Colecalciferol Sandoz 500 IE, tabletten

Cholecalciferol Sandoz 500 IE, tabletten contains vitamin D3 (equivalent to cholecalciferol) for the regulation of the absorption and metabolism of calcium and for the integration of calcium into bone tissue.

Cholecalciferol Sandoz 500 IE, tabletten is used

• for prophylaxis of rickets (impaired bone hardening during the growth phase).
• for prophylaxis in persons at a known risk of vitamin D deficiency.
• for the supportive treatment of osteoporosis (thinning of bone tissue).

Do not take Cholecalciferol Sandoz 500 IE, tabletten:

• if you are allergic to cholecalciferol or any of the other ingredients of this medicine (listed in section 6).
• if you suffer from hypercalcaemia (high calcium levels in the blood).
• if you have hypercalciuria (high calcium levels in the urine).
• if you have been diagnosed with hypervitaminosis D (high vitamin D levels in the blood).
• if you have kidney stones.

Warnings and precautions

Talk to your doctor or pharmacist before taking Cholecalciferol Sandoz 500 IE, tabletten.

Take special care with Cholecalciferol Sandoz 500 IE, tabletten

• if you have a tendency to get calcium-containing kidney stones.
• if you have problems in calcium and phosphate excretion through your kidneys.
• if you are being treated with medicines to increase urine output (benzothiadiazine derivatives).

• if your mobility is greatly restricted, as there is a risk in this case of hypercalcaemia (high calcium levels in the blood) and hypercalciuria (high calcium levels in the urine).
• if you have sarcoidosis (a specific disease that affects the connective tissue of the lungs, skin and joints), as there is a risk of increased conversion of vitamin D into its active form. In such cases, blood and urine calcium levels should be monitored by the doctor.
• if you have parathyroid hormone imbalance (pseudohypoparathyroidism), as vitamin D requirements may be reduced by the sometimes normal sensitivity to vitamin D. In this case, there is a risk of long-term overdose. For such patients, more manageable active substances with vitamin D activity are available.

If your kidneys are not working properly and you are being treated with Cholecalciferol Sandoz 500 IE, tabletten, the effect of treatment on the calcium and phosphate balance should be monitored by your doctor.

If other medicines containing vitamin D are prescribed, the vitamin D dose consumed when using Cholecalciferol Sandoz 500 IE, tabletten must be taken into account. Additional vitamin D or calcium should only be administered under medical supervision. In such cases, calcium levels in the blood and urine must be monitored.

During long-term treatment with Cholecalciferol Sandoz 500 IE, tabletten at daily doses above 500 IU of vitamin D, your doctor should monitor the calcium levels in your blood and urine and check your kidney function via measurements of serum creatinine. Such monitoring is particularly important in elderly patients and when treating at the same time with cardiac glycosides (medicines to stimulate heart muscle function) or diuretics (medicines to stimulate urine output). In the event of increased calcium levels in the blood (hypercalcaemia) or signs of impaired kidney function, the dose must be reduced or treatment discontinued. It is recommended to reduce the dose or discontinue treatment when calcium levels in the urine exceed 7.5 mmol/24 hours (300 mg/24 hours).

Infants and toddlers

Cholecalciferol Sandoz 500 IE, tabletten should be used with particular caution in infants and toddlers, as they may not be able to swallow the tablets. It is advisable to dissolve the tablets as stated or to use drops.

Other medicines and Cholecalciferol Sandoz 500 IE, tabletten

Tell your doctor or pharmacist if you are taking/ using, have recently taken/ used or might take/ use any other medicines.

The effect of Cholecalciferol Sandoz 500 IE, tabletten can be affected by the simultaneous use of

• phenytoin (medicine used to treat epilepsy) or barbiturates (medicines used to treat epilepsy and sleep disorders and for anaesthesia)
• glucocorticoids (medicines used to treat certain allergic conditions)
• rifampicin and isoniazid (medicines used to treat tuberculosis)
• cholestyramine (medicine used to lower high cholesterol levels), laxatives containing liquid paraffin.

