Colecalciferol

Colecalciferol is a form of vitamin D. It helps your body to take in more calcium and phosphorus from the food you eat, and helps your kidneys to keep more calcium instead of peeing it out.

We usually get our vitamin D through exposure to sunlight and our diet. Not having enough vitamin D in your body can lead to bone conditions such as rickets and osteomalacia in children, and osteoporosis (thinning of the bones) in adults.

Long-term vitamin D deficiency can cause bone loss, muscle weakness, falls and fractures in older people.

Everyone can benefit from taking colecalciferol as a daily vitamin D supplement. Adults who are not at risk of vitamin D deficiency should consider taking a daily supplement of 10 micrograms (mcg) of vitamin D during autumn and winter.

Adults who are at risk of vitamin D deficiency should take a daily supplement of 10 micrograms of vitamin D, throughout the year.

It is recommended that you take vitamin D if you have a deficiency, or to prevent a deficiency if you:

• are not often outdoors, for example if you're housebound or in an institution, like a care home
• are pregnant or breastfeeding
• usually wear clothes that cover up most of your skin when you're outside
• have dark skin – darker skin may not make enough vitamin D from sunlight
• are 1 to 4 years old or a baby that is breastfed or having less than 500ml of infant formula a day

Vitamin D deficiency is the most common cause of rickets so if your child has low vitamin D levels, your doctor may prescribe colecalciferol for them.

To find out if you have low vitamin D levels, your doctor will give you a blood test. If your levels are severely low, they may prescribe a loading dose course of vitamin D. This is a high strength dose that is only available on prescription.

If your vitamin D levels are OK, or you want to prevent deficiency, you can buy lower dose colecalciferol from pharmacies and shops.

Colecalciferol comes as chewable, dissolvable (soluble) and melt-in-the-mouth (orodispersible) tablets, capsules, a syrup, and oral drops.

There is also a type of vitamin D called calcipotriol, which sounds similar to colecalciferol. Calcipotriol is used to treat the skin condition caused by plaque psoriasis.

Most adults, babies and children can take colecalciferol.

Colecalciferol is not suitable for some people.

To make sure it's safe for you or your child, tell your doctor before starting to take colecalciferol if you:

• have ever had an allergic reaction to colecalciferol or to any of the other ingredients in the capsules, tablets, syrup or drops
• have a peanut or soya allergy
• have hypercalcaemia – high levels of calcium in your blood
• have hypercalciuria – high levels of calcium in your pee
• have problems with your kidneys, such as kidney failure, or you've ever had kidney stones
• have hypervitaminosis D – high levels of vitamin D in your blood
• have a rare condition called sarcoidosis
• have calcification – high levels of calcium in your body tissues or organs

Colecalciferol capsules may also not be suitable for you if you are vegan or vegetarian, or have a kosher or halal diet, as they may contain an animal product called gelatine.

Colecalciferol doses are measured in international units (IU). 1 microgram of vitamin D is the same as 40IU.

Adult loading doses

If you have severe vitamin D deficiency, your doctor may prescribe a loading dose of up to 300,000IU. This can be taken as:

• 50,000IU once a week for 6 weeks
• 40,000IU once a week for 7 weeks
• 1,000IU four times a day for 10 weeks
• 800IU five times a day for 10 weeks

Maintenance dose

If you've had a loading dose but need to maintain your vitamin D levels, your doctor may prescribe a maintenance dose of 800IU to 2,000IU a day.

Lower colecalciferol doses

Colecalciferol is also available in lower doses. You can take 400IU a day if you're an adult maintaining your vitamin D levels.

Doses for children

Your child's dose will depend on their age and how severe their vitamin D deficiency is.

The usual loading dose for children is:

• age 1 to 5 months – 3,000IU daily for 8 to 12 weeks
• age 6 months to 11 years – 6,000IU daily for 8 to 12 weeks
• age 12 to 17 years – 10,000IU daily for 8 to 12 weeks

Maintenance dose for children

Your child's doctor may recommend changes to your child's diet to improve their vitamin D levels. If changes to their diet still do not provide enough vitamin D then the doctor may prescribe a maintenance dose of 400IU to 600IU for them to take daily long term.

Prevention doses for children

To help your child grow healthy bones and prevent rickets, you can give them:

• 340IU to 400IU a day – from birth to 1 year
• 400IU a day – from 1 year to 4 years

If you're unsure how to take colecalciferol, ask your doctor or your pharmacist. Take your medicine exactly as they advise you to.

Capsules and tablets

If you're taking colecalciferol capsules or tablets, swallow them whole with some water. Take them with your main meal of the day.

Chewable tablets

If you're taking chewable tablets, chew them. Do not swallow them whole.

Syrup (oral solution)

Your colecalciferol liquid should come with a plastic syringe. If you do not have one, ask your pharmacist for one.

Follow the instructions included with your medicine about how to take the syrup with a syringe.

1. Measure the amount prescribed by your doctor into the syringe.
2. Squirt the medicine straight into your mouth until the syringe is empty.
3. Wash the syringe and allow to dry.

Colecalciferol oral drops

If you're using colecalciferol drops, you can either drop them straight into your mouth or onto a spoon before you take it.

Colecalciferol dissolvable tablets

Drop 1 tablet into a glass of water and as soon as it dissolves drink straight away. Do not chew or swallow the tablets whole.

For adults, if you're taking a loading dose for severe vitamin D deficiency you'll usually take it daily or weekly for 6 to 10 weeks.

To maintain your vitamin D levels or prevent deficiency you'll usually take colecalciferol long term.

Children with severe vitamin D deficiency usually take a loading dose for 8 to 12 weeks. They may then take a lower, maintenance dose of vitamin D long term.

