2010/06/08

Colecalciferol

Mode of action:
Tool, fills a deficiency of vitamin D3. Participates in the regulation of calcium-phosphorus metabolism, increases absorption of Ca2 + and phosphate in the intestine (by increasing the permeability of cell and mitochondrial membranes of the intestinal epithelium), and their reabsorption in the renal tubules of the kidneys, promotes bone mineralization and formation of skeleton and teeth in children, strengthens the process of ossification is necessary for normal functioning parathyroid glands. Vitamin D3 is formed in the skin under the influence of UV rays from the provitamin 7-degidroholesterina. In order to maintain normal levels of vitamin D in blood serum of sufficient exposure to sunlight only the face and hands of the child for 2 hours a week, and UV radiation, the mother (1.5 erythemic minimum dose to the whole body for 90 s) increases levels of vitamin D3 in its milk 10 times.

Indications:
Hypo-and vitamin deficiency of vitamin D (prevention and treatment), the state increased the body's need for vitamin D: rickets, osteomalacia, osteoporosis, Renal osteopathy, inadequate and unbalanced nutrition (including parenteral, vegetarian diet), malabsorption syndrome, lack of insolation , hypocalcemia, hypophosphataemia (including family), alcoholism, liver failure, cirrhosis, jaundice, diseases of the digestive tract (gluteinovaya enteropathy, persistent diarrhea, tropical sprue, Crohn's disease), rapid weight loss, pregnancy (especially nicotine and drug dependence , multiple pregnancy), lactation, newborn babies who are breastfed, the lack of insolation, receiving barbiturates, kolestiramina, colestipol, mineral oil, anticonvulsive drugs (including phenytoin and primidona). Gipoparatireoz: postsurgical, idiopathic, tetany ( postoperative and idiopathic), psevdogipoparatireoz.

Contraindications:
Hypersensitivity, hypercalcemia, hypervitaminosis D, renal osteodystrophy with giperfosfatemiey.C caution. Atherosclerosis, sarcoidosis or other granulomatosis, CHF, nefrourolitiaz history, hyperphosphatemia, chronic renal failure, pregnancy, lactation, children's age.

Side effects:
Allergic reactions. Hypercalcemia, hypercalciuria, decreased appetite, polyuria, constipation, headache, myalgia, arthralgia, increased blood pressure, arrhythmia, renal failure, exacerbation of tuberculous process in legkih.Peredozirovka. Symptoms of hypervitaminosis of vitamin D: early (due to hypercalcemia) - constipation or diarrhea, dryness of the oral mucosa, headache, thirst, thamuria, nocturia, polyuria, anorexia, metallic taste in the mouth, nausea, vomiting, unusual tiredness, weakness, hypercalcemia , hypercalciuria; later - bone pain, clouding of urine (appearance in the urine hyaline cylinders, proteinuria, leukocyturia), increased blood pressure, itching, photosensitivity of the eyes, conjunctival hyperemia, arrhythmia, drowsiness, myalgia, nausea, vomiting, pancreatitis, stomachalgia, weight loss rarely - mental changes (up to the development of psychosis) and mood. Symptoms of chronic intoxication with vitamin D (at reception for a few weeks or months to adults in doses of 20-60 thousand m / day, children - 2-4 thousand m / d): calcification of soft tissues, kidneys, lungs, blood vessels, hypertension, kidney failure and the SSA until death (these effects are most often arise in the accession of hypercalcaemia hyperphosphataemia), dysplasia in children (long term administration of a dose of 1.8 thousand IU / day). Treatment: removal of the drug, a diet low in Ca2 +, the consumption of large amounts of fluid, the appointment of the SCS, alpha-tocopherol, ascorbic acid, retinol, thiamine, in severe cases - in / to the introduction of large amounts of 0.9% solution of NaCl, furosemide, electrolytes, hemodialysis.