The effect/side effects of Cholecalciferol Sandoz 500 IE, tabletten can be increased by the simultaneous use of

• vitamin D metabolites or analogues (e.g. calcitriol). Combination with Cholecalciferol Sandoz 500 IE, tabletten is recommended only in exceptional cases under strict medical supervision.
• medicines for increasing urine output (thiazide diuretics). A reduction in the elimination of calcium via the kidneys can cause calcium concentrations in the blood to rise (hypercalcaemia). Calcium levels in the blood and urine should therefore be monitored during long-term treatment.

When taken at the same time, Cholecalciferol Sandoz 500 IE, tabletten can increase the risk of side effects of

• cardiac glycosides (medicines used to increase the functioning of the heart muscles). The risk of heart rhythm disturbances can increase as a result of a rise in calcium levels in the blood during treatment with vitamin D. In such cases, the doctor in charge should carry out ECG monitoring as well as monitoring of calcium levels in the blood and urine and of levels of the medicine in the blood.

Please note that this information may also apply to medicines that you have recently used.

Cholecalciferol Sandoz 500 IE, tabletten with food and drink

Cholecalciferol Sandoz 500 IE, tabletten can be taken either on its own or together with food and drink.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy

Daily intake up to 500 I.U./d

In this dose range, there are no known risks to date.

Long-term overdoses of vitamin D must be avoided during pregnancy, as a resulting hypercalcaemia (increased blood level of calcium) may lead to physical and mental disability as well as to congenital heart and eye diseases in the child.

Daily intake more than 500 I.U./d

During pregnancy,Cholecalciferol Sandoz 500 IE, tabletten should be taken only when strictly indicated and dosed only as it is absolutely necessary to correct the vitamin D deficiency. Overdoses of vitamin D must be avoided during pregnancy, as prolonged hypercalcaemia (increased blood level of calcium) may lead to physical and mental disability as well as to congenital heart and eye diseases in the child.

Breast-feeding

Women may breast-feed during treatment with Cholecalciferol Sandoz 500 IE, tabletten. As vitamin D and its metabolites are excreted in breast milk, this should be borne in mind however when administering additional vitamin D to the child.

Driving and using machines

Cholecalciferol Sandoz 500 IE, tabletten is not known to have any effect on driving or using machines.

Cholecalciferol Sandoz 500 IE, tabletten contains lactose and sucrose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

Always take this medicine exactly as described in this leaflet or as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

The recommended dose is:

• for the prophylaxis of rickets 1 tablet Cholecalciferol Sandoz 500 IE, tabletten daily (equivalent to 0.0125 mg or 500 IU of vitamin D), and for the prophylaxis of rickets in preterm newborn infants 2 tablets Cholecalciferol Sandoz 500 IE, tabletten daily (equivalent to 0.025 mg or 1000 IU of vitamin D). The doctor in charge shall decide on the dose.

• for prophylaxis in persons at known risk of vitamin D deficiency 1 - 2 tablets <trade name> 500 daily (equivalent to 0.0125 – 0.025 mg or 500 – 1000 IU of vitamin D).
• for the supportive treatment of osteoporosis 2 tablets Cholecalciferol Sandoz 500 IE, tabletten daily (equivalent to 0.025 mg or 1000 IU of vitamin D).

Please take the tablets with a sufficient amount of fluid.

Please ask your doctor about the length of treatment required!

Daily doses above 500 IU/d

During long-term treatment with Cholecalciferol Sandoz 500 IE, tabletten in daily doses above 500 IU/d, calcium levels in the blood and urine should be monitored regularly and kidney function checked via measurements of serum creatinine. If necessary, a dose adjustment should be made on the basis of blood calcium levels.

Use in infants and toddlers

Dissolve the tablet on a teaspoon with water or milk and administer the dissolved tablet directly into the child’s mouth, preferably during a meal.

Adding tablets to a baby’s bottle feed or soft mashed food is not recommended, as complete vitamin D administration cannot be guaranteed.

Nevertheless, if the tablets are to be administered with food, it should first be cooked and then allowed to cool before the tablets are added. When using vitamin-enriched food, the amount of vitamin D that it contains should be taken into account.

Infants are given Cholecalciferol Sandoz 500 IE, tabletten from two weeks up until one year of age. In their second year of life, further doses of Cholecalciferol Sandoz 500 IE, tabletten are to be recommended, especially during the winter months.

