Correcting vitamin D deficiency using over-the-counter supplements.

A patient was seen in a mass-merchandiser community pharmacy for medication therapy management services. The patient was taking over-the-counter vitamin D3 for the treatment of deficiency. Her therapy had increased her vitamin D serum levels, but not sufficiently. The literature was evaluated to establish that she is indicated for supplementation, to determine what an appropriate vitamin D level would be for this patient, and appropriately select a therapeutic regimen. This patient had several risk factors for low vitamin D levels including her race, weight, and age. After reviewing the recommendations for vitamin D supplementation, it was determined that an appropriate vitamin D serum level for this patient would be between 30 ng/dL and 40 ng/dL. Her original serum level of 10.2 ng/dL indicated that she was a candidate for supplementation. Generally, 1,000 IU daily of vitamin D will produce an increase of 10 ng/dL. This proved to be true with our patient, who had a level of 22.1 ng/dL after four months of treatment. She therefore needed an increase to 2,000 IU daily to further raise her levels and put her within her target goal. After working with the physician, the patient was started on 2,000 IU of vitamin D3 daily. A vitamin D serum concentration obtained after three months showed the patient reached her goal with a level of 35.4 ng/dL. The patient was put on a maintenance dosage of 800 IU daily and will receive periodic follow-up.