Vitamin D Replacement
| Objective: Monitor for and manage Vitamin D deficiency |
| Patient population: Individuals with known diagnosis of IBD and low serum 25-hydroxyvitamin D |
These clinical decision support tools were developed by Canadian experts in IBD, based on their interpretation of current evidence and considerations specific to Canadian healthcare. International guidelines from Europe and the United States are available. However, these may reflect regional factors not directly applicable in Canada.
Highlight BoxVitamin D deficiency is common among IBD patients. Restoring and maintaining appropriate levels of Vitamin D may help maintain remission. |
Introduction
This care protocol provides a general guideline for monitoring and managing vitamin D deficiency in adults with inflammatory bowel disease. The availability of the listed options for vitamin D replacement may vary across organizations.
IBD Provider:
1. Check serum Vitamin D annually.
- If 75-125nmol/l – recommend 1000 – 2000 IU daily
- 50-75 nmol/L – recommend 5000-10000 IU daily, or replace
- Replace if <50 nmol/L
2. Re-assess vitamin D levels at 4 months, if vitamin D deficiency identified
3. Generate a vitamin D replacement Rx as per options for replacement below and give it to support staff
Support Staff:
4. Use letter templates for low vitamin D and send them to the patient and one to the patient’s GP.
5. Print bloodwork requisition to test vitamin D and calcium levels for the patient to complete in 4 months
6. Parenteral vitamin D needs to be compounded. Therefore, it is important to establish a strong working relationship with a compounding pharmacy.
Table 1 Options for replacement
| Type of Vitamin D | Availability | Dosage | Form | Route |
| Vitamin D3 | OTC | 400 IU, 1000 IU | Tablet | Oral |
| Vitamin D3 (D-VI-SOL) | OTC | 400 IU/mL | Liquid | Oral |
| Vitamin D3 (DROPS) | OTC | 600 or 1000 units/drop (5ml=180drops) | Liquid | Oral |
| Vitamin D3 (Euro-D) | Rx | 10,000 IU | Capsule | Oral |
| Vitamin D3 | Rx | 2000-75,000 IU | Capsule/Tab | Oral |
| Vitamin D2 (OSTO-D2, D- FORTE) | Rx | 50,000 IU | Capsule | Oral |
| Calcitriol (ROCALTROL) | Rx | 0.25ug, 0.5ug | Capsul | Oral |
| Cholecalciferol (in sesame oil) | Rx | 250,000 – 500,000 IU | Injection | Intramuscular |
Note: Vitamin D3 may have a longer half-life than vitamin D2 and may be more potent, causing two- to threefold greater storage in vitamin D. Vitamin D3 is preferred over vitamin D2
Table 4: Recommended Dose
| Vitamin D level | Intramuscular** |
| 50-75 nmol/L | 250,000 IU x 1 |
| <50 nmol/L | 500,000 IU x 1 |
Note: Indications for Intramuscular (IM) vitamin D therapy
- May be considered following a trial of oral vitamin D supplementation.
- Recommended in cases of profound vitamin D deficiency (serum concentration < 25 nmol/L).
- May be initiated in patients presenting with clinical symptoms such as fatigue, without prior oral therapy.
- Preference for patients with a history of multiple intestinal resections (≥ 2).
Resources for Providers
RxFiles: Vitamin D supplementation evidence (PDF)