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600,000 vitamin D loading doses – good response to both oral and muscular – Oct 2015

COMPARISON OF VITAMIN D REPLACEMENT STRATEGIES WITH HIGH-DOSE INTRAMUSCULAR OR ORAL CHOLECALCIFEROL: A PROSPECTIVE INTERVENTION STUDY

Endocrine Practice: October 2015, Vol. 21, No. 10, pp. 1125-1133.doi: http://dx.doi.org/10.4158/EP15680.
Muhammad Qamar Masood, MBBS, FACE1; Aysha Khan, MBBS, FCPS2; Safia Awan, MSc1; Farhan Dar, MBBS, FCPS3; Sabahat Naz, MSc1; Ghazala Naureen, MSc2; Shakil Saghir, PhD4; Abdul Jabbar, MBBS, FRCP1
1From the Section of Endocrinology, Department of Medicine, Aga Khan University, Karachi, Pakistan
2Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
3Clinical pathology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
4Toxicology Services, Smithers Avanza, Gaithersburg, Maryland.
Address correspondence to Dr. Muhammad Qamar Masood; Section of Endocrinology, Department of Medicine; Aga Khan University; Stadium Road, P.O. Box 3500; Karachi, Pakistan., E-mail: qamar.masood at aku.edu


ABSTRACT
Objective: To ascertain the frequency of correction of vitamin D deficiency (VDD) with single or multiple doses of oral (PO) and intramuscular (IM) administration of 2 high-dose preparations of vitamin D3 (VD3).

Methods: This was a prospective intervention study conducted in an ambulatory care setting. One hundred participants with VDD (25-hydroxy vitamin D [25-OHD] <20 ng/mL) were randomized to receive a dose of 600,000 or 200,000 IU of VD3 via a PO or IM route. The main outcome measure was serum 25-OHD levels at 2, 4, and 6 months after the intervention.

The same dose was repeated in participants if 25-OHD remained <30 ng/mL at 2 and 4 months.

Results: At 2 months, VDD was corrected in

  • 93.8% of participants in Group 1 (600,000 IU IM);
  • 83.3% in Group 2 (600,000 IU PO),
  • 87.5% in Group 3 (200,000 IU IM), and
  • 70.6% in Group 4 (200,000 IU PO).

The mean changes from baseline in vitamin D levels at 2 months were

  • 29.6 ± *13.7,
  • 19.8 ± 12.3,
  • 18.3 ± 10.6, and
  • 13.7 ± 7.8 ng/mL

in Groups 1, 2, 3, and 4, respectively.
The mean levels remained significantly higher from baseline in all groups at all time points during the 6 months of observation.
The mean 25-OHD level achieved in Group 1 was significantly higher than all other groups at 6 months.

Conclusion: Two months after the intervention, VDD was corrected in more than 70% of participants with a single dose of either 600,000 or 200,000 IU given PO or IM.

Abbreviations:
ALT = alanine transaminase
IM = intramuscular
iPTH = intact parathyroid hormone
IQR = interquartile range
25-OHD = 25 hydroxyvitamin D
PO = oral
VD3 = vitamin D3 (cholecalciferol)
VDD = vitamin D deficiency
VDI = vitamin D insufficiency

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