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Vitamin D3

 Vitamin D is a vitamin. It can be found in small amounts in a few foods, including fatty fish such as herring, mackerel, sardines and tuna. To make vitamin D more available, it is added to dairy products, juices, and cereals that are then said to be “fortified with vitamin D.” But most vitamin D – 80% to 90% of what the body gets – is obtained through exposure to sunlight. Vitamin D can also be made in the laboratory as medicine.


Vitamin D is used for preventing and treating rickets, a disease that is caused by not having enough vitamin D (vitamin D deficiency). Vitamin D is also used for treating weak bones (osteoporosis), bone pain (osteomalacia), bone loss in people with a condition called hyperparathyroidism, and an inherited disease (osteogenesis imperfecta) in which the bones are especially brittle and easily broken. It is also used for preventing falls and fractures in people at risk for osteoporosis, and preventing low calcium and bone loss (renal osteodystrophy) in people with kidney failure.

Vitamin D is used for conditions of the heart and blood vessels, including high blood pressure and high cholesterol. It is also used for diabetes, obesity, muscle weakness, multiple sclerosis, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), asthma, bronchitis, premenstrual syndrome (PMS), and tooth and gum disease.

Some people use vitamin D for skin conditions including vitiligo, scleroderma, psoriasis, actinic keratosis, and lupus vulgaris.

It is also used for boosting the immune system, preventing autoimmune diseases, and preventing cancer.

Because vitamin D is involved in regulating the levels of minerals such as phosphorous and calcium, it is used for conditions caused by low levels of phosphorous (familial hypophosphatemia and Fanconi syndrome) and low levels of calcium (hypoparathyroidism and pseudohypoparathyroidism).

Vitamin D in forms known as calcitriol or calcipotriene is applied directly to the skin for a particular type of psoriasis.

If you travel to Canada, you may have noticed that Canada recognizes the importance of vitamin D in the prevention of osteoporosis. It allows this health claim for foods that contain calcium: "A healthy diet with adequate calcium and vitamin D, and regular physical activity, help to achieve strong bones and may reduce the risk of osteoporosis.” But the US version of this osteoporosis health claim does not yet include vitamin D.


                                               Effective for:

 

                                        Likely effective for:

 

                                  Possibly  effective for:

                                      Possibly ineffective for:

 

                     Insufficient evidence to rate effectiveness for:

                                                Special precautions & warnings:

Pregnancy and breast-feeding: Vitamin D is LIKELY SAFE during pregnancy and breast-feeding when used in daily amounts below 4000 units. Do not use higher doses. Vitamin D is POSSIBLY UNSAFE when used in higher amounts during pregnancy or while breast-feeding. Using higher doses might cause serious harm to the infant.

Kidney disease: Vitamin D may increase calcium levels and increase the risk of “hardening of the arteries” in people with serious kidney disease. This must be balanced with the need to prevent renal osteodystrophy, a bone disease that occurs when the kidneys fail to maintain the proper levels of calcium and phosphorus in the blood. Calcium levels should be monitored carefully in people with kidney disease.

High levels of calcium in the blood: Taking vitamin D could make this condition worse.

“Hardening of the arteries” (atherosclerosis): Taking vitamin D could make this condition worse, especially in people with kidney disease.

Sarcoidosis: Vitamin D may increase calcium levels in people with sarcoidosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Histoplasmosis: Vitamin D may increase calcium levels in people with histoplasmosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Over-active parathyroid gland (hyperparathyroidism): Vitamin D may increase calcium levels in people with hyperparathyroidism. Use vitamin D cautiously.

Lymphoma: Vitamin D may increase calcium levels in people with lymphoma. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Tuberculosis: Vitamin D might increase calcium levels in people with tuberculosis. This might result in complications such as kidney stones.

         Are there interactions with medications?

               Moderate

Be cautious with this combination.

Aluminum

Aluminum is found in most antacids. Vitamin D can increase how much aluminum the body absorbs. This interaction might be a problem for people with kidney disease. Take vitamin D two hours before, or four hours after antacids.

