Alfacalcidol Strides: Uses, Dosage & Side Effects
A vitamin D analogue (1α-hydroxyvitamin D3) used to regulate calcium and phosphate metabolism in chronic kidney disease, hypoparathyroidism, and bone disorders
Alfacalcidol Strides is a prescription medicine containing alfacalcidol, a synthetic analogue of vitamin D. Alfacalcidol is converted in the liver to calcitriol (1,25-dihydroxyvitamin D3), the most active form of vitamin D, which plays a critical role in regulating calcium and phosphate balance in the body. Because alfacalcidol bypasses the kidney’s role in vitamin D activation, it is especially valuable for patients with chronic kidney disease whose kidneys can no longer perform this conversion. It is used to treat and prevent bone diseases related to impaired vitamin D metabolism, including renal osteodystrophy, hypoparathyroidism, osteomalacia, rickets, and certain forms of osteoporosis.
Quick Facts: Alfacalcidol Strides
Key Takeaways
- Alfacalcidol Strides contains alfacalcidol (1α-hydroxyvitamin D3), a prodrug that is converted in the liver to calcitriol, the active form of vitamin D responsible for calcium and phosphate regulation throughout the body.
- It is primarily used for renal osteodystrophy in chronic kidney disease, hypoparathyroidism, neonatal hypocalcemia, nutritional and malabsorptive rickets and osteomalacia, and certain types of osteoporosis where impaired vitamin D metabolism contributes to bone loss.
- Regular blood tests to monitor serum calcium and phosphate levels are essential during treatment, as hypercalcemia (elevated calcium) is the most significant adverse effect and can lead to serious complications if undetected.
- Alfacalcidol interacts with several medications including thiazide diuretics, cardiac glycosides (digoxin), antiepileptic drugs, and calcium supplements; always inform your doctor of all medicines you are taking.
- The standard starting dose for adults is 1 microgram per day, adjusted based on blood calcium response; lower starting doses of 0.25–0.5 microgram per day may be appropriate for elderly patients or those with mild disease.
What Is Alfacalcidol Strides and What Is It Used For?
Alfacalcidol Strides contains the active substance alfacalcidol, also known as 1α-hydroxycholecalciferol or 1α-hydroxyvitamin D3. It belongs to a class of medications called vitamin D analogues. Vitamin D is essential for maintaining healthy bones, teeth, and muscles because it regulates how the body absorbs and uses calcium and phosphate — two minerals that are fundamental building blocks of bone tissue. Without adequate active vitamin D, the body cannot absorb sufficient calcium from the diet, leading to weakened bones and a range of metabolic disturbances.
In healthy individuals, the body produces vitamin D through a multi-step process. First, sunlight exposure converts a precursor molecule in the skin into cholecalciferol (vitamin D3). This inactive form then travels to the liver, where it undergoes 25-hydroxylation to become calcifediol (25-hydroxyvitamin D3). Finally, calcifediol is transported to the kidneys, where the enzyme 1α-hydroxylase converts it into calcitriol (1,25-dihydroxyvitamin D3), the biologically active hormone. Calcitriol acts on the vitamin D receptor (VDR) in the intestines to promote calcium absorption, in the kidneys to enhance calcium reabsorption, in bone tissue to regulate mineralization, and in the parathyroid glands to suppress parathyroid hormone (PTH) secretion.
Alfacalcidol is a synthetic prodrug that has already been 1α-hydroxylated. This means it only requires one activation step in the liver (25-hydroxylation) to become calcitriol. By bypassing the renal 1α-hydroxylation step, alfacalcidol is particularly effective for patients whose kidneys are unable to perform this conversion, such as those with chronic kidney disease (CKD). This pharmacological advantage makes alfacalcidol a critical treatment option for managing the complex mineral and bone disorders that accompany kidney failure.
