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Vitamin D3, controller calcium and phosphorus metabolism. Strengthens the intestinal absorption of calcium and phosphorus reabsorption in the renal tubules. It promotes the formation of skeleton and teeth in children, the preservation of bone structure. It is necessary for normal functioning of the parathyroid glands. It participates in the synthesis of ATP and lymphokines.

Pharmacokinetics
absorbed in the distal small intestine with bile acids in the blood binds to alpha 2 globulins and partially – albumin, transferred to the liver (first hydroxylation) is transformed into 25-hydroxycholecalciferol (calcidiol). This is a major circulating form, which in kidneys (second hydroxylation) is converted into the corresponding active form. The most important of these is the 1,25-dihydroxycholecalciferol (calcitriol).
Main place of deposit – fat tissue and muscles.
Vitamin D is excreted mainly with faeces. A slight amount of it is excreted in the urine.

Indications
Prevention and treatment of rickets, spazmofiliya, osteomalacia of various origins, metabolic osteopathy (hypoparathyroidism, pseudohypoparathyreosis), hypocalcemic tetany.

Contraindications
: Hypersensitivity to vitamin D3, hypercalcemia, giperkalydiuriya, sarcoidosis, calcium nefrourolitiaz, thyrotoxicosis (probability hypersensitivity), renal osteodystrophy with hyperphosphatemia, hypervitaminosis D.

Precautions :
atherosclerosis, heart failure, renal failure, pulmonary tuberculosis (active form), hyperphosphatemia, phosphate nefrourolitiaz, organic heart disease, acute and chronic liver and kidney disease, gastrointestinal disease (including gastric ulcer and duodenal ulcer ), during pregnancy and lactation, hypothyroidism.

Pregnancy and lactation
hypercalcemia during pregnancy can cause defects in physical and mental development of the fetus.
Since vitamin D3 and its metabolites into breast milk during pregnancy D3 daily dose should not exceed 600 the ME.

Dosing and Administration
The drug is used as an intramuscular injection or orally. Infants receiving milk with vitamin the D: 1/2 vials (ie 100 000 ME) every 6 months Infants breastfed or receiving milk with vitamin D, children at the age of 5 years: 1 vial (ie 200 000 ME) every 6 months, Teenagers: 1 USD (ie 200 000 ME) every 6 months during the winter Pregnant: 1/2 ampoule (ie 100000 ME) from 6 to 7 month of pregnancy, possible re-use of the same dose in the case of lack of sun, or the last trimester of pregnancy falls on the winter period. older people: 1/2 vials (ie 100 000 ME) every 3 month Adults or children with eating disorders:1/2 to 1 capsules (ie from 100 000 to 200 000 ME ME) every 3 months Adults or children with concomitant antiepileptic therapy: 1/2 to 1 capsules (ie. e from 100,000 to 200,000 ME ME) every 3 months. at deficiency of vitamin D3: 1 ampoule (i.e. 200 000 ME), once again use is recommended within the next 1-6 months. For accurate to use the required volume of the drug glass syringe

Side effects

Hyperphosphatemia, hypercalcemia, hypercalciuria, anorexia, polyuria, constipation, headache, myalgia, arthralgia, increase aretrialnogo pressure, arrhythmia, renal insufficiency, and allergic reactions.

Overdose
Symptoms of vitamin D hypervitaminosis:
early (due to hypercalcemia) – constipation or diarrhea, dryness of the oral mucosa, headache, pollakiuria, nocturia, polyuria, anorexia, metallic taste, nausea, vomiting, unusual tiredness, weakness, hypercalcemia, . hypercalciuria
Late: bone pain, clouding of urine (appearance of hyaline casts in urine, proteinuria, leukocyturia), increased blood pressure, itching, fotochustvitelnost eye, conjunctival hyperemia, arrhythmia, drowsiness, myalgia, nausea, vomiting, pancreatitis, gastralgia, weight loss, rare – psychosis (a change of mentality and mood).
Symptoms of chronic deficiency of vitamin D. When taken for a few weeks or months to adults in doses of 20-60 thousand IU / day, children – 2-4 thousand IU / day)..:. calcification of soft tissues, kidneys, lungs, blood vessels, hypertension, renal and chronic heart failure (these effects occur most frequently when attaching the related hypercalcemia, hyperphosphatemia), growth disorders in children (long-term use at a dose of 1.8 IU / day).
Treatment: removal of the drug, a diet low in calcium, consumption of large quantities of liquid, the appointment of glucocorticosteroids, a-tocopherol, ascorbic acid, retinol, thiamine, in severe cases – intravenous administration of large amounts of 0.9% sodium chloride solution, furosemide, electrolytes, hemodialysis.
no specific antidote does not exist.
to exclude overdose in some cases, it is recommended to define the blood calcium concentration (see. “Special instructions”).

Interaction with other drugs
The risk of hypercalcaemia increase thiazide diuretics. Effect reduce phenytoin (increase biotrasformatsii speed); cholestyramine, corticosteroids, calcitonin and derivatives etidronovoy pamidronic acids plikamitsin, gallium nitrate, reduces toxicity – vitamin A. The rate of biotransformation increase barbiturates. It increases the toxicity of cardiac glycosides. Long-term therapy on the background of the simultaneous use of antacids containing aluminum and magnesium, increases their concentration in the blood and the risk of intoxication (especially in nalichichii chronic renal failure).
Cholestyramine, colestipol, mineral oil reduces the absorption of fat-soluble vitamins in the digestive tract and need to increase their dosage. Increases the absorption of phosphorus-containing drugs and the risk of hyperphosphataemia.
Together with the application of sodium fluoride dozhen interval between doses of at least 2 hours, with oral forms of tetracycline -. At least 3 hours
The simultaneous use of other analogues of vitamin D3 increases the risk of hypervitaminosis.

Cautions
When using doses up to 1000 IU / day, and while continuously taking the drug for several months, it is recommended periodic determination of serum calcium and phosphorus concentrations to avoid chronic hypervitaminosis D3 and hyperphosphatemia.
To prevent hyperphosphatemia development in patients with bone lesions of renal origin, the drug can be administered together with phosphate resources. steroiden bijwerkingen