From the Guidelines
The normal starting dose for Vitamin D (Cholecalciferol) supplementation is 800 IU/day for all individuals except infants, who should start with 400 IU/day. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
Key Considerations
- The starting dose may need to be adjusted based on serum values, which vary with dietary intake and sun exposure.
- Maintenance doses should be adapted to annual serum values, preferably measured at the end of dark months.
- Vitamin D3 (cholecalciferol) is the preferred form of vitamin D supplementation.
Special Populations
- Infants should start with a dose of 400 IU/day, which can be advanced to a maximum of 1000 IU/day.
- Children between 1-10 years old can start with a dose of 800 IU/day, which can be advanced to a maximum of 2000 IU/day.
- Older children and adults can start with a dose of 800 IU/day, which can be advanced to a maximum of 4000 IU/day.
Monitoring and Adjustment
- Serum 25(OH)D levels should be monitored annually and 3-6 months after a dosage change.
- The goal is to maintain a serum 25(OH)D level of at least 20 ng/mL (50 nmol/L).
- Dosage adjustments should be made based on serum levels and individual patient needs.
It's essential to note that individual needs may vary based on factors like age, weight, geographic location, and overall health, and that excessive vitamin D can lead to toxicity, so doses should not exceed 4000 IU daily without medical supervision 1.
From the Research
Normal Starting Dose for Vitamin D (Cholecalciferol)
- The normal starting dose for Vitamin D (Cholecalciferol) is between 800 to 2000 international units (IU) per day for adults, as recommended by a European expert panel 2.
- This dose is also recommended for the treatment of vitamin D deficiency, but higher doses (e.g., 6000 IU per day) may be used for the first 4 to 12 weeks of treatment if a rapid correction of vitamin D deficiency is clinically indicated 2.
- The American Academy of Pediatrics recommends that infants and children receive at least 400 IU per day from diet and supplements, while evidence shows that vitamin D supplementation of at least 700 to 800 IU per day reduces fracture and fall rates in adults 3.
- For patients with documented vitamin D deficiency, a cumulative dose of at least 600,000 IU administered over several weeks appears to be necessary to replenish vitamin D stores, with a maintenance dose of 800-1000 IU per day 4, 5.
- Daily doses of 800-1000 IU with calcium have been shown to decrease falls and non-vertebral fractures in the elderly with vitamin D deficiency, and are recommended for patients with or at risk of osteoporosis 5, 6.