Colecalciferol: clinical use

Prescribing considerations

• Confirm the indication and consider baseline vitamin D and calcium status where appropriate.
• Account for all dietary, prescribed and non-prescription vitamin D and calcium.
• Use caution in renal impairment, sarcoidosis, malabsorption, conditions affecting vitamin D metabolism and cardiovascular disease treated with cardiac glycosides.
• The selected solid formulations should not be used in children under 12 because of choking risk.

Contraindications and cautions

• Hypersensitivity to vitamin D or a product excipient
• Hypervitaminosis D
• Nephrolithiasis
• Hypercalcaemia, hypercalciuria or a condition causing either
• Severe renal impairment
• For the selected tablet: hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency

Monitoring

• Monitor serum calcium when clinically indicated, particularly with prolonged higher exposure or increased hypercalcaemia risk.
• Consider urinary calcium when hypercalciuria is a concern.
• Assess calcium and phosphate in renal impairment and consider soft-tissue calcification risk.
• Use clinical response and serum 25-hydroxyvitamin D where needed to assess replacement.

Clinical pharmacology

Colecalciferol is hydroxylated in the liver to 25-hydroxycolecalciferol and then in the kidney to calcitriol. Active vitamin D promotes calcium and phosphate absorption, renal tubular retention and bone mineralisation while suppressing parathyroid hormone secretion.

Formulation and product differences

• The selected soft capsule has a liquid fill in a gelatin shell containing sorbitol and should be swallowed whole, preferably with the main meal.
• The selected tablet is a larger solid preparation containing sucrose and should be swallowed whole with water.
• Neither selected solid formulation is suitable for children under 12 because of choking risk.

Capsule

Route: Oral

Strengths: 800 units, 20000 units

Tablet

Route: Oral

Strengths: 25000 units