Management of Vitamin D Deficiency in Adults The following guidance has been developed through joint working between DBH FT D&TC and DCCG Prescribing Sub Group, following consultation with clinical specialists. It is acknowledged that preparations suitable for use in Secondary Care and Primary Care will vary. 1. 25‐OHD level <30 nanomol/l Initiate high dose vitamin D supplementation Oral Colecalciferol 100,000 units once monthly for 3 months and recheck level and calcium 1 month after the last of these doses Primary Care prescribe as: branded ProD3 capsules 20,000units – 5 capsules once a month (In the case of patients with severe mal‐absorption, obesity or where compliance is an issue, consider ergocalciferol intramuscular injection 300,000 units STAT and recheck 25–OHD in 3 months) 25‐OHD level 30‐50nanomol/l Oral Colecalciferol 100,000 units STAT Primary Care prescribe as: branded ProD3 capsules 20,000units – 5 capsules 2. 3. followed by maintenance dose of vitamin D 800 units daily (with or 4. without calcium) 5. 6. Primary Care prescribe as: Branded Fultium D3 800iunits 25‐OHD now >50nanomol/l Maintenance of Vitamin D 800 units daily (with or without calcium) Primary Care prescribe as: Branded Fultium D3 800iunits 2. 25‐OHD level 30‐50nanomol/l Initiate Oral Colecalciferol 100,000 units Stat Primary Care prescribe as: branded ProD3 capsules 20,000units – 5 capsules Followed by maintenance of Vitamin D 800 units daily (with or without calcium) Primary Care prescribe as: branded Fultium D3 800iunits 3. 25‐OHD level >50 nanomol/l Life style Advice  Exposure to sunlight is the main source of vitamin D. Aim to spend 20‐30 minutes on the face and forearms at midday in summer three times weekly without sunscreen.  Dietary source of vitamin D includes oily fish, cod liver oils, dairy products, liver and egg yolk Primary Care Guidance 
Primary Care prescribing of Vitamin D preparations should always be using a brand name. This is because prescribing by generic names may lead to the item being dispensed as an unlicensed high cost Special.  Vitamin D treatment 800 units may be obtained using prescription product ’Fultium D3’ or a different preparation may be purchased from Chemists.  Please note Pro D3 is an unlicensed preparation, the dose of 100,000units should be achieved by prescribing 5 x 20,000units capsules.  The choice of branded Vitamin D preparations will be subject to ongoing review.  Patients with CKD 4 and 5 may require additional monitoring (IPTH, Calcium) as determined by clinical need. Monitoring will be requested by, and the results will be interpreted by the initiating Consultant. References 1. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society of Clinical Practice. Journal Clinical Endocrinology Metabolism.2011 2. Pearce SHS, Cheetham TD. Diagnosis and management of Vitamin D deficiency. British Medical Journal 2010;340:b566 Author: Patrick Mok, Senior Clinical Pharmacist, DBH (following consultation with clinical specialists),
Medicines Management Team, Doncaster CCG
Approved by Drugs & Therapeutics Committee: April 2013
Review Date: April 2016