Issues for surgery
Risk of vitamin D deficiency if omitted for prolonged period.
Reduced protection against osteoporosis if discontinued for prolonged period.
Risk of hypercalcaemia and / or hyperphosphataemia, particularly at high dose, if continued (particularly in combination with calcium supplementation).
Advice in the perioperative period
Elective and emergency surgery
Continue, including the following combination products:
- Colecalciferol with calcium carbonate (see also calcium carbonate)
- Colecalciferol with calcium phosphate
Except:
- Combination product containing alendronic acid and colecalciferol – see alendronic acid.
- Combination product containing risedronate and calcium carbonate and colecalciferol – see risedronate and calcium carbonate.
Consider checking serum calcium levels pre-operatively.
Be aware doses and frequency vary depending on if prescribed for treatment or maintenance – confirm dose and frequency with patient or carer.
Patients undergoing bariatric surgery or emergency orthopaedic surgery
Consider checking serum vitamin D levels pre-operatively – refer to local guidelines if vitamin D levels are low.
Post-operative advice
Restart post-operatively, when dose next due, once enteral intake resumed.
Monitor renal function post-operatively. Patients with reduced renal function post-operatively should have their vitamin D supplementation reviewed as appropriate.
Care if phosphate supplementation is required post-operatively since there is a potential risk of hypercalcaemia with concomitant vitamin D supplementation.
Patients undergoing bariatric surgery
Please refer to the British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery for post-operative management of vitamin D.
Interactions with common anaesthetic agents
None.
Interactions with other common medicines used in the perioperative period
Concomitant use of glucocorticoids can decrease the effect of vitamin D. Whilst single perioperative doses should not pose a problem, continued post-operative treatment may require close monitoring.
Further information
None relevant.
References
O-Kane M, Paretti HM, Pinkeny J et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for bariatric patients undergoing bariatric surgery – 2020 update. Obesity Reviews 2020; 21(11); e13087 http:doi.org/10.1111/obr.13087
Summary of Product Characteristics – STRIVIT-D3 20,0000 (colecalciferol; cholecalciferol) 20,000 IU Capsules, Soft. Strides Pharma UK Ltd. Accessed via www.medicines.org.uk 14/03/2023 [date of revision of the text February 2023]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 14th March 2023]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press http://www.medicinescomplete.com [Accessed on 14th March 2023]