Alfacalcidol Strides is indicated for the following conditions:
- Renal osteodystrophy: Bone disease that develops in patients with chronic kidney disease (stages 3–5) due to impaired renal synthesis of calcitriol. As kidney function declines, calcitriol production falls, leading to secondary hyperparathyroidism, defective bone mineralization, and increased fracture risk. Alfacalcidol directly addresses this deficiency by providing a substrate that bypasses the failing kidneys.
- Hypoparathyroidism: A condition in which the parathyroid glands produce insufficient parathyroid hormone (PTH), resulting in low blood calcium levels (hypocalcemia). This can occur after thyroid or parathyroid surgery, or as an autoimmune or genetic condition. Alfacalcidol helps maintain adequate calcium levels by enhancing intestinal calcium absorption.
- Pseudohypoparathyroidism: A rare inherited disorder where the body is resistant to the effects of PTH, leading to symptoms similar to hypoparathyroidism despite normal or elevated PTH levels.
- Nutritional and malabsorptive rickets and osteomalacia: Softening and weakening of bones due to inadequate vitamin D or impaired absorption. In children, this manifests as rickets (bowed legs, growth retardation); in adults, it presents as osteomalacia (bone pain, muscle weakness, increased fracture risk).
- Neonatal hypocalcemia: Low calcium levels in newborns, which can lead to seizures and other complications if untreated.
- Osteoporosis with impaired vitamin D metabolism: In certain patients with osteoporosis, particularly elderly individuals with reduced renal function or inadequate sun exposure, alfacalcidol may be used to improve calcium absorption and reduce fracture risk.
Regular vitamin D supplements (cholecalciferol or ergocalciferol) require two activation steps: one in the liver and one in the kidneys. In patients with chronic kidney disease, the kidney step is impaired, so standard vitamin D cannot be fully activated regardless of the dose given. Alfacalcidol is pre-hydroxylated at the 1α position, meaning it only needs the liver step, making it effective even when kidney function is severely compromised. This is why alfacalcidol is the preferred form of vitamin D therapy in CKD patients.
What Should You Know Before Taking Alfacalcidol Strides?
Alfacalcidol is a potent vitamin D analogue, and its primary risk is causing hypercalcemia (excessively high blood calcium levels). Before starting treatment, your healthcare provider will conduct thorough baseline blood tests including serum calcium, phosphate, alkaline phosphatase, and creatinine levels. Understanding the contraindications, warnings, and precautions is essential for safe and effective use of this medication.
Contraindications
You should not take Alfacalcidol Strides if you have any of the following conditions:
- Hypercalcemia: If your blood calcium is already elevated, alfacalcidol will increase it further, potentially to dangerous levels. Symptoms of hypercalcemia include nausea, vomiting, excessive thirst, frequent urination, confusion, and in severe cases, cardiac arrhythmias and kidney damage.
- Metastatic calcification: If you have evidence of calcium deposits in soft tissues (such as blood vessels, kidneys, or lungs), alfacalcidol may worsen this condition.
- Hypersensitivity: If you are allergic to alfacalcidol, other vitamin D analogues, or any of the excipients in the capsule formulation.
- Vitamin D toxicity: If you are already taking high doses of other vitamin D preparations, adding alfacalcidol can lead to vitamin D toxicity.
Warnings and Precautions
Several important precautions apply when using alfacalcidol:
- Regular calcium monitoring: Blood calcium levels must be checked regularly during treatment — typically weekly during the initial dose adjustment phase and at least monthly once a stable dose has been established. This is the single most important safety measure for patients on alfacalcidol therapy.
- Phosphate control: In patients with chronic kidney disease, elevated phosphate levels (hyperphosphatemia) must be adequately controlled before and during alfacalcidol treatment. A high calcium-phosphate product (Ca × P) increases the risk of metastatic calcification, where calcium deposits form in soft tissues including blood vessels, heart valves, and kidneys.
- Kidney stones: Patients with a history of nephrolithiasis (kidney stones) are at increased risk because alfacalcidol increases urinary calcium excretion, potentially promoting stone formation.
