serum calcium and phosphate, and elevated parathyroid hormone. Dosage adjustments of ergocalciferol, Vitamin D2 may be required. [30314] Selumetinib: (Moderate) Coadministration of selumetinib with supplemental vitamin E is not recommended if the total daily dose of vitamin E (amount in selumetinib plus the supplement) exceeds the recommended or safe daily limit; high dose vitamin E may increase the bleeding risk by antagonizing vitamin K dependent clotting factors and inhibiting platelet aggregation. Selumetinib contains 32 mg of vitamin E in the 10 mg capsules and 36 mg of vitamin E in the 25 mg capsules. [65246] Thiazide diuretics: (Moderate) Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with thiazide diuretics. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. Hypercalcemia may be exacerbated by coadministration of vitamin D or vitamin D analogs and thiazide diuretics. Thiazide diuretics are known to induce hypercalcemia by reducing the excretion of calcium in the urine. [27970] [30166] [34775] [60895] Tipranavir: (Major) Tipranavir should be used with caution in patients who may be at risk of increased bleeding, such as in patients taking high doses of vitamin E. In vitro, tipranavir was observed to inhibit human platelet aggregation at concentrations consistent with human exposure at regular doses. In rats, coadministration with vitamin E increased the bleeding effects of tipranavir. [8102] Warfarin: (Moderate) Vitamin E should be used cautiously in patients receiving warfarin. While the mechanism is unclear, it is believed that concomitant administration of large doses of vitamin E (e.g., more than 400 units per day) with warfarin potentiates hypoprothrombinemia due to the vitamin K antagonistic activity of vitamin E. [29137]
Revision Date: 09/29/2023, 01:50:00 AM

References

7576 - Welchol (colesevelam) package insert. Basking Ridge, NJ: Daiichi Sankyo 2021Oct.8102 - Aptivus (tipranavir) package insert. Ridgefield, CT: Boehringer Ingelheim; 2020 Jun.27970 - Calderol (calcifediol) package insert. W. Orange, NJ: Organon Inc.; 1988 Feb.27971 - Xenical (orlistat) package insert. Montgomery, AL: H2-Pharma, LLC; 2022 Nov.28070 - Questran and Questran Light (cholestyramine) powder for suspension package insert. Chestnut Ridge, NY: Par Pharmaceutical Inc; 2018 Jan.29137 - Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health-Syst Pharm 2000;57:1221-30.29362 - Robinson DS, Benjamin DM, McCormack JJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther 1971;12:491-5.30153 - Rocaltrol (calcitriol) capsules and solution package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 May.30166 - Drisdol (ergocalciferol) package insert. Parsippany, NJ: Validus Pharmaceuticals LLC; 2018 July.30173 - McNamara JO. Drugs effective in the therapy of the epilepsies. Gilman AG, Hardman JG, Limbird LE, (eds.) In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed., New York, McGraw-Hill Companies. 2001:530-2.30314 - Rifadin capsules and injection (rifampin) package insert. Bridgewater, NJ: Sanofi-Aventis, LLC; 2023 Feb.30408 - Curry CE. Laxative products. In: Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association 1996;225-244.30448 - Marcus R. Agents affecting calcification and bone turnover: Calcium phosphate, parathyroid hormone, vitamin D, calcitonin, and other compounds. Gilman AG, Hardman JG, Limbird LE, (eds.) In: Goodman and Gilman's The Pharmacological Basis of Therapeutics. 10th ed., New York, McGraw-Hill Companies. 2001:1715-43.34775 - Vectical ointment (calcitriol) package insert. Fort Worth, TX: Galderma Laboratories, L.P.; 2020 July.44272 - Castor oil product label. Deerfield, IL:Walgreens, Inc.; 2011 May.45899 - Mahadevan U, Kane S. American Gastroenterological Association Institute technical review on the use of gastrointestinal medications in pregnancy. Gastroenterology 2006;131:283-311.48282 - Colestid and Flavored Colestid (Colestipol hydrochloride) tablet package insert. NY, NY: Pfizer; 2014 May.49493 - Hectorol (doxercalciferol) injection package insert. Cambridge, MA: Genzyme Corporation; 2016 Jun.60895 - Calcifediol (Rayaldee) extended-release capsules package insert. Miami, FL: Opko Pharmaceuticals, LLC; 2019 Dec.65246 - Koselugo (selumetinib) capsules package insert. Wilmington, DE: AstraZeneca Pharmaceuticals, LP; 2021 Dec.

Monitoring Parameters

  • serum 25(OH)hydroxyvitamin D concentrations

US Drug Names

  • Calcidol
  • Calciferol
  • D3 Vitamin
  • DECARA
  • Deltalin
  • Dialyvite Vitamin D
  • Dialyvite Vitamin D3
  • Drisdol
  • D-Vita
  • Enfamil D-Vi-Sol
  • Ergo D
  • Fiber with Vitamin D3 Gummies Gluten-Free
  • Happy Sunshine Vitamin D3
  • MAXIMUM D3
  • PureMark Naturals Vitamin D
  • Replesta
  • Replesta Children's
  • Super Happy SUNSHINE Vitamin D3
  • Thera-D 2000
  • Thera-D 4000
  • Thera-D Rapid Repletion
  • THERA-D SPORT
  • UpSpring Baby Vitamin D
  • UpSpring Baby Vitamin D3
  • YumVs
  • YumVs Kids ZERO
  • YumVs ZERO
;