Nano-D Special Precautions

NANO-D should be used with caution in patients with impairment of renal function. In such patient the effect on calcium and phosphate levels should be monitored regularly. The risk of soft tissue calcification should be taken into account.
Caution is required in patients receiving treatment for cardiovascular disease.
NANO-D should be prescribed with caution in patients with sarcoidosis, due to a possible increase in the metabolism of Vitamin D3 in its active form. In these patients the serum and urinary calcium levels should be monitored.
Total dose of Vitamin D3 should be adjusted in patients which are already associated on Vitamin D3 treatment, foods enriched with Vitamin D3, milk enriched with Vitamin D3, and level of sun exposure.
There is no clear evidence for causation between Vitamin D3 supplementation and renal stones, but the risk is plausible, especially in the context of concomitant calcium supplementation. The need for additional calcium supplementation should be considered for individual patients. Calcium supplements should be given under close medical supervision.
Oral administration of high-dose Vitamin D3 was reported to result in an increased risk of fractures in elderly subjects, with the greatest increase occurring during the first 3 months after dosing.