- Cardiovascular disease: Hypercalcemia can worsen cardiac conditions and interact with cardiac medications, particularly digoxin. Patients with heart disease require especially careful calcium monitoring.
- Granulomatous diseases: In conditions such as sarcoidosis or tuberculosis, the granulomatous tissue can convert calcifediol to calcitriol independently of PTH regulation. Adding alfacalcidol in these patients may cause unpredictable hypercalcemia.
- Immobilized patients: Prolonged immobilization increases the risk of hypercalcemia because bone resorption is accelerated while calcium demand by muscles is reduced.
Pregnancy and Breastfeeding
Alfacalcidol should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Animal studies have demonstrated that supraphysiological doses of vitamin D analogues can cause teratogenic effects, including skeletal malformations and organ abnormalities. Hypercalcemia during pregnancy may harm the developing baby, potentially causing suppression of parathyroid function in the newborn, leading to neonatal hypocalcemia and tetany.
Calcitriol, the active metabolite of alfacalcidol, is excreted in breast milk. While the amounts are generally small, nursing infants of mothers taking alfacalcidol should be monitored for signs of hypercalcemia, including poor feeding, irritability, and excessive urination. The decision to breastfeed while taking alfacalcidol should be made in consultation with your healthcare provider, weighing the benefits of breastfeeding against the potential risks to the infant.
Women of childbearing potential should use effective contraception during treatment unless pregnancy is specifically planned and closely monitored. If you become pregnant while taking alfacalcidol, contact your doctor immediately; do not stop the medication abruptly without medical guidance, as sudden discontinuation could cause dangerous drops in calcium levels.
The most critical aspect of alfacalcidol therapy is regular monitoring of blood calcium levels. Hypercalcemia can develop gradually and may initially be asymptomatic. Early signs include increased thirst, frequent urination, nausea, and fatigue. If you notice these symptoms, contact your doctor promptly and have your calcium levels checked before taking the next dose.
How Does Alfacalcidol Strides Interact with Other Drugs?
Drug interactions with alfacalcidol can be clinically significant and may require dose adjustments, additional monitoring, or avoidance of certain combinations. Because alfacalcidol’s primary pharmacological effect is to increase calcium absorption and blood calcium levels, the most important interactions involve drugs that are affected by or influence calcium homeostasis. Understanding these interactions is essential for safe prescribing and patient self-management.
Major Interactions
| Drug / Class | Interaction | Clinical Significance |
|---|---|---|
| Cardiac glycosides (Digoxin) | Alfacalcidol-induced hypercalcemia increases the risk of digoxin toxicity, potentially causing life-threatening cardiac arrhythmias | Frequent calcium and digoxin monitoring required; dose adjustment of either drug may be necessary |
| Thiazide diuretics | Thiazides reduce renal calcium excretion, potentiating the hypercalcemic effect of alfacalcidol | Increased risk of hypercalcemia; monitor calcium levels more frequently when co-administered |
| Calcium supplements | Additive effect on serum calcium levels | May need to reduce calcium supplement dose; monitor total calcium intake carefully |
| Magnesium-containing antacids | Risk of hypermagnesemia, particularly in patients with renal impairment | Avoid combination in CKD patients; monitor serum magnesium if co-administration is unavoidable |
Minor Interactions
| Drug / Class | Interaction | Clinical Significance |
|---|---|---|
| Phenytoin, Barbiturates, Carbamazepine | Hepatic enzyme inducers accelerate the metabolism of alfacalcidol and its active metabolite, reducing its effectiveness | Higher doses of alfacalcidol may be required; monitor calcium response closely |
| Cholestyramine, Colestipol | Bile acid sequestrants may reduce the intestinal absorption of alfacalcidol | Separate administration by at least 2 hours; take alfacalcidol 1 hour before or 4–6 hours after the bile acid sequestrant |
| Mineral oil (liquid paraffin) | May reduce intestinal absorption of fat-soluble vitamins including alfacalcidol | Avoid prolonged concurrent use; monitor calcium levels if combination is necessary |
| Corticosteroids | May counteract the effects of alfacalcidol on calcium absorption | May need to increase alfacalcidol dose; monitor bone density and calcium levels |
| Phosphate binders | Aluminium-containing phosphate binders may interact with vitamin D analogues, increasing aluminium absorption in CKD patients | Prefer non-aluminium phosphate binders in patients receiving alfacalcidol; monitor aluminium levels if used |
In addition to the interactions listed above, patients should inform their healthcare provider about all prescription medications, over-the-counter drugs, herbal supplements, and dietary supplements they are taking. High dietary calcium intake from dairy products or fortified foods should also be considered when calculating total calcium exposure during alfacalcidol therapy.
