it is recommended to re-check vitamin D levels 6 months after a course of high dose vitamin D replacement
if levels are still sub-optimal, compliance with medication should be discussed with the patient, then treatment repeated. Re-testing should not be done sooner than 6 months after starting treatment, as it can take 6 months to reach steady state on treatment
treatment with high dose vitamin D is unlikely to lead to toxicity. If concerned, serum calcium levels are a more appropriate indicator of toxic levels of vitamin D.
Notes:
salcium and vitamin D combined supplements are not routinely indicated in patients with low vitamin D3 levels unless the patient also has hypocalcaemia. The calcium component may be unnecessary and can reduce compliance due to unpalatability. Serum calcium levels should, however, be monitored
short acting potent analogues of vitamin D such as alfacalcidol or calcitriol should NOT be used in the management of vitamin D deficiency in adults because there is no evidence to support efficacy and it can lead to hypercalcaemia
Reference:
1) NHS Coventry and Warwickshire. Brief Prescribing guide - Treatment of Vitamin D Deficiency in Adults (February 2012)
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