If you take more Cholecalciferol Sandoz 500 IE, tabletten than you should

If you or your infant take more Cholecalciferol Sandoz 500 IE, tabletten than you should, contact a doctor immediately.

The signs of an overdose are not very characteristic, manifesting as nausea, vomiting, initial diarrhoea progressing to constipation, loss of appetite, lassitude, headache, painful muscles and joints, azotaemia (high nitrogen levels in the blood), increased thirst, increased urinary urge and - at the final stage - dehydration.

Please ask your doctor about the signs of a vitamin D overdose.

There is no specific antidote.

Your doctor will then initiate the necessary countermeasures.

If you forget to take Cholecalciferol Sandoz 500 IE, tabletten

Do not take a double dose to make up for a forgotten dose.

If you stop taking Cholecalciferol Sandoz 500 IE, tabletten

Your symptoms may get worse again or return if you stop your treatment or end it before you should. Please ask your doctor for more information!

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

The frequencies of side effects are not known, as no major clinical studies allowing any estimation of frequencies have been conducted.

You should stop taking Cholecalciferol Sandoz 500 IE, tabletten and immediately contact your doctor if any of the following signs of a severe allergic reaction appear:

• swollen face, swollen lips, tongue or throat
• swallowing difficulties

• hives and laboured breathing The following side effects can occur:
• Hypercalcaemia (high calcium levels in the blood) and hypercalciuria (high calcium levels in the urine).
• Gastrointestinal complaints such as constipation, flatulence, nausea, abdominal pain or diarrhoea.
• Hypersensitivity reactions such as itching, skin rash or nettle rash.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see details below). By reporting side effects you can help provide more information on the safety of this medicine.

Nederlands Bijwerkingen Centrum Lareb

Website: www.lareb.nl

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton. The expiry date refers to the last day of that month.

Storage conditions

Do not store above 25ºC.

Keep Cholecalciferol Sandoz 500 IE, tabletten in the outer carton in order to protect from light.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

What Cholecalciferol Sandoz 500 IE, tabletten contains

• The active substance is cholecalciferol. Each tablet contains: 5 mg of cholecalciferol concentrate (powder form) (equivalent to 12.5 µg of cholecalciferol = 500 IU vitamin D3).
• The other ingredients are: lactose monohydrate, microcrystalline cellulose, maize starch, modified maize starch, sodium starch glycolate (type A) (Ph.Eur.), sucrose, colloidal anhydrous silica, magnesium stearate (Ph.Eur.), sodium ascorbate, medium-chain triglycerides, all-rac-alpha-tocopherol.

What Cholecalciferol Sandoz 500 IE, tablettenlook like and contents of the pack

The tablets are white and round.

Cholecalciferol Sandoz 500 IE, tabletten is available in blister packs containing 20, 50 and 100 tablets.

Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer

Marketing Authorisation Holder

Sandoz B.V.

Postbus 10332

1301 AH Almere

Tel.: +31/365241600

Fax: +31/365373322

Manufacturer

mibe GmbH Arzneimittel Münchener Straße 15 06796 Brehna

Duitsland

Tel.: +49/34954/247-0

Fax: +49/34954/247-100

This medicinal product is authorised in the member states of the EEA under the following names:

Oostenrijk:	Vit D 3 Dermapharm 500 I.E. Tabletten
Duitsland:	Dekristol® 500 I.E.

Deze bijsluiter is voor het laatst goedgekeurd in oktober 2013.

Other information

Fish liver oil and fish are particularly rich in vitamin D, whilst small quantities are found in meat, egg yolk, milk, dairy products and avocado.

The requirement for adults is 5 micrograms, equivalent to 200 IU of vitamin D per day. When sunlight exposure is adequate, healthy adults can cover their requirements by producing it themselves. Intake via food is only of secondary significance, but may be of importance under certain critical conditions (climate, lifestyle).

Signs of deficiency can appear, for instance, in immature preterm newborn infants, infants exclusively breast-fed for more than six months without calcium supplements, or children on a strict vegetarian diet. Causes for vitamin D deficiency, which rarely occurs in adults, may be insufficient intake with food, insufficient exposure to sunlight, impaired absorption of nutrients from the gut, cirrhosis of the liver and impaired kidney function.