From the Guidelines
Ergocalciferol can be taken once a week as a high-dose supplement for treating vitamin D deficiency, with a typical weekly dosage of 50,000 IU, usually prescribed for 8 weeks followed by a recheck of the serum 25(OH)D level and subsequent dosing based on the results 1.
Key Considerations
- The weekly regimen is often preferred over daily dosing because it improves adherence and can rapidly correct severe deficiency.
- After completing the initial treatment course, patients typically transition to a lower maintenance dose, either weekly or daily (1,000-2,000 IU daily or equivalent weekly dose).
- The once-weekly dosing works because vitamin D is fat-soluble and stored in body tissues, allowing for less frequent administration.
- Patients should take ergocalciferol with food containing some fat to enhance absorption.
- Blood levels should be monitored after 8-12 weeks of therapy to assess response and adjust dosing as needed.
- Side effects are rare but can include hypercalcemia at very high doses.
Dosage and Administration
- The recommended dosage for ergocalciferol is 50,000 IU weekly for 8 weeks, followed by a recheck of the serum 25(OH)D level and subsequent dosing based on the results 1.
- Alternative dosing regimens include 50,000 IU twice a month or 1000 IU daily, depending on the severity of the deficiency and patient response 1.
Monitoring and Adjustment
- Serum 25(OH)D levels should be monitored after 8-12 weeks of therapy to assess response and adjust dosing as needed.
- Patients with severe deficiency may require more frequent monitoring and dose adjustments.
- The goal of treatment is to achieve a serum 25(OH)D level of 30 ng/mL or higher, which is associated with optimal bone health 1.
From the Research
Ergocalciferol Dosage
- Ergocalciferol is often prescribed once a week, with a common dosage of 50,000 IU/week 2
- A study found that patients prescribed 50,000-100,000 IU/week were significantly more likely to attain vitamin D sufficiency compared to those prescribed less than 50,000 IU/week 2
- Another study used a dosage of 72,000 IU/week for 12 weeks, followed by 24,000 IU/week as maintenance therapy, to correct vitamin D deficiency/insufficiency in hemodialysis patients 3
Safety and Efficacy
- A case report found no toxicity after massive doses of ergocalciferol (150,000 IU orally daily) for 28 years 4
- A study found that an ergocalciferol regimen of 50,000-100,000 IU/week with no loading dose could be considered as a starting point for vitamin D repletion 2
- High-dose vitamin D2 supplementation was found to be safe and sufficient to obtain and maintain optimal serum 25(OH)D concentrations in chronic kidney disease patients on dialysis 3
Vitamin D Deficiency and Supplementation
- Vitamin D deficiency is associated with unfavorable skeletal outcomes, including fractures and bone loss 5
- A 25(OH)D level of >50 nmol/L or 20 ng/ml is the primary treatment goal, although some data suggest a benefit for a higher threshold 5
- Vitamin D supplementation may be beneficial, but the intake of vitamin D should be under the supervision of health professionals because overdosing leads to intoxication with severe health consequences 6