Vitamin A Repletion Dosing Regimen

For vitamin A deficiency in adults, the recommended treatment is 10,000-25,000 IU oral vitamin A daily for 1-2 weeks for clinical improvement. 1

Age-Specific Dosing for Vitamin A Deficiency

Treat vitamin A deficiency with 10,000-25,000 IU oral vitamin A daily for 1-2 weeks 1
Recheck vitamin A levels at 3 months after treatment 1
For vitamin A deficiency that does not respond to oral treatment, refer to a specialist for assessment and consideration of intramuscular vitamin A injections 1

For children with eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), follow this treatment schedule: 1
- 200,000 IU oral vitamin A on day 1
- 200,000 IU oral vitamin A on day 2
- 200,000 IU oral vitamin A 1-4 weeks later
- Children less than 12 months of age receive half doses (100,000 IU)

All children with severe malnutrition (WFH Z-score less than -3) should receive the full treatment schedule as above 1
This treatment is critical as vitamin A deficiency increases mortality risk in malnourished children 2

Children with measles complications (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems) should receive: 1
- 200,000 IU vitamin A on day 1
- A second dose of vitamin A on day 2
- Children less than 12 months of age receive half doses (100,000 IU)
This two-dose regimen has been shown to reduce overall mortality and pneumonia-specific mortality, with greatest effect in children under two years 3

Children 12 months to 5 years of age: 200,000 IU every 3-6 months 1
Infants less than 12 months of age: 100,000 IU every 3-6 months (total 400,000 IU in first year of life) 1

Mothers should receive 200,000 IU within 2 months of giving birth to provide adequate vitamin A in breast milk 1
If supplementation cannot be provided within 2 months of giving birth, mothers should receive 100,000 IU during the third trimester of pregnancy 1

Document all doses of vitamin A on the child's growth record chart 1
Recheck vitamin A levels 3 months after treatment in adults 1
Monitor for clinical improvement in night vision and other symptoms of deficiency 1

Vitamin A toxicity is rare but possible, particularly with prolonged high doses 1
Acute toxicity (>150,000 μg) can present with increased intracranial pressure (headache, nausea/vomiting, vertigo, blurred vision) 1
Chronic toxicity (approximately 30,000 μg/day) can present with bone abnormalities, dermatitis, alopecia, and other symptoms 1
Avoid doses above 10,000 IU in women during the first trimester of pregnancy due to potential teratogenic effects 2
For adolescents with vitamin A deficiency, specialist referral is recommended 1

For vitamin A deficiency that does not respond to standard oral treatment, refer to specialists for assessment and consideration of intramuscular vitamin A injections 1
Consider investigating for underlying malabsorption or other causes of persistent deficiency 1