colecalciferol; cholecalciferol: clinical use

Prescribing considerations

• Confirm the indication and consider total vitamin D and calcium exposure from medicines, supplements and diet.
• Use caution in renal impairment, sarcoidosis, granulomatous disease, cardiovascular disease, malabsorption and people prone to renal calculi.
• Choose a formulation suitable for age, swallowing ability, dietary requirements and pregnancy or breastfeeding status.

Contraindications and cautions

• Hypersensitivity to colecalciferol or product excipients
• Hypervitaminosis D
• Hypercalcaemia or hypercalciuria
• Nephrolithiasis or nephrocalcinosis where specified
• Severe renal impairment for selected products

Monitoring

• Consider serum calcium and renal function during prolonged treatment or in higher-risk patients.
• Monitor calcium and phosphate in renal impairment and serum or urinary calcium in states of increased vitamin D sensitivity.
• Assess biochemical response when correcting confirmed deficiency.
• Consider calcium and ECG monitoring with cardiac glycosides.

Clinical pharmacology

A fat-soluble vitamin converted in the liver to 25-hydroxycolecalciferol and then mainly in the kidneys to calcitriol. The active metabolite binds vitamin D receptors and increases calcium and phosphate absorption and renal conservation.

Formulation and product differences

• Selected film-coated tablets may be swallowed whole or crushed; excipients differ between brands.
• Fultium-D3 soft capsules contain gelatin and refined maize oil and must be swallowed whole.
• THORENS drops and oral solution are olive-oil formulations that should be shaken and may be mixed with a small amount of food immediately before administration.
• Age licensing differs between tablets, capsules and drops.
• The THORENS oral-solution bottle intended for initial adult treatment is not recommended during pregnancy or breastfeeding; select a suitable lower-strength formulation.