Dosage and administration:
Inside or / m, for the prevention of rickets - a dose of 200 thousand m (5 mg) 1 every 6 months (up to 5 years). If a child is rarely in the sun or the skin hyperemic, a single dose increased to 400 thousand m, is introduced as a semi-annual (5 years). Treatment of rickets and hypocalcemia spazmofilii - 200 thousand m 1 times per week for 2 weeks (in combination with drugs Ca2 +). To prevent tetany attacks - up to 1 million IU / day. In osteomalacia and osteoporosis - 200 thousand m every 15 days for 3 months. drops for oral administration (1 cap = 500 IU): for the prevention of rickets infants (term), beginning with 2 weeks of life - every day, 500 IU / day, in special circumstances (eg premature babies) - up to 1000 IU / day when I prematurity Art. and 1000-2000 IU / day) with prematurity II and Stage III. (Excluding summer months) for the treatment of rickets - at 2000-5000 IU / day in 2-3 reception for 1-1.5 months, and then move on to maintenance therapy - 500 IU / day) for 2 years and in winter for 3 year of life. A dose of 5000 IU is assigned only when expressed by bone changes. 3 months after completion of a course of at-risk children to repeat courses antirecurrent treatment of 2000-5000 IU / day for 3-4 weeks, except in the summer months. Babies suffering spazmofiliey - 5000 IU 3 times a day. adults for the prevention of osteomalacia - by 500-1000 IU 3 times a day, for the treatment of osteomalacia - up to 2500 IU 3 times a day. When gipoparatireoze and psevdogipoparatireoze - to 7500-15000 IU / day). It is necessary to monitor the concentration of Ca2 + in the blood every 3-6 months and if necessary correction of dosing regimen.

Cautions:
The daily requirement of vitamin D3 for adults - 400 IU (10 mcg). Use under close medical supervision concentration Ca2 + in blood and in urine (especially in combination with thiazide diuretics). When prophylactic use is necessary to bear in mind the possibility of overdose, especially in children (not should appoint more than 10-15 mg per year). Prolonged use at high doses leads to chronic hypervitaminosis D3. It should be borne in mind that the sensitivity to vitamin D in different patients is individual and in some patients receiving therapeutic doses can even cause the phenomenon of hypervitaminosis sensitivity. infants of vitamin D may be different, some of them may be sensitive even to very low doses. Children receiving vitamin D over a long period of time, and increased risk of growth retardation. To prevent hypovitaminosis D is the preferred balanced diet. Infants who are breastfed, especially born to mothers with dark skin and / or receive little solar exposure, have a high risk a shortage of vitamin D. In animal experiments demonstrated that calcitriol in doses of 4-15 times the recommended dose for humans, has a teratogenic effect. Hypercalcaemia in the mother (associated with prolonged overdose of vitamin D during pregnancy) can cause the fetus increased sensitivity to vitamin D, suppression of the function of the parathyroid glands, syndrome-specific elfopodobnoy appearance, mental retardation, aortic stenosis. In old age the need for vitamin D may increase due to reduced absorption of vitamin D, reducing the ability of skin to synthesize pro-vitamin D3, reducing the time of insolation, increasing the incidence of renal failure.

Interactions:
Toxic effects of impaired vitamin A, tocopherol, ascorbic acid, pantothenic acid, thiamine, riboflavin. In hypervitaminosis D may strengthen action of cardiac glycosides and increased risk of arrhythmias caused by the development of hypercalcemia (expedient correction doses of cardiac glycosides). Under the influence of barbiturates (including h. phenobarbital), phenytoin and primidona need kolekaltsiferole significantly increase (increase the rate of metabolism). Long-term therapy on the background of the simultaneous application of Al3 + and Mg2 +-containing antacids increases their concentration in the blood and the risk of intoxication (especially in the presence of CRF). Calcitonin, derivatives etidronovoy and pamidronovoy acids plikamitsin, gallium nitrate, and reduce the effect of SCS. Kolestiramin, colestipol, mineral oil reduces the absorption of fat-soluble vitamins in the digestive tract and need to increase their dosage. Increases absorption of phosphorus-containing drugs and the risk of hyperphosphataemia. With simultaneous application of sodium fluoride as the interval between doses must be at least 2 hours, with oral forms of tetracycline - at least 3 h. The simultaneous use of other analogues of vitamin D increases the risk of hypervitaminosis.