Therapeutic and maintenance regimens of vitamin D3 supplementation in healthy adults: A systematic review.
Cell Mol Biol (Noisy-le-grand). 2018 Nov 30;64(14):8-14, PMID: 30511630
Hassan AB1, Hozayen RF2, Alotaibi RA2, Tayem YI3.
1 Dept of Internal Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Bahrain.
2 Internal Medicine Department, Salmanyia Medical Complex, Bahrain.
3 Dept of Pharmacology and Therapeutics, College Of Medicine and Medical Sciences, Arabian Gulf University, Bahrain.
Overview Loading of vitamin D contains the following
If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given
- Loading = repletion = quick replacement (previously known as Stoss)
- Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
- The size of the loading dose is a function of body weight - see below
Unfortunately, some doctors persist in using Vitamin D2 instead of D3
- Loading may be done as quickly as a single day, to as slowly as 3 months.
It appears that spreading the loading dose over 4-20 days is a good compromise
- Loading is typically oral, but sometimes by injection (I.M,)
- The loading dose persists in the body for about 3 months
The loading dose should be followed up with continuing maintenance
Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
it appears prudent to test with a small amount of vitamin D before giving a loading dose
- The causes of a mild allergic reaction appear to be: (in order of occurance)
1) lack of magnesium - which can be easily added
2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
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Studies carried out assessing the effect of different doses of cholecalciferol (vitamin D3) on correcting serum 25-hydroxyvitamin D deficiency in healthy adults are limited and review studies are lacking. Moreover, the maintenance dose and its duration offered by these few studies are inconsistent. We performed a systematic review of randomized clinical controlled trials (RCTs) that assessed the effect of different doses of vitamin D3 on serum 25(OH)D in healthy adults. PubMed database was searched from 2010 to 2018 using the following search terms:
- "vitamin D deficiency",
- "vitamin D3 dose",
- "vitamin D supplement",
- "vitamin D therapy".
RCTs and original articles that evaluated different doses of vitamin D3 were identified. A total of sixteen (out of 3016) acceptable studies fulfilling our inclusion criteria were included in the current systematic review. Our results revealed that supplementation with vitamin D3 had a significant positive effect in raising serum 25(OH) D concentrations.
Our findings indicated that the best regimen of vitamin D3 supplement consisted of an initial large bolus dose either IM injection of 600.000 IU monthly or oral dose of 200.000 IU monthly or 50.000 IU weekly for 8 weeks, followed by a maintenance dose of 50.000 IU monthly or bimonthly.
A large bolus therapeutic dose of vitamin D3, frequently or infrequently for 8 weeks, followed by long-term oral maintenance dose of 50.000 IU monthly or bimonthly optimize and maintain vitamin D serum levels year round.