If you are taking digoxin (a heart medication), it is especially important to have your calcium levels monitored closely while on alfacalcidol. Elevated calcium levels can increase the toxicity of digoxin, potentially causing dangerous heart rhythm disturbances. Report any symptoms such as nausea, visual disturbances, or irregular heartbeat to your doctor immediately.
What Is the Correct Dosage of Alfacalcidol Strides?
Dosing of alfacalcidol must be individualized for each patient based on the underlying condition, severity of disease, baseline calcium levels, and clinical response. The goal of therapy is to normalize calcium metabolism without causing hypercalcemia. Regular monitoring of serum calcium is essential for dose titration. Each Alfacalcidol Strides capsule contains 0.25 microgram of alfacalcidol.
Adults
Standard Adult Dosage
The usual starting dose for adults with renal osteodystrophy or hypoparathyroidism is 1 microgram per day (four capsules of 0.25 mcg). The dose should be adjusted according to the biochemical response, typically in increments of 0.25–0.5 microgram at intervals of 2–4 weeks. Most adults require a maintenance dose in the range of 0.25–2 micrograms per day, although some patients with severe disease may require higher doses under specialist supervision.
For osteoporosis in adults with impaired vitamin D metabolism, a lower starting dose of 0.25–0.5 microgram per day may be appropriate, gradually titrated according to calcium levels.
Children
Pediatric Dosage
Dosing in children is based on body weight. The recommended starting dose is:
- Neonates: 0.05–0.1 microgram/kg/day
- Children under 20 kg: 0.05 microgram/kg/day
- Children over 20 kg: 1 microgram per day (same as adult dose)
Pediatric dosing requires close collaboration with a pediatric specialist, and calcium levels should be monitored at least weekly during dose adjustment.
Elderly
Elderly Dosage
Elderly patients may be more sensitive to the effects of alfacalcidol, particularly those with mild renal impairment or reduced physical activity. A lower starting dose of 0.25–0.5 microgram per day is often recommended, with gradual dose increases guided by calcium monitoring. Elderly patients are at higher risk for both hypercalcemia and its complications, including dehydration, confusion, and cardiac effects.
Missed Dose
If you miss a dose, take it as soon as you remember on the same day. If it is nearly time for your next scheduled dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one. If you frequently forget doses, consider setting a daily alarm or keeping the capsules with other medications you take at the same time each day. Alfacalcidol can be taken with or without food, although taking it with a meal that contains some fat may improve absorption.
Overdose
An overdose of alfacalcidol can cause severe hypercalcemia, which is a medical emergency. Symptoms of overdose may include intense nausea and vomiting, severe constipation, extreme thirst and frequent urination, drowsiness or confusion, muscle weakness, irregular heartbeat, and in severe cases, kidney failure or cardiac arrest. If you suspect an overdose, stop taking the medication immediately and seek emergency medical attention.
