Calcirol

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What is Calcirol?

Calcirol is high-dose oral cholecalciferol (vitamin D3) supplied as 60,000 IU granule sachets by Cipla. It is the most widely used vitamin D loading regimen on the Indian subcontinent and works equally well in any population with documented deficiency. Cholecalciferol is the same molecule the skin synthesises from 7-dehydrocholesterol on UV-B exposure; it is hydroxylated to 25-hydroxyvitamin D in the liver and to 1,25-dihydroxyvitamin D (calcitriol) in the kidney.

Indikationer

• Vitamin D deficiency (serum 25-OH-D < 20 ng/ml or < 50 nmol/l)
• Vitamin D insufficiency (20–30 ng/ml or 50–75 nmol/l)
• Osteomalacia in adults and rickets in children (specialist supervision)
• Adjunct in osteoporosis treatment alongside bisphosphonates and calcium
• Pregnancy and lactation in documented deficiency (lower-dose maintenance after loading)
• Post-bariatric surgery malabsorption
• Long-term anticonvulsants (phenytoin, carbamazepine, phenobarbital induce vitamin D catabolism)

How to take

Empty the sachet contents into a glass of milk or water, stir, and drink. Best taken with the largest fat-containing meal of the day — vitamin D is fat-soluble and absorption is meaningfully better with fat in the meal.

Biverkningar

At standard doses Calcirol is exceptionally well tolerated. At high cumulative doses or with monitoring lapses:

• Hyperkalcemi — nausea, anorexia, constipation, polyuria, polydipsia, confusion (rare with proper dosing)
• Hypercalciuria — can precipitate kidney stones
• Mjukdelskalcifiering at sustained toxic levels

Läkemedelsinteraktioner

• Tiaziddiuretika — potentiate hypercalcaemia risk; monitor calcium
• Anticonvulsants (phenytoin, carbamazepine, phenobarbital) — induce vitamin D catabolism, may need higher doses
• Glucocorticoids — antagonise vitamin D action; long-term steroid users often need higher doses
• Cholestyramine, orlistat, mineral oil — reduce fat-soluble vitamin absorption; separate by 4 hours
• Digoxin — hypercalcaemia increases digoxin toxicity risk

Kontraindikationer

• Hypercalcaemia of any cause
• Hypervitaminos D
• Active sarcoidosis or other granulomatous disease (extra-renal 1-α-hydroxylation can cause severe hypercalcaemia)
• Severe renal impairment (use alfacalcidol — see Alphadol — or calcitriol instead)

Förvaring

Store below 25°C. Keep dry. Use immediately after opening the sachet.

Vanliga frågor

Why 60,000 IU and not a daily 1,000 IU tablet?

Both work. Weekly 60,000 IU loading achieves replete 25-OH-D faster (typically by week 8 versus 3–6 months for daily 1,000 IU) and adherence is much better — one weekly sachet is harder to forget than a daily tablet. After loading, the choice is preference: monthly sachet or daily 1,000–2,000 IU.

Should I take calcium with Calcirol?

Only if dietary calcium is low or osteoporosis is being treated. Vitamin D supplementation alone is enough to correct deficiency in most patients with adequate dietary calcium (>700 mg/day from dairy, leafy greens, tofu, sardines).

How quickly will I feel better?

If symptoms (fatigue, bone pain, muscle weakness) are due to confirmed deficiency, expect partial improvement at 4–6 weeks and full benefit by 12 weeks. Many patients with vague fatigue do NOT have deficiency-driven symptoms — check the level first rather than assuming.

Can I take Calcirol in pregnancy?

Yes, in documented deficiency under obstetric guidance. Vitamin D in pregnancy supports fetal bone development, reduces gestational diabetes risk, and is safe at doses up to 4,000 IU/day. Avoid megadose loading without supervision.

How does Calcirol differ from Arachitol 6L Injection?

Calcirol is oral (granule sachet, 60,000 IU per dose, weekly). Arachitol 6L Injection is intramuscular (6,00,000 IU = 600,000 IU per dose, single annual injection in selected severe-deficiency cases). The IM depot is reserved for severe malabsorption, very poor adherence, or when rapid loading is needed.

How does it differ from Alphadol (alfacalcidol)?

Calcirol is cholecalciferol — the precursor that requires liver and kidney activation. Alphadol is alfacalcidol — pre-activated by skipping the renal 1-α-hydroxylation step. Alphadol is used in chronic kidney disease where the kidney cannot activate cholecalciferol; everyone else uses Calcirol.

What is the target 25-OH-D level?

Most guidelines target 30–50 ng/ml (75–125 nmol/l). Above 50 ng/ml has no proven additional benefit. Above 100 ng/ml is approaching toxicity and should prompt dose reduction.

Is taking it long-term safe?

Yes, at maintenance doses with periodic 25-OH-D monitoring. Many patients with limited sun exposure (high latitude, indoor occupations, modest clothing, dark skin) need lifelong supplementation. The weekly-then-monthly Calcirol regimen is comfortable to maintain for years.

Will Calcirol prevent COVID-19?

No. The early-pandemic claim that vitamin D supplementation prevents COVID-19 has not been confirmed by randomised trials. Correcting deficiency is worth doing for established benefits (bone, muscle, fall prevention); supplementing the already-replete patient adds nothing.

Can children take Calcirol?

Yes, under paediatric supervision for documented deficiency or rickets. Dosing is weight-based and lower than adult loading. Routine prophylaxis in well children is typically 400 IU/day from birth (UK / WHO guidance), not high-dose sachets.

Andra vitaminer och mineraler

• Calcirol — kolekalciferol 60 000 IU påse
• Arachitol 6L Injektion — kolekalciferol 6,00,000 IU IM depot
• Alphadol — alfacalcidol för CKD-relaterad brist
• Cipcal — kalciumkarbonat + vitamin D
• Topcal M — kalcium + magnesium + vitamin D
• Osteofos — alendronsyra mot osteoporos

Medicinsk ansvarsfriskrivning

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