Study Of Various Vitamin D3 Supplementation Protocols That Are Used In Community Practice For Treatment Of Hypovitaminosis D
Endo 2014 - Chicago: Poster Board, Session: SAT 0229-0266-Vitamin D Metabolism & Action
Pratibha Shahajirao Pawal, M.D, DM Endocrinology
T. N. Medical College & B.Y.L. Nair hospital, Mumbai, Mumbai
Pawal PS,Joshi AS,Lathia T,Mittal S,Sharma BR,Dalwadi PP,Bhagwat NM, Chadha MD, Varthakavi PK.
Introduction: Hypovitaminosis D is widely prevalent in India (70-90%). Different dosing protocols have been used for Vitamin D(VITD) supplementation; however there is no universally accepted regimen.
Objectives: Comparison of serial VITD concentrations attained with various VITD supplementation protocols in VITD deficient subjects.
Methods: 242 subjects were screened. 105 consenting subjects( age 20-60 years) with Hypovitaminosis D(VITD <16ng/ml) participated in the study and were randomized to receive 4 different supplemental regimens i.e. single dose 6lacIU orally, single dose 6lacIU intramuscular, 60000IU once weekly for 8 weeks and 2000IU daily for 8 weeks.
Outcome measures: Primary outcome measure was the serial serum VITD concentration attained. VITD, Parathyroid Hormone (PTH), calcium, phosphorus, alkaline phosphatase were monitored at baseline, 1,3,6,8 & 12 weeks of therapy.
Results: 66.5% subjects were found to be vitamin D deficient (<20ng/ml). Baseline VITD concentrations for Oral, IM, Weekly and Daily groups were 10.6±3.7; 9.7±4.5; 8.9±4.4 and 10.2±4.3 ng /ml respectively. VITD concentrations increased significantly in all groups at 3 weeks(P <0.001).
After 8 weeks, VITD concentrations for Oral, IM, Weekly and Daily groups were 34.6±9.4; 40.6±15.1 ; 40.2±13.9 and 24.7±7.7ng/ml respectively. VITD concentration decreased from 8 weeks to 12 weeks in all groups except in IM group which maintained steady increasing trend from 8wks to 12 wks.VITD level >100ng/ml was observed in 40% of subjects in oral group while none of other groups showed VITD >100ng/ml at all time points. All groups were compared with mean percentage increment in VITD concentration at different time points. Serum intact PTH was increased in only in 40% of subjects with VITD <16 ng/ml.
Conclusions:
- Only IM mega dose group showed sustained increment of VITD concentration at 12 weeks without VITD toxicity or hypercalcaemia.
- Only oral group had VITD levels >100 ng/ml(40%) without clinical manifestations of hypervitaminosisD .
- Oral loading dose is adequate for maintaining VITD sufficiency only for duration of 3 months & need for resupplementation at 3 monthly interval.
- Weekly group also showed decline in VITD sufficiency at 12 weeks indicates need for retesting and supplementation.
- 2000IU daily is not adequate to achieve sufficiency in VITD deficient subjects.
Summary by VitaminDWiki
Dose | 8 weeks (end of dosing) | 12 weeks |
600,000 IU oral | 35 ng | |
600,000 IU injection | 40 ng | 40% > 100 ng |
60,000 IU weekly | 40 ng | declined by 12 weeks |
2,000 IU daily | 25 ng |
See also VitaminDWiki
- Vitamin D loading doses of up to 400,000 IU OK for adolescents – meta-analysis Dec 2014
- Review of Vitamin D (including free, frequency, injection, how much.) – Sept 2013
- 600,000 vitamin D loading doses – good response to both oral and muscular – Oct 2015
- Injection category listing has
65 items along with related searches VitaminDWiki pages in both categories Loading and Injection
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- Those getting an injection of 300,000 IU Vitamin D got out of the ICU a week sooner – RCT Dec 2020
- Several Diabetic pains reduced by injection of 300,000 IU of Vitamin D – RCT Feb 2020
- 10 fewer days of ICU Mechanical Ventilation 300,000 IU injection of vitamin D – RCT March 2019
- Traumatic Brain Injury recovery helped by injection of 100,000 IU of Vitamin D – March 2019
- Vitamin D loading dose of 300,000 IU for children – 3 weeks with capsules, biscuits, injection – RCT Aug 2018
- Pregnancies helped a lot by Vitamin D (injection then 50,000 IU monthly) – RCT May 2018
- Neuropathy - 5X more had a good Quality of Life after 600,000 IU of Vitamin D - 2017
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- Ulcerative colitis treated by injection of 300,000 IU of vitamin D – RCT July 2016
- Vitamin D injection is far better than oral for diabetics (poor gut) – RCT March 2017
- Better outcome following Ischemic stroke if injected with 600,000 IU of vitamin D – RCT Feb 2017
- Vitamin D injection lasts longer and has bigger response than weekly oral – Jan 2017
- Diabetic neuropathy reduced by injection of 600,000 IU of vitamin D – Feb 2016
- Vitamin D supplementation protocols: loading, injection, etc – RCT June 2014
- Long time between large vitamin D injections resulted in 6X increase in health complaints – April 2014
- Diabetes (Type II) reduced by single injection of 300,000 IU of vitamin D3 – RCT March 2014
- Injection of 300,000 IU of vitamin D3 similar to 10 months of oral 25,000 IU – Jan 2014
- Review of Vitamin D (including free, frequency, injection, how much.) – Sept 2013
- Vitamin D injections of a total of 1,800,000 IU reduced shinbone tenderness – Feb 2013
- 600,000 IU vitamin D normalized virtually all seniors in 3 months (Injection better than oral)– May 2012
- 300,000 IU injection loading dose of vitamin D3 stopped gestational diabetes in RCT – Oct 2011
- 300000 IU injection of vitamin D3 – Mar 2010
- 600,000 IU intramuscular D3 helped BMD after pancreatic surgery – June 2010
- Megadose injection of up to 600,000 IU vitamin D3 every three months for adolescents - April 2010
Overview Loading of vitamin D contains the following
Loading dose:207 studies at VitaminDWiki Vitamin D loading dose (stoss therapy) proven to improve health overview
If a person is or is suspected to be, very vitamin D deficient a loading dose should be given- Loading = restore = quick replacement by 1 or more doses
- Loading doses range in total size from 100,000 IU to 1,000,000 IU of Vitamin D3
- = 2.5 to 25 milligrams
- 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 (Stoss), to as slowly as 3 months.
- It appears that spreading the loading dose over 4+ days is slightly better if speed is not essential
- Loading is typically oral, but can be Injection (I.M,) and Topical
- Loading dose is ~3X faster if done topically or swished inside of the mouth
- Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
- The loading dose persists in the body for 1 - 3 months
- The loading dose should be followed up with on-going maintenance dosing
- Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
- 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 occurrence)
- 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 )
- 4) allergy of the gut to Vitamin D - alternative = topical
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