Treatment of alfacalcidol overdose involves stopping the drug, maintaining adequate hydration with intravenous fluids, reducing dietary calcium intake, and in severe cases, administering loop diuretics (furosemide) to enhance urinary calcium excretion, calcitonin, or bisphosphonates. The effects of alfacalcidol overdose may persist for several days after the last dose because of the time required for the active metabolite calcitriol to be cleared from the body.
| Patient Group | Starting Dose | Maintenance Range | Monitoring |
|---|---|---|---|
| Adults (renal osteodystrophy) | 1 mcg/day | 0.25–2 mcg/day | Calcium weekly initially, then monthly |
| Adults (hypoparathyroidism) | 1 mcg/day | 1–3 mcg/day | Calcium weekly initially, then monthly |
| Adults (osteoporosis) | 0.25–0.5 mcg/day | 0.5–1 mcg/day | Calcium monthly, bone density annually |
| Elderly | 0.25–0.5 mcg/day | 0.25–1 mcg/day | Calcium weekly initially, then monthly |
| Children (<20 kg) | 0.05 mcg/kg/day | Individualized | Calcium weekly |
| Children (>20 kg) | 1 mcg/day | Individualized | Calcium weekly |
| Neonates | 0.05–0.1 mcg/kg/day | Individualized | Calcium every 2–3 days initially |
Alfacalcidol doses are always adjusted based on blood calcium levels, not on symptoms alone. If serum calcium rises above the upper limit of normal (typically 2.60 mmol/L or 10.5 mg/dL), the dose should be reduced or temporarily stopped until calcium returns to normal. Never increase your dose without consulting your doctor and having blood tests first.
What Are the Side Effects of Alfacalcidol Strides?
Like all medicines, alfacalcidol can cause side effects, although not everybody gets them. The majority of adverse effects are related to its primary pharmacological action — increasing calcium levels. Hypercalcemia is both the most common and the most clinically important adverse effect. When detected early through regular monitoring, it is readily managed by dose adjustment. The following frequency classification is based on clinical trial data and post-marketing surveillance reports.
Side effects are classified according to how often they occur using the standard medical frequency categories. Understanding these categories helps you assess the likelihood of experiencing a particular side effect and know when to seek medical attention.
Common
- Hypercalcemia (elevated blood calcium) — the most important side effect to monitor
- Nausea
- Abdominal pain or discomfort
- Diarrhea or constipation
- Skin rash or itching (pruritus)
- Headache
Uncommon
- Hyperphosphatemia (elevated blood phosphate)
- Fatigue and weakness
- Loss of appetite (anorexia)
- Increased thirst (polydipsia)
- Increased urination (polyuria)
- Vomiting
- Dizziness
- Metallic taste in the mouth
Rare
- Nephrocalcinosis (calcium deposits in the kidneys)
- Kidney stones (nephrolithiasis)
- Muscle pain (myalgia)
- Joint pain (arthralgia)
- Bone pain
- Confusion or mental changes
- Cardiac arrhythmias (irregular heartbeat due to severe hypercalcemia)
- Calcification of soft tissues (metastatic calcification)
Not Known
- Allergic reactions (urticaria, angioedema)
- Pancreatitis (associated with severe hypercalcemia)
- Corneal and conjunctival calcification (with prolonged hypercalcemia)
The symptoms of hypercalcemia deserve special attention because they can develop gradually and may initially be attributed to other causes. Early signs include mild nausea, decreased appetite, increased thirst, and more frequent urination. As calcium levels rise further, patients may experience constipation, fatigue, muscle weakness, confusion, and eventually cardiac rhythm disturbances. In patients with chronic kidney disease who are on dialysis, the calcium-phosphate product must be monitored carefully, as elevated levels increase the risk of vascular calcification, which is associated with cardiovascular morbidity and mortality.
If you experience any of the symptoms described above, particularly persistent nausea, excessive thirst, or unusual fatigue, contact your healthcare provider promptly. Do not wait until your next scheduled appointment if symptoms are significant. In most cases, hypercalcemia resolves rapidly once the alfacalcidol dose is reduced or the drug is temporarily discontinued.
Contact your doctor or seek emergency care immediately if you experience: severe nausea and vomiting with inability to keep fluids down, significant confusion or altered consciousness, irregular or rapid heartbeat, severe muscle weakness, or signs of an allergic reaction (swelling of the face, lips, tongue, or difficulty breathing).