If you or your child's vitamin D levels are OK, your doctor may recommend safely increasing your exposure to sunlight and adding more foods that are high in vitamin D to your diet.

If you stop taking colecalciferol, your symptoms may come back and your bone health may be affected. Stopping colecalciferol could cause the calcium levels in your body to fall. This can cause problems like bone pain or muscle weakness.

If you forget to take your daily or weekly dose of colecalciferol, take it as soon as you remember, unless it's nearly time for your next dose. In this case, leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time and do not take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm or make a note in your diary to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

Unless you're taking a loading dose of vitamin D, as prescribed by your doctor, taking an extra dose is unlikely to harm you.

• you have taken more than 4,000IU of colecalciferol in 1 day
• your child is between 1 and 10 years of age and has had more than 2,000IU in 1 day
• your child is under 12 months and has had more than 1,000IU in 1 day

Go to 111.nhs.uk or call 111 . Call 111 if you are asking about a child under the age of 5 years.

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the colecalciferol packet or leaflet inside it, any remaining medicine, and any other medicines you take.

If you have taken too much colecalciferol, tell your doctor or contact 111 straight away if you (or your child):

• feel weak or have pain in your muscles or bones
• need to pee more often
• feel thirsty
• feel tired
• are sick (vomit) or feel sick
• have constipation, or lose your appetite
• are sweating a lot
• have headaches
• feel confused
• feel drowsy
• feel pain in the abdomen – this could be a sign of kidney stones

There are things you can do to help cope with these common side effects of colecalciferol:

Speak to your doctor if you have a pain in your stomach.

Try taking your tablets with food. It may also help if you avoid rich or spicy food.

If it carries on, tell your doctor. They may be able to prescribe an extra medicine to protect your stomach.

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Speak to a doctor or pharmacist if a side effect continues to bother you, or lasts more than a few days.

Call your doctor or call 111 if:

• you find that you need to pee more often
• you get swelling in any part of your body
• you get a high temperature and a sharp pain in your side or on one side of your lower back – this could be the early stages of kidney stones
• you are sick (vomit), feel confused, get bone or joint pain, or an irregular heartbeat – these could be signs of too much calcium (hypercalcemia)

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to colecalciferol.

Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
• your throat feels tight or you're struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who's unwell may also have a rash that's swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Taking too much colecalciferol over a long period of time can cause a skin rash. It can also cause high levels of calcium.

Too much calcium in your body (hypercalcaemia) can cause stomach pain, weaken your bones and damage your kidneys and heart.

Your doctor will arrange a blood test to check your calcium levels. If your test result shows that your calcium levels are high, they may ask you to stop taking colecalciferol until your calcium levels are normal again.

These are not all the side effects of colecalciferol. For a full list, see the leaflet inside your medicine's packet.

It is recommended that you take a daily vitamin D (colecalciferol) supplement of 400IU throughout pregnancy. This will help you and your baby stay healthy.

Many pregnancy multivitamins already contain 400IU (10 micrograms) of vitamin D so if you're taking one of these, you will not need an extra vitamin D supplement. Check the packet to see what dose of vitamin D it contains.

If you have been diagnosed with vitamin D deficiency (where your blood levels of vitamin D are too low), your doctor or midwife may offer a higher dose of colecalciferol. Higher doses are also safe to take during pregnancy. This treatment is important to help protect your teeth and muscles, and make sure your baby develops strong bones and teeth.

You may need extra blood tests to make sure that you are taking enough vitamin D.

You can take colecalciferol (vitamin D) while you are breastfeeding.

Vitamin D is a natural part of breast milk. When you take colecalciferol as a supplement or treatment, it passes into your breast milk in low amounts and helps your baby to stay healthy.

If you have been prescribed a very high dose of colecalciferol (over 6,000IU a day), your baby may need extra blood tests. This is to make sure they're not getting too much.

Babies up to the age of 1 year need 340IU to 400IU of vitamin D drops a day as a supplement. Unless you're taking very high doses of colecalciferol for long periods, it's still safe to give it to your baby, even though they are getting colecalciferol through breast milk. This ensures they are getting enough.

If your baby is having at least 500ml of formula milk a day, they do not need supplements as formula milk already has vitamin D added.

If you notice your baby is not feeding as well as usual, or you have any other concerns about your baby, contact your doctor, pharmacist, health visitor or midwife.

There's no evidence to suggest that taking colecalciferol reduces fertility in men or women.

Tell your doctor if you're:

• trying to get pregnant
• pregnant
• breastfeeding

Some medicines can affect the way colecalciferol works and colecalciferol can stop other medicines from working properly.

Tell your doctor if you (or your child) are taking any of these medicines before you start taking colecalciferol:

• digoxin, a medicine for heart problems – you may get too much calcium in your blood and this may cause an abnormal heartbeat
• some diuretics (or "water" tablets which make you pee more) such as bendroflumethiazide or indapamide – you may get too much calcium in your blood
• medicines for epilepsy such as phenytoin, carbamazepine, phenobarbital or primidone – you may need a larger dose of colecalciferol
• laxatives such as paraffin oil, or cholestyramine (a medicine to lower cholesterol) – your colecalciferol may not enter your blood as usual
• steroids such as prednisolone or hydrocortisone – these may reduce the effects of colecalciferol
• antifungal medicines such as ketoconazole or clotrimazole – these may affect the breakdown of colecalciferol
• actinomycin (a medicine used to treat cancer) – this may affect the breakdown of colecalciferol

Do not take any other vitamin or mineral supplements that contain calcium or vitamin D without talking to your doctor first.

There's not enough information to say whether other complementary medicines, herbal remedies and supplements are safe to take with colecalciferol. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.