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Recommendations for vitamin D intake and treatment for children and adults with cystic fibrosis

Recommendations for vitamin D intake and treatment for children and adults with cystic fibrosis
  Routine dosing* of vitamin D3 Step 1Δ
dose increase		 Step 2◊
dose titration maximum		 Step 3§
0 to 12 months 10 to 12.5 mcg/day
(400 to 500 units/day)		 20 to 25 mcg/day
(800 to 1000 units/day)		 50 mcg/day
(2000 units/day)		 Refer
1 to 10 years 20 to 25 mcg/day
(800 to 1000 units/day)		 40 to 75 mcg/day
(1600 to 3000 units/day)		 100 mcg/day
(4000 units/day)		 Refer
11 to 18 years 20 to 50 mcg/day
(800 to 2000 units/day)		 40 to 150 mcg/day
(1600 to 6000 units/day)		 250 mcg/day
(10,000 units/day)		 Refer
Over 18 years 20 to 50 mcg/day
(800 to 2000 units/day)		 40 to 150 mcg/day
(1600 to 6000 units/day)		 250 mcg/day
(10,000 units/day)		 Refer
Stepwise approach to vitamin D replacement and monitoring, as recommended by the CFF. Target serum 25-hydroxyvitamin D (25OHD) levels are at least 30 ng/mL (75 nmol/L). Serum 25OHD levels should be checked at least annually (preferably near the end of winter), and approximately three months after a change in vitamin D dose.
CF: cystic fibrosis; CFF: Cystic Fibrosis Foundation.
* Routine dosing of vitamin D3 (cholecalciferol) is achieved with use of CF-specific multivitamins.
¶ Conversion: for vitamin D, 1 microgram = 40 units
Δ Step 1: If serum 25OHD is less than 30 ng/mL (or <75 nmol/L), with good adherence to supplements, increase to step 1 dose as shown.
◊ Step 2: If serum 25OHD is 10 to 20 ng/mL (or 25 to 50 nmol/L), with good adherence to supplements, or if unable to achieve a serum 25OHD level of at least 30 ng/mL after treatment with step 1 doses, increase dose and titrate as needed, up to the maximum dose shown.
§ Step 3: If serum 25OHD is less than 10 ng/mL (or <25 nmol/L), with good adherence to supplements, or if unable to achieve a serum 25OHD level of at least 30 ng/mL after treatment with step 2 doses, refer to a specialist with expertise in vitamin D therapy.
Modified with permission from: Tangpricha V, Kelly A, Stephenson K, et al. An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis: Evidence-based recommendations from the Cystic Fibrosis Foundation. J Clin Endocrinol Metab 2012; 97:1082. Copyright © 2012 The Endocrine Society.
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