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Prescription Ergocalciferol Dosing for Vitamin D Repletion: A Retrospective Evaluation
Author(s) -
Vande Griend Joseph P.,
McQueen Robert B.,
Linnebur Sunny A.,
Vondracek Sheryl F.
Publication year - 2012
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1052
Subject(s) - ergocalciferol , medical prescription , medicine , vitamin d and neurology , logistic regression , dosing , vitamin d deficiency , vitamin , regimen , retrospective cohort study , cholecalciferol , pharmacology
Study Objectives To determine the efficacy and safety of vitamin D repletion with prescription ergocalciferol and to determine patient‐specific factors that may influence the amount of ergocalciferol needed to attain vitamin D sufficiency. Design Retrospective medical record review. Setting University‐affiliated outpatient health system. Patients A total of 1446 patients aged 18–89 years who had a prescription for ergocalciferol 50,000 IU between January 1, 2007, and December 31, 2008, were identified; of these patients, 582 patients had a vitamin D concentration measured 120 days before their first prescription (baseline) and had another concentration measured 60–180 days after this prescription (follow‐up) and were deemed “first‐time users” of ergocalciferol. Measurements and Main Results Vitamin D sufficiency was defined as a 25‐hydroxyvitamin D (vitamin D) concentration of 30 ng/ml or higher. Twenty‐nine different ergocalciferol prescribing regimens were identified in the 1446 patients. For the 582 first‐time users of ergocalciferol, vitamin D concentrations increased from a mean ± SE of 17.7 ± 0.32 ng/ml at baseline to 32.9 ± 0.73 ng/ml at first follow‐up concentration, with a mean ± SE prescribed ergocalciferol dose of 63,876 ± 1973 IU given over an average of 17 weeks. Overall, 326 (56%) of the 582 first‐time users attained sufficiency with their prescribed regimen. With use of a logistic regression model to control for variables that could influence a patient's response to vitamin D, patients prescribed 50,000–100,000 IU/week were significantly more likely to attain vitamin D sufficiency compared with those prescribed less than 50,000 IU/week (OR 2.61, 95% CI 1.37–4.99). Body mass index of 30 kg/m 2 or higher decreased the odds of attaining vitamin D sufficiency, whereas use of a loading dose did not increase the odds of attaining sufficiency. Conclusion Many different ergocalciferol regimens were used to replace vitamin D, and overall attainment of vitamin D sufficiency appeared to be moderate. Based on our findings, 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.