Use and availability of high dose vitamin D

In the past vitamin D deficiency was judged to be present when the concentrations were low enough to lead to osteomalacia or rickets (25 hydroxyvitamin D (25 OHD) of less than 25 nmol /L (10 ng p/mL)). Recent reports have suggested that it may be necessary to exceed plasma 25 OHD of 75 nmol/L (30 ng/mL) in order to preserve optimum health. In order to achieve higher circulating 25 OHD it has become common practice to prescribe higher strength calciferol preparations usually ergocalciferol (vitamin D2)1.25 mg (50,000 international units). A single tablet (50,000 IU) once monthly was often all that was necessary to maintain satisfactory vitamin D status.

However, in the spring of 2008 it became increasingly difficult to obtain supplies of ergocalciferol. This is because of problems obtaining raw materials of sufficient purity to generate ergocalciferol which satisfies British pharmaceutical requirements. It has been possible to import alternative ergocalciferol preparations from the United States via IDIS but this is substantially more expensive and the quality standards required in America are not as stringent as in the UK.

As an alternative it is possible to obtain colecalciferol (Vitamin D3) again via IDIS but this time from Jenapharm in Germany under the name Dekristol®. This is supplied in 20,000 international units capsules and can be given in a dose of two capsules per month in order to achieve suitable vitamin D status. It may be useful to give a initial higher dose (e.g. two capsules daily for 10 days or two capsules weekly for six weeks) to replenish vitamin D stores in severe deficiency.

The Society is in communication with the Principal Pharmacist at the Department of Health and will provide further updates when more information becomes available.