How Should You Store Alfacalcidol Strides?
Proper storage of alfacalcidol is essential to maintain its potency and safety. Alfacalcidol is a relatively fragile molecule that can degrade when exposed to excessive heat, light, or moisture. The soft gelatin capsules also have specific storage requirements to prevent the capsule shell from becoming too soft, sticky, or brittle.
Follow these storage guidelines to ensure your medication remains effective throughout its shelf life:
- Temperature: Store at or below 25°C (77°F). Do not freeze. Brief exposure to temperatures up to 30°C may be acceptable during transport, but prolonged exposure to heat should be avoided.
- Light protection: Keep the capsules in their original blister pack or container until ready to use. Alfacalcidol is sensitive to ultraviolet light, which can cause degradation of the active substance.
- Moisture: Keep the container tightly closed. Do not transfer capsules to pill organizers for extended periods, as exposure to ambient moisture can affect the capsule shell.
- Children: Store out of sight and reach of children. Even a single capsule could be harmful to a young child.
- Expiry date: Do not use the capsules after the expiry date (EXP) printed on the blister or outer carton. The expiry date refers to the last day of that month.
- Disposal: Do not dispose of unused or expired capsules via household waste or wastewater. Return them to your pharmacist for safe disposal in accordance with local environmental regulations.
If you notice any visible changes to the capsules, such as discoloration, leaking, or a unusual odor, do not take them. Return the affected capsules to your pharmacy and obtain a fresh supply. Soft gelatin capsules that have been exposed to excessive heat may appear swollen, stuck together, or have an altered shape; these should not be consumed.
What Does Alfacalcidol Strides Contain?
Understanding the full composition of your medication is important, particularly if you have known allergies or dietary restrictions. Each Alfacalcidol Strides soft capsule is formulated to deliver a precise dose of the active substance in a form that is readily absorbed from the gastrointestinal tract.
Active substance: Each soft capsule contains 0.25 microgram (0.00025 mg) of alfacalcidol. Despite this seemingly small amount, alfacalcidol is an extremely potent compound — microgram-level doses are sufficient to produce significant biological effects on calcium metabolism. For comparison, standard vitamin D3 (cholecalciferol) supplements are typically dosed in the range of 10–50 micrograms (400–2000 IU), but alfacalcidol is approximately 1,000 times more potent because it is a pre-activated form that acts directly after a single hepatic conversion step.
Typical excipients in the capsule fill may include:
- Medium-chain triglycerides (MCT oil) — serves as a lipid vehicle to dissolve and stabilize the alfacalcidol
- Citric acid anhydrous — antioxidant to protect the active substance from degradation
- Alpha-tocopherol (vitamin E) — antioxidant to prevent oxidation of the lipid fill
Typical excipients in the capsule shell may include:
- Gelatin — forms the soft capsule shell (note: this product contains gelatin of animal origin)
- Glycerol — plasticizer to make the capsule shell flexible
- Sorbitol liquid (non-crystallising) — additional plasticizer
- Titanium dioxide (E171) — opacifier to protect contents from light
- Iron oxide yellow (E172) — coloring agent
Appearance: Alfacalcidol Strides 0.25 microgram soft capsules are typically small, oval or round, and may be white, off-white, or pale yellow in color, depending on the specific formulation. The capsules are designed to be swallowed whole with water. Do not chew, crush, or open the capsules.
Alfacalcidol Strides capsules contain gelatin, which is derived from animal sources. Patients who avoid gelatin for religious, ethical, or medical reasons should discuss alternative formulations with their healthcare provider. The capsules may also contain sorbitol; patients with rare hereditary fructose intolerance should consult their doctor before taking this medicine. Always check the full list of ingredients in the patient information leaflet that comes with your specific product.
