English
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
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.
for nutritional supplementation in healthy persons based on recommended reference dietary intakes
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 indicationReferences
How Supplied
Vitamin D (Cholecalciferol) Chewable tablet
GNP Vitamin D3 400units Chewable Tablet (null) (AmerisourceBergen Corporation) nullVitamin D (Cholecalciferol) Chewable tablet
Today's Health Vitamin D3 400units Chewable Tablet (null) (Today's Health, Inc.) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D 400units Chewable Tablet (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3 400units Chewable Tablet (Vanilla) (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3-400units Chewable Tablet (Orange) (null) (21st Century HealthCare, Inc.) nullVitamin D (Cholecalciferol) Chewable tablet
Fiber with D3 Adult Gummies Soft Chew (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin 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) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D 1000units Chewable Tablet (Peach Vanilla) (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3 1000units Chewable Tablet (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Chewable tablet
Walgreens Vitamin D3 2000units Gummies Soft Chew (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3 2000units Chewable Tablet (null) (Natures Way Brands) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3 2000units Chewable Tablet (Vanilla) (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Chewable tablet
D5000 Fast Meltz Chewable Tablet (Fruity) (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Chewable tablet
Vitamin D3 125mcg (5000units) Chewable Tablet(Chocolate) (null) (Integrative Therapeutics, LLC) nullVitamin D (Cholecalciferol) Chewable tablet
Replesta Children's Chewable Wafer (null) (Everidis Health Sciences) nullVitamin D (Cholecalciferol) Chewable tablet
Replesta Chewable Wafer (null) (Everidis Health Sciences) null
Vitamin D (Cholecalciferol) Oral capsule
Vitamin D3 1,000units (25mcg) Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
D3-5 5000units Capsule (53191-0244) (Bio-Tech Pharmacal, Inc.) nullVitamin D (Cholecalciferol) Oral capsule
Dialyvite Vitamin D 5000unit (125mcg) Capsule (null) (Hillestad Pharmaceuticals Inc USA) nullVitamin 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) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule
MAXIMUM D3 10000units Capsule (66594-0999) (Pro Pharma LLC) nullVitamin D (Cholecalciferol) Oral capsule
Optimal D3M 14,000IU Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
Optimal D3M Pack 14,000IU Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
D3-50 50,000units Capsule (53191-0362) (Bio-Tech Pharmacal, Inc.) nullVitamin D (Cholecalciferol) Oral capsule
Optimal D3 50,000units Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
Optimal D3 Pack 50,000IU Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
Vitamin D3 1250mcg (50,000IU) Capsule (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) nullVitamin D (Cholecalciferol) Oral capsule
Vitamin D3 50,000unit Capsule (75834-0020) (Nivagen Pharmaceuticals) nullVitamin D (Cholecalciferol) Oral capsule
Vitamin D3 50,000units (1,250mcg) Capsule (null) (RV Nutritional LLC) nullVitamin D (Cholecalciferol) Oral capsule
Vitamin D3 50000unit (1250mcg) Capsule (null) (Rugby Laboratories a Division of The Harvard Drug Group, LLC) null
Vitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 10mcg (400units) Softgel (null) (CVS Health) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Natural Vitamin D 400units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 1000units Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 25mcg (1,000units) Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
D3 25mcg (1000units) Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
GNP Vitamin D3 25mcg (1,000units) Softgel (null) (AmerisourceBergen Corporation) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Happy Sunshine Vitamin D3 25mcg (1000IU) Softgel (null) (Basic Organics) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Leader Rapid Release Vitamin D3 25mcg (1,000units) Softgel (null) (Cardinal Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Leader Vitamin D3 25mcg Softgel (null) (Cardinal Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Nutressa Vitamin D3 1000unit Softgel (null) (WynnPharm Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Premier Value Vitamin D3 1000units Softgel (68016-0619) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Radiance Platinum Vitamin D3 1000units Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Spring Valley Vitamin D3 25mcg (1,000units) Softgel (null) (Wal-Mart Stores, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Today's Health Vitamin D 1000unit Softgel (null) (Today's Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D 1000units Softgel (null) (Mason Vitamins) nullVitamin 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.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 1000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 25mcg (1000IU) Softgel (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 25mcg (1000IU) Softgel (null) (National Vitamin Company Inc) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 25mcg (1000units) Softgel (null) (Piping Rock Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3-1000units High Potency Softgel (null) (21st Century HealthCare, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3-1000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Natural Vitamin D 1000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Nutrition Vitamin D3 25mcg (1000IU) Softgel (11917-0220) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Nutrition Vitamin D3 25mcg Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 25mcg (1,000IU) Softgel (11917-0136) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 25mcg (1,000IU) Softgel (null) (Walgreens Co) null
Vitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 Bone Health 1000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Satin Collection Vitamin D3 2000units Softgel (null) (CVS Health) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 2000units Softgel (null) (CVS Health) (off market)
Vitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 50mcg (2000units) Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Leader Vitamin D3 50mcg Softgel (null) (Cardinal Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Leader Vitamin D3 50mcg Softgel (null) (Cardinal Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Premier Value Vitamin D3 2000units Softgel (68016-0597) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Radiance Vitamin D3 2000units Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D-3 2000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Sunmark Vitamin D3 2000units Softgel (null) (McKesson Corporation) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Sunmark Vitamin D3 50mcg (2000units) Softgel (null) (McKesson Corporation) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Today's Health Vitamin D 2000unit Softgel (null) (Today's Health, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D 2000unit Softgel (null) (Mason Vitamins) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Easy-To-Swallow Super Strength Softgel (54629-0909) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (57896-0890) (Geri-Care Pharmaceuticals) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (69618-0009) (Reliable 1 Laboratories LLC ) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Softgel (null) (Xymogen, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 2000units Super Potency Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 50mcg (2,000 IU) Softgel (null) (Mason Vitamins) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3-2000units Super Strength Softgel (null) (21st Century HealthCare, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Nutrition Vitamin D3 50mcg (2,000units) Softgel (11917-0220) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 2000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 Bone Health 2000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 Bone Health 50mcg (2,000units) Softgel (11917-0198) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Sunmark Vitamin D3 4000units Softgel (null) (McKesson Corporation) nullVitamin 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)
Vitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 5000units Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
CVS Vitamin D3 125mcg Softgel (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D3 5000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D-3 5000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
RITE AID Vitamin D-3 5000units Softgel (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Spring Valley Vitamin D3 5000units (125mcg) Extra Strength Softgel (null) (Wal-Mart Stores, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Spring Valley Vitamin D3 5000units Maximum Strength Softgel (null) (Wal-Mart Stores, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Sunmark Vitamin D3 Maximum Strength 125mcg (5000units) Softgel (null) (McKesson Corporation) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Super Happy SUNSHINE Vitamin D3 125mcg (5000IU) Softgel (null) (Basic Brands Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D Advanced 5000units Softgel (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 125mcg (5,000 IU) Softgel (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 125mcg (5000units) Softgel (69618-0042) (Reliable 1 Laboratories LLC ) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 5000units Easy-To-Swallow Ultra Strength Softgel (50268-0868) (AvPAK; a Division of AvKARE Inc) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 5000units Easy-To-Swallow Ultra Strength Softgel (54629-0909) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 5000units Softgel (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 5000units Softgel (null) (Xymogen, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3-5000units Maximum Strength Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3-5000units Maximum Strength Softgel (null) (Natures Bounty, a subsidiary of NBTY, Inc.) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Nutrition Vitamin D3 5000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 125mcg (5,000IU) Softgel (11917-0021) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Vitamin D3 Bone Health 5000units Softgel (null) (Walgreens Co) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D 10,000units Softgel (null) (Mason Vitamins) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Vitamin D3 250mcg (10,000IU) Softgel (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
