Q J Med 1991; 78: 113-122
© 1991 Association of Physicians
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A Prospective Study to Evaluate the Dose of Vitamin D Required to Correct Low 25-Hydroxyvitamin D Levels, Calcium, and Alkaline Phosphatase in Patients at Risk of Developing Antiepileptic Drug-Induced Osteomalacia
From the Department of Neurology and Clinical Investigation Unit, Cork Regional Hospital, and the Department of Medicine and Statistics, University College Cork Ireland
Address correspondence to Dr N. Callaghan, Department of Neurology, Regional Hospital, Wilton, Cork, Ireland
Accepted for publication 6 August 1990.
The dose of vitamin D3 required to maintain normal serum 25-hydroxyvitamin D levels in epileptic patients was evaluated in a prospective study. Patients were divided into two groups, comprising 14 institutionalized and 18 non-institutionalized subjects; they were taking carbamazepine, phenytoin and phenobarbitone, alone or in combination. The study was divided into a dose titration stage and a further period of assessment on a fixed dose after attainment of normal serum 25-hydroxyvitamin D levels. Seventeen of the 18 non-institutionalized patients achieved normal levels over a period of 12 months; the remaining patient became normal after 15 months. The dose required to achieve normal levels ranged from 400 to 4000 IU/day; three patients required <2400 IU vitamin D3, 12 required 2400 IU and three required > 2400 IU. All institutionalized patients achieved normal levels over a period of 12 months, six patients required < 2400 IU, six required 2400 IU and two required > 2400 IU vitamin D3.
Raised alkaline phosphatase levels occurred in 11 patients, and reverted to normal in six patients during the initial return of 25-hydroxyvitamin D levels to normal. During the second 12 months, when patients were taking a fixed dose of vitamin D3 alkaline phosphatase increased in five patients who had achieved normal levels. During this phase normal 25-hydroxyvitamin D levels were not maintained in five patients. There was a significant seasonal variation of 25-hydroxyvitamin D levels in institutionalized patients, being highest in June and lowest in December. Our findings show that while there was a wide range in the dose required to achieve normal serum 25-hydroxyvitamin D levels—between 400 and 4000 IU/day—78 per cent of patients responded to a dose of 2400 IU/day.
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