Vitamin D: Prescription vs. over the counter

Vitamin D is a vital nutrient your body gets from food and sunlight. Many people take OTC supplements to help keep their vitamin D levels within the recommended range. 

If you have a vitamin D deficiency, you may be able to treat it through diet and supplementing with OTC products. However, some medical conditions or a severe deficiency may mean you need to take prescription-strength vitamin D.

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What to know about prescription vitamin D

A doctor may prescribe vitamin D in higher doses than OTC options if you have a severe condition that makes it difficult for your body to produce vitamin D. This can include kidney or liver failure.

Taking too much vitamin D comes with a risk of side effects and toxicity, so healthcare professionals rarely prescribe high doses unless necessary. A healthcare professional will also monitor you while you’re taking high dose vitamin D.

Prescription vitamin D can come in two forms. Prescription vitamin D2 is known as ergocalciferol. The medication is available in generic form and under the brand name Drisdol. Both come in capsules that contain 50,000 international units (IU) of vitamin D. 

Prescription vitamin D3 is called cholecalciferol or as its brand name Decara. This comes in either 25,000 IU or 50,000 IU.

A doctor may prescribe this form of high dose vitamin D if you have:

• hypoparathyroidism
• refractory rickets (vitamin D-resistant rickets)

According to the product label for Drisdol, the dosage recommendations are as follows:

• Vitamin D-resistant rickets: 12,000 IU to 500,000 IU units daily.
• Hypoparathyroidism: 50,000 IU to 200,000 IU units daily with 4 grams (g) of calcium six times daily.

Both the generic and brand labels note the range between helpful doses of ergocalciferol and toxic doses is narrow, and close medical supervision is necessary when taking this medication.

The main adverse reaction to high dose vitamin D is vitamin D toxicity, also known as hypervitaminosis D.

The effects can include:

• impaired kidney function
• irritability
• osteoporosis
• nausea
• constipation
• anemia

It’s important to seek medical attention if you think you may be experiencing signs of vitamin D toxicity.

Combination and topical products containing vitamin D

Some medications have Food and Drug Administration (FDA) approval that contain vitamin D but aren’t suitable for treating vitamin D deficiency. Instead, a doctor may prescribe them for conditions like osteoporosis.

Examples include:

• Alendrondate and cholecalciferol (Fosamax Plus D): While regular Fosamax contains only alendrondate, Fosamax Plus D contains both alendrondate and vitamin D at doses of 2,800 IU and 5,600 IU. This medication is FDA approved to treat osteoporosis.
• Calcipotriene (Dovonex): Calcipotriene is a topical medication and a synthetic form of vitamin D3 that helps treat psoriasis.
• Calcitriol (Vectical): Calcitriol is a topical medication that helps treat mild to moderate plaque psoriasis.

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What to know about OTC vitamin D supplements

If a doctor recommends supplementing with vitamin D, you may be able to get the recommended dose OTC.

According to the Office of Dietary Supplements, adults between 19 and 70 years need 600 IU of vitamin D daily. Adults ages 71 years and older need 800 IU daily. 

The upper limit of vitamin D in people 19 years and older is typically 4,000 IU. However, if you have a deficiency, a doctor may recommend you take more than this for a set period. The upper limit includes vitamin D from all sources, including food and supplements. 

Vitamin D supplements are available in two forms: D2 and D3. Both types can help raise the levels of vitamins in your blood, although vitamin D3 may raise levels more and for a longer period.

Vitamin D2 is typically made from plant-based sources, while vitamin D3 is typically animal-sourced.

Natural food sources of vitamin D include:

• fatty fish like trout and salmon
• fish liver oils
• beef liver
• egg yolks
• cheese
• mushrooms

In addition to these natural sources, many foods are fortified with vitamin D. This means the manufacturer has added the vitamin to the product. Common examples of fortified foods include milk and plant-based alternatives like soy and almond beverages.

How to choose the best option for you

If you’re concerned about your vitamin D levels, consider speaking with a healthcare professional about whether they can order a blood test. If you have a deficiency, a doctor can recommend which of the following options may be most suitable for you:

• increasing your food intake of vitamin D
• taking OTC vitamin D supplements
• taking prescription vitamin D supplements

Certain groups of people are more likely to have low vitamin D levels, including:

• older adults
• people who rarely expose their skin to sunshine
• individuals with darker skin tones
• people who have had gastric bypass surgery
• those with medical conditions like Crohn’s disease, celiac disease, or ulcerative colitis

If you fall into one of these groups and think you may be experiencing vitamin D deficiency, consider speaking with a healthcare professional.

Summary

Vitamin D is a vital nutrient, but many people don’t get enough through diet and sun exposure.

Taking OTC supplements can help increase your vitamin D levels.

However, very high doses of vitamin D are available via prescription only. A doctor may prescribe a high dose of vitamin D if you have a severe deficiency or a specific medical condition. 

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