Formulary
Alfacalcidol: Indications, Dosing, Side Effects and Interactions
Alfacalcidol clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Alfacalcidol: Indications, Dosing, Side Effects and Interactions
Alfacalcidol clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Patients with severe renal impairment requiring vitamin D therapy**
- **Adult** (By Mouth, Or By Intravenous Injection): Initially 1 microgram daily, dose to be adjusted to avoid hypercalcaemia; maintenance 0.25-1 microgram daily.
- **Elderly** (By Mouth, Or By Intravenous Injection): Initially 500 nanograms daily, dose adjusted to avoid hypercalcaemia; maintenance 0.25-1 microgram daily.
**Hypophosphataemic rickets,Persistent hypocalcaemia due to hypoparathyroidism or pseudohypoparathyroidism**
- **Child** (By Mouth, Or By Intravenous Injection): 12-17 years 1 microgram once daily, dose to be adjusted as necessary.
**Prevention of vitamin D deficiency in renal or cholestatic liver disease**
- **Child** (By Mouth, Or By Intravenous Injection): 12-17 years 250-500 nanograms once daily, dose to be adjusted as necessary.
**Hypophosphataemic rickets, Persistent hypocalcaemia due to hypoparathyroidism or pseudohypoparathyroidism for alfacalcidol**
- **Child 1 month-11 years** (By mouth, or by intravenous injection): 25-50 nanograms/kg once daily, dose to be adjusted as necessary; maximum 1 microgram per day.
- **Child 12-17 years** (By mouth, or by intravenous injection): 1 microgram once daily, dose to be adjusted as necessary.
**Persistent neonatal hypocalcaemia for alfacalcidol**
- **Neonate** (By mouth, or by intravenous injection): 50-100 nanograms/kg once daily, dose to be adjusted as necessary, in resistant cases higher doses may be needed; increased if necessary up to 2 micrograms/kg daily.
**Prevention of vitamin D deficiency in renal or cholestatic liver disease for alfacalcidol**
- **Neonate** (By mouth, or by intravenous injection): 20 nanograms/kg once daily, dose to be adjusted as necessary.
- **Child 1 month-11 years (body-weight up to 20 kg)** (By mouth, or by intravenous injection): 15-30 nanograms/kg once daily (max. per dose 500 nanograms).
- **Child 1 month-11 years (body-weight 20 kg and above)** (By mouth, or by intravenous injection): 250-500 nanograms once daily, dose to be adjusted as necessary.
- **Child 12-17 years** (By mouth, or by intravenous injection): 250-500 nanograms once daily, dose to be adjusted as necessary.
Cautions
Granulomatous diseases (risk of increased sensitivity to vitamin D); nephrolithiasis; take care to ensure correct dose in infants
Contraindications
D and analogues (systemic) Hypercalcaemia; metastatic calcification
Side effects
D and analogues (systemic) Common or very common Abdominal pain; headache; hypercalcaemia; hypercalciuria; nausea; skin reactions Uncommon Appetite decreased; arrhythmia; asthenia; constipation; diarrhoea; dry mouth; myalgia; vomiting; weight decreased Overdose Symptoms of overdosage include anorexia, lassitude, nausea and vomiting, diarrhoea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine. Side-effects For alfacalcidol Common or very common Abdominal discomfort; hyperphosphataemia; rash pustular Uncommon Malaise; urolithiases Rare or very rare Dizziness Frequency not known Confusion; renal impairment
Interactions
**Other interactions (9):**
- Patients taking digitalis and alfacalcidol concomitantly should be frequently monitored with ECG and measurements of plasma levels of digitalis glycosides and calcium.
- Thiazide diuretics and calcium containing preparations Use with caution in patients being treated with thiazide diuretics or calcium containing preparations as they may have an increased risk of...
- Other vitamin D containing preparations Vitamin D or its analogous should not be given concurrently with alfacalcidol as may enhance the risk of hypercalcaemia.
- Anticonvulsants Patients taking barbiturates or anticonvulsants may require larger doses of Alfacalcidol to produce the desired effect due to the induction of hepatic detoxification enzymes.
- Magnesium-containing antacids Magnesium based antacids and laxatives should not be used during treatment with alfacalcidol due to increased risk of hypermagnesaemia.
- Aluminium-containing preparations Alfacalcidol may increase the serum concentration of aluminium.
Pregnancy
D and analogues (systemic) High doses teratogenic in animals but therapeutic doses unlikely to be harmful.
Breast feeding
D and analogues (systemic) Caution with high doses; may cause hypercalcaemia in infant-monitor serum-calcium concentration.
Renal impairment
Patients with severe renal impairment requiring vitamin D therapy for alfacalcidol By mouth, or by intravenous injection Adult Initially 1 microgram daily, dose to be adjusted to avoid hypercalcaemia; maintenance 0.25-1 microgram daily. Elderly Initially 500 nanograms daily, dose adjusted to avoid hypercalcaemia; maintenance 0.25-1 microgram daily.
Medicinal forms
Solution,Capsule,Drops,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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