Frequently Asked Questions
Alfacalcidol Strides is a vitamin D analogue used to treat conditions where the body cannot properly activate vitamin D. Its primary indications include renal osteodystrophy (bone disease caused by chronic kidney disease), hypoparathyroidism (underactive parathyroid glands), pseudohypoparathyroidism, nutritional and malabsorptive rickets and osteomalacia, neonatal hypocalcemia, and certain types of osteoporosis where impaired vitamin D metabolism contributes to bone loss. It works by bypassing the kidney’s role in vitamin D activation, making it especially important for patients with kidney disease.
Unlike regular vitamin D (cholecalciferol or ergocalciferol), which requires two activation steps (one in the liver and one in the kidneys), alfacalcidol has already been pre-hydroxylated at the 1α position. This means it only needs one activation step in the liver to become calcitriol, the active form of vitamin D. For patients with chronic kidney disease, the kidneys cannot perform the 1α-hydroxylation step, so regular vitamin D supplements are ineffective. Alfacalcidol bypasses this limitation, making it the treatment of choice for CKD-related bone and mineral disorders.
The most important and common side effect is hypercalcemia (elevated blood calcium levels), which can cause symptoms such as nausea, vomiting, loss of appetite, constipation, excessive thirst, frequent urination, fatigue, headache, and muscle weakness. Skin rash and itching may also occur. Most side effects are dose-related and reversible: reducing the dose or temporarily stopping the medication allows calcium levels to normalize. Regular blood tests are essential for early detection and management of hypercalcemia.
Alfacalcidol should only be used during pregnancy if the potential benefit clearly justifies the potential risk to the fetus. Animal studies have shown that high doses of vitamin D analogues can cause birth defects, including skeletal abnormalities. Hypercalcemia during pregnancy may also harm the developing baby by suppressing its parathyroid gland function, potentially leading to neonatal hypocalcemia. If treatment is necessary during pregnancy, close monitoring of calcium levels is essential. Women who are pregnant or planning pregnancy should discuss the risks and benefits with their doctor.
Store Alfacalcidol Strides capsules below 25°C (77°F) in the original packaging to protect from light and moisture. Do not freeze the capsules. Keep the medicine out of sight and reach of children. Do not use the capsules after the expiry date printed on the packaging. If capsules appear discolored, swollen, or damaged, do not take them. Return unused or expired medicines to your pharmacy for proper disposal — do not dispose of them via household waste or wastewater.
If you miss a dose, take it as soon as you remember unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a forgotten one. Alfacalcidol can be taken with or without food, though taking it with a meal containing fat may improve absorption. If you frequently forget doses, consider setting a daily reminder or associating the medication with another daily routine.
References
- European Medicines Agency (EMA). Alfacalcidol – Summary of Product Characteristics. European public assessment reports. Updated 2024.
- Kidney Disease: Improving Global Outcomes (KDIGO). 2024 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder (CKD-MBD). Kidney International Supplements. 2024;14(1):S1–S130.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. Geneva: World Health Organization; 2023.
- National Institute for Health and Care Excellence (NICE). Chronic kidney disease: assessment and management. NICE guideline [NG203]. Updated 2024.
- Sprague SM, et al. Use of calcitriol and alfacalcidol in chronic kidney disease. Seminars in Dialysis. 2022;35(4):303–312.
- Rizzoli R, et al. Vitamin D supplementation in elderly or postmenopausal women: a 2023 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Osteoporosis International. 2023;34(4):617–630.
- British National Formulary (BNF). Alfacalcidol. NICE Evidence Services. Accessed December 2025.
- Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clinical Journal of the American Society of Nephrology. 2011;6(4):913–921.
- Goldsmith DJA, et al. Clinical Practice Guideline on Diagnosis and Treatment of Hypoparathyroidism in Adults. European Journal of Endocrinology. 2022;186(6):G1–G20.
- Eastwood JB, et al. Alfacalcidol in the treatment of renal bone disease. In: Vitamin D: Basic Research and Its Clinical Application. De Gruyter; 2019.
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