Atorvastatin (Lipitor)

Vitamin D might decrease the amount of atorvastatin (Lipitor) that enters the body. This might decrease how well atorvastatin (Lipitor) works.

Calcipotriene (Dovonex)

Calcipotriene is a drug that is similar to vitamin D. Taking vitamin D along with calcipotriene (Dovonex) might increase the effects and side effects of calcipotriene (Dovonex). Avoid taking vitamin D supplements if you are taking calcipotriene (Dovonex).

 

Digoxin (Lanoxin)

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Digoxin (Lanoxin) is used to help your heart beat stronger. Taking vitamin D along with digoxin (Lanoxin) might increase the effects of digoxin (Lanoxin) and lead to an irregular heartbeat. If you are taking digoxin (Lanoxin), talk to your doctor before taking vitamin D supplements.

Diltiazem (Cardizem, Dilacor, Tiazac)

Vitamin D helps your body absorb calcium. Calcium can affect your heart. Diltiazem (Cardizem, Dilacor, Tiazac) can also affect your heart. Taking large amounts of vitamin D along with diltiazem (Cardizem, Dilacor, Tiazac) might decrease the effectiveness of diltiazem.

Medications changed by the liver (Cytochrome P450 3A4 (CYP 3A4) substrates)

Some medications are changed and broken down by the liver. Vitamin D may increase how quickly the liver breaks down some medications. Taking vitamin D along with some medications may decrease the effectiveness of some medications. Before taking vitamin D, talk to your health care provider if you are taking any medications that are changed by the liver.

Some of these medications changed by the liver include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and others.

Verapamil (Calan, Covera, Isoptin, Verelan)

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Verapamil (Calan, Covera, Isoptin, Verelan) can also affect the heart. Do not take large amounts of vitamin D if you are taking verapamil (Calan, Covera, Isoptin, Verelan).

Water pills (Thiazide diuretics)

Vitamin D helps your body absorb calcium. Some "water pills" increase the amount of calcium in the body. Taking large amounts of vitamin D along with some "water pills" might cause to be too much calcium in the body. This could cause serious side effects including kidney problems.

Some of these "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).

 

                                                     Minor

Be watchful with this combination.

 

Cimetidine (Tagamet)

The body changes vitamin D into a form that it can use. Cimetidine (Tagamet) might decrease how well the body changes vitamin D. This might decrease how well vitamin D works. However, this interaction probably isn't important for most people.

Heparin

Heparin slows blood clotting and can increase the risk of breaking a bone when used for a long period of time. People taking these medications should eat a diet rich in calcium and vitamin D.

Low molecular weight heparins (LMWHs)

Some medications called low molecular weight heparins can increase the risk of breaking a bone when used for a long periods of time. People taking these medications should eat a diet rich in calcium and vitamin D.

These drugs include enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep).



The following doses have been studied in scientific research:

                                                                          BY MOUTH:

Most vitamin supplements contain only 400 IU (10 mcg) vitamin D.

The Institute of Medicine publishes recommended daily allowance (RDA), which is an estimate of the amount of vitamin D that meets the needs of most people in the population. The current RDA was set in 2010. The RDA varies based on age as follows: 1-70 years of age, 600 IU daily; 71 years and older, 800 IU daily; pregnant and lactating women, 600 IU daily. For infants ages 0-12 months, an adequate intake (AI) level of 400 IU is recommended.

Some organizations are recommending higher amounts. In 2008, the American Academy of Pediatrics increased the recommended minimum daily intake of vitamin D to 400 IU daily for all infants and children, including adolescents. Parents should not use vitamin D liquids dosed as 400 IU/drop. Giving one dropperful or mL by mistake can deliver 10,000 IU/day. The US Food and Drug Administration (FDA) will force companies to provide no more than 400 IU per dropperful in the future.

The National Osteoporosis Foundation recommends vitamin D 400 IU to 800 IU daily for adults under age 50, and 800 IU to 1000 IU daily for older adults.

The North American Menopause Society recommends 700 IU to 800 IU daily for women at risk of deficiency due to low sun (e.g., homebound, northern latitude) exp