Walgreens Finest Nutrition Vitamin D3 10,000units Softgel (null) (Walgreens Co) nullVitamin D (Cholecalciferol) Oral capsule, liquid filled
DECARA 25,000units Vegicap (67112-0901) (Medecor Pharma LLC) nullVitamin D (Cholecalciferol) Oral disintegrating tablet
CVS Vitamin D3 1000units Instant Dissolving Tablet (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral disintegrating tablet
Natrol Vitamin D3 Bone & Joint Heath 2000IU Fast Dissolve Tablet (Strawberry) (null) (Natrol LLC., a Vytalogy Wellness Company) nullVitamin D (Cholecalciferol) Oral disintegrating tablet
Natrol Vitamin D3 Bone & Joint Heath 5000IU Fast Dissolve Tablet (Strawberry) (null) (Natrol LLC., a Vytalogy Wellness Company) nullVitamin D (Cholecalciferol) Oral disintegrating tablet
Walgreens Finest Nutrition D3 Quick Dissolve Tablet (Strawberry) (null) (Walgreens Co) nullVitamin 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) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral drops, solution
Infants Aqueous Vitamin D 400IU/mL Drops (54838-0006) (Silarx Pharmaceuticals Inc) null
Vitamin D (Cholecalciferol) Oral drops, solution
Leader Infant Vitamin D 400IU/mL Drops (Cherry) (null) (Cardinal Health, Inc.) nullVitamin D (Cholecalciferol) Oral drops, solution
Pedia D-Vite 400IU/mL Drops (76518-0050) (Bayshore Pharmaceuticals) nullVitamin D (Cholecalciferol) Oral drops, solution
Pediatric D-Vite 400IU/mL Drops (71399-7401) (Akron Pharma Inc.) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral drops, solution
UpSpring Baby Vitamin D3 400IU/0.025mL Drops (null) (UpSpring, Ltd.) nullVitamin 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 ) nullVitamin 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) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral drops, solution
Vitamin D3 1000IU(25mcg)/0.0394mL Liquid Drops (null) (Xymogen, Inc.) nullVitamin D (Cholecalciferol) Oral drops, solution
Vitamin D3 125mcg (5000IU)/mL Ultra Strength Drops (Lemon) (54629-0772) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral drops, solution
Vitamin D3 Maximum Strength 5000IU/mL Drops (null) (Sundown Nutrition, a subsidiary of NBTY, Inc.) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D 400units Tablet (57896-0874) (Geri-Care Pharmaceuticals) nullVitamin 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,) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 10mcg (400IU) Tablet (77333-0948) (GenDose Pharmaceuticals) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 10mcg Tablet (68094-0114) (Precision Dose, Inc.) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 400units Tablet (50268-0863) (AvPAK; a Division of AvKARE Inc) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 400units Tablet (54629-0011) (National Vitamin Company Inc) nullVitamin 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.) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral tablet
Premier Value Vitamin D 1000units Tablet (68016-0328) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) nullVitamin D (Cholecalciferol) Oral tablet
RITE AID Vitamin D-3 1000units Tablet (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral tablet
RITE AID Vitamin D-3 1000units Tablet (null) (Rite Aid Corp) nullVitamin D (Cholecalciferol) Oral tablet
Sunmark Vitamin D 1000units Tablet (49348-0874) (McKesson Corporation) nullVitamin D (Cholecalciferol) Oral tablet
Sunmark Vitamin D3 1000units Tablet (null) (McKesson Corporation) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D 1000units Tablet (57896-0876) (Geri-Care Pharmaceuticals) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 1000units Tablet (null) (Freeda Vitamins, Inc.) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 1000units Tablet (54629-0050) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 1000units Tablet (54629-0502) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 25mcg (1000IU) Tablet (null) (Basic Drugs Inc,) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 25mcg (1000IU) Tablet (10135-0749) (Marlex Pharmaceuticals) null
Vitamin D (Cholecalciferol) Oral tablet
Premier Value Vitamin D 2000units Tablet (68016-0329) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) nullVitamin D (Cholecalciferol) Oral tablet
THERA-D 2000 Tablet (null) (Theralogix, LLC) nullVitamin D (Cholecalciferol) Oral tablet
THERA-D Rapid Repletion Tablet (null) (Theralogix, LLC) nullVitamin 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) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 2000units Tablet (54629-0411) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 50mcg (2000IU) Tablet (null) (Basic Drugs Inc,) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 50mcg (2000IU) Tablet (10135-0750) (Marlex Pharmaceuticals) null
Vitamin D (Cholecalciferol) Oral tablet
Thera-D 4000 Tablet (null) (Theralogix, LLC) nullVitamin D (Cholecalciferol) Oral tablet
Premier Value Vitamin D 5000units Tablet (68016-0335) (Pharmacy Value Alliance LLC formerly Chain Drug Consortium , LLC) nullVitamin D (Cholecalciferol) Oral tablet
Radiance Platinum Vitamin D3 5000units Tablet (null) (CVS Health) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 5000units Tablet (00761-0178) (Basic Vitamins) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 5000units Ultra Strength Tablet (50268-0866) (AvPAK; a Division of AvKARE Inc) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 5000units Ultra Strength Tablet (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Oral tablet
