What supplements are recommended for hypovitaminosis D and iron deficiency?

Vitamin D and Iron Supplementation Recommendations for Hypovitaminosis D and Iron Deficiency

For this patient with vitamin D level of 28 ng/mL and iron deficiency (iron saturation 16%, ferritin 25), I recommend vitamin D3 (cholecalciferol) 2,000-3,000 IU daily and 150-200 mg of elemental iron daily.

Vitamin D Supplementation

Assessment and Recommendations

• The patient's vitamin D level of 28 ng/mL indicates vitamin D insufficiency (defined as 25(OH)D levels between 16-30 ng/mL) 1
• For vitamin D insufficiency, cholecalciferol (vitamin D3) is preferred over ergocalciferol (vitamin D2) due to higher bioefficacy 1
• Recommended dosage: 2,000-3,000 IU of vitamin D3 daily to achieve optimal serum levels of ≥30 ng/mL 1, 2
• Alternative dosing regimen: 50,000 IU every 4 weeks for maintenance therapy 1

Target Levels and Duration

• Treatment goal is to achieve serum 25(OH)D levels of 30-50 ng/mL (75-125 nmol/L) 3, 4
• Vitamin D levels should be rechecked after 3-6 months of supplementation to ensure adequate dosing 1
• Once optimal levels are achieved, continue with maintenance dose of 1,500-2,000 IU daily 1, 2

Iron Supplementation

Assessment and Recommendations

• The patient's iron saturation of 16% and ferritin of 25 indicate iron deficiency 1
• Recommended treatment: 150-200 mg of elemental iron supplements daily 1
• Iron supplements should be taken between meals rather than with meals to maximize absorption 1
• Avoid taking iron supplements with tea, as this can interfere with iron absorption 1

Monitoring and Duration

• Iron studies (ferritin, iron saturation) should be rechecked after 2-3 months of supplementation 1
• Continue supplementation until ferritin levels normalize (typically >50 ng/mL) and iron saturation improves to >20% 1

Supplement Selection Considerations

Vitamin D Brands/Types

• Any pharmaceutical-grade vitamin D3 (cholecalciferol) supplement is appropriate 2
• Look for USP (United States Pharmacopeia) verified products to ensure quality and accurate dosing 5
• Liquid or softgel formulations may have better absorption than tablet forms 6

Iron Brands/Types

• Ferrous sulfate, ferrous gluconate, or ferrous fumarate are all acceptable forms 1
• Consider iron formulations with vitamin C to enhance absorption 1
• Extended-release or enteric-coated formulations may reduce gastrointestinal side effects but may have lower absorption 1

Additional Considerations

• The patient's B12 level of 404 is within normal range and does not require supplementation 1
• Dietary modifications to increase vitamin D (fatty fish, egg yolks, fortified dairy) and iron (lean meats, legumes, dark leafy greens) should complement supplementation 1
• Monitor for potential side effects of iron supplementation, including constipation, nausea, and abdominal discomfort 1
• If gastrointestinal side effects occur with iron supplementation, consider starting with a lower dose and gradually increasing 1