Dialyvite Vitamin D3 Max 1,250mcg (50,000units) Tablet (10542-1000) (Hillestad Pharmaceuticals Inc USA) null
Vitamin D (Cholecalciferol) Oral tablet
Vitamin D 1,250mcg (50,000units) High Potency Tablet (57896-0815) (Geri-Care Pharmaceuticals) nullVitamin D (Cholecalciferol) Oral tablet
Vitamin D3 50,000units Ultra Potency Caplet (57896-0815) (Geri-Care Pharmaceuticals) nullVitamin 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.) nullVitamin 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)
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) nullVitamin D (Cholecalciferol) Soft chew
CVS Vitamin D3 50mcg Gummies (Orange, Strawberry & Lemon) (null) (CVS Health) nullVitamin D (Cholecalciferol) Soft chew
GNP Vitamin D3 2000units Gummies (null) (AmerisourceBergen Corporation) nullVitamin D (Cholecalciferol) Soft chew
Leader Vitamin D3 50mcg Gummies (Peach & Berry) (null) (Cardinal Health, Inc.) null
Vitamin D (Cholecalciferol) Soft chew
Vitamin D3 2000units Gummies Soft Chew (Peach Mango Strawberry) (null) (National Vitamin Company Inc) nullVitamin D (Cholecalciferol) Soft chew
Vitamin D3 2000units Gummies Soft Chew (Strawberry Orange Lemon) (null) (Rexall Sundown, Inc.) nullVitamin D (Cholecalciferol) Soft chew
YumVs Kids ZERO Vitamin D3 25mcg (1000units) Gummies (Berry) (null) (Teelahvit, LLC) nullVitamin D (Cholecalciferol) Soft chew
YumVs Vitamin D3 50mcg (2000units) Gummies (Berry) (null) (Teelahvit, LLC) nullVitamin D (Cholecalciferol) Soft chew
YumVs Vitamin D3 50mcg (2000units) Gummies (Berry) (null) (Teelahvit, LLC) nullVitamin D (Cholecalciferol) Soft chew
YumVs ZERO Vitamin D3 50mcg (2000units) Gummies (Strawberry) (null) (Teelahvit, LLC) nullVitamin D (Cholecalciferol) Soft chew
YumVs ZERO Vitamin D3 125mcg (5000units) Gummies (Strawberry) (null) (Teelahvit, LLC) nullVitamin D (Cholecalciferol), Vitamin E (Alpha Tocopherol) Oral capsule, liquid filled
Vitamin D3 10,000units Softgel (63044-0401) (Nnodum Pharmaceuticals) nullVitamin D (Ergocalciferol) Oral capsule
PureMark Naturals Vitamin D 2000IU Vegetarian Capsule (null) (21st Century HealthCare, Inc.) null
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) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Ergo D 50000unit Softgel (61298-0020) (Optimum Pharmaceuticals Inc) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Ergocalciferol 1.25mg Capsule (42291-0266) (AvKARE, Inc.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Ergocalciferol 1.25mg Capsule (50268-0297) (AvPAK; a Division of AvKARE Inc) nullVitamin 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.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Ergocalciferol 1.25mg Capsule (64380-0737) (Strides Pharma., Inc.) nullVitamin 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.) nullVitamin 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) nullVitamin 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) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg Capsule (62135-0439) (Chartwell RX LLC) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg Capsule (42806-0547) (Epic Pharma LLC) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg Capsule (51407-0143) (Golden State Medical Supply, Inc.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg Capsule (60429-0245) (Golden State Medical Supply, Inc.) nullVitamin 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.) nullVitamin 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) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg Capsule (57664-0136) (Sun Pharmaceutical Industries, Inc.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D 1.25mg (50,000units) Capsule (23155-0809) (Avet Pharmaceuticals Inc.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D2 50,000units (1250 mcg) Capsule (71335-0062) (Bryant Ranch Prepack, Inc.) nullVitamin D (Ergocalciferol) Oral capsule, liquid filled
Vitamin D2 50,000units (1250mcg) Capsule (71335-0278) (Bryant Ranch Prepack, Inc.) nullVitamin 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.) nullVitamin 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) nullVitamin D (Ergocalciferol) Oral drops, solution
Ergocalciferol Vitamin D Supplement 8000IU (0.2mg)/mL Drops (75834-0010) (Nivagen Pharmaceuticals) nullVitamin 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.) nullVitamin D (Ergocalciferol) Oral drops, solution
Calcidol 200mcg (8000IU)/mL Drops (39328-0357) (Patrin Pharma Inc) nullVitamin D (Ergocalciferol) Oral drops, solution
Vitamin D Supplement 8000IU/mL Drops (00091-4150) (UCB Pharma Inc) nullDescription/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
- Vitamin D Supplements (new)
- Vitamin and Mineral Supplements
References
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 DatabaseReferences
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]
References
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]
References
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 PMReferences
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]
References
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]
References
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
References
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
