Bonion Inj 200,000 IU is a high-dose injectable vitamin D3 supplement indicated for the treatment of severe vitamin D deficiency and related conditions including osteomalacia, rickets, and hypocalcemia due to vitamin D deficiency. It is used in patients who cannot achieve adequate vitamin D levels through oral supplementation alone, those with malabsorption syndromes, patients with very low baseline 25-OH vitamin D levels requiring rapid correction, and as quarterly or biannual depot therapy for the long-term prevention of vitamin D deficiency recurrence in at-risk patients.
MECHANISM OF ACTION
Cholecalciferol (vitamin D3) is the natural form of vitamin D produced in the skin upon ultraviolet Blight exposure. After intramuscular injection, cholecalciferol is absorbed from the depot site into the circulation and undergoes 25-hydroxylation in the liver to form 25-hydroxyvitamin D3 (calcidiol), the major circulating storage form. Calcidiol is subsequently hydroxylated in the kidney to 1,25-dihydroxyvitamin D3 (calcitriol), the biologically active hormone that acts on vitamin D receptors in the intestinal epithelium to enhance calcium and phosphorus absorption, in the kidney to reduce urinary calcium excretion, in bone to support mineralization, and in various immune and endocrine cells to modulate immune responses and parathyroid hormone secretion. The 200,000 IU intramuscular depot provides a sustained rise in serum 25-OH vitamin D over several weeks.
DOSAGE AND ADMINISTRATION
- Severe vitamin D deficiency treatment: 200,000 IU (1 ampoule) by intramuscular injection as a single loading dose; repeat after 2 to 3 months based on serum 25-OH vitamin D levels
- Maintenance and prevention: 200,000 IU IM every 3 to 6 months depending on clinical assessment and blood levels
- Administer by deep intramuscular injection by a trained healthcare professional
- Always follow the dosage and monitoring schedule prescribed by your doctor; check serum 25-OH vitamin D, calcium, and phosphate before each injection
SIDE EFFECTS
Common:
- Injection site pain and mild local reaction (expected with IM depot injection)
- Generally, well tolerated at recommended doses
- Mild nausea or headache transiently after injection
- Transient mild hypercalciuria in the weeks following injection
Less common:
- Hypercalcemia with excessive or too-frequent dosing: symptoms include thirst, polyuria, weakness, confusion, nausea, and constipation
- Hypercalciuria and nephrocalcinosis with repeated high-dose injections without monitoring
- Metastatic calcification in soft tissues with vitamin D toxicity
- Fatigue and anorexia at toxic plasma levels
NOT RECOMMENDED IN
- Hypercalcemia or hypercalciuria
- Known hypersensitivity to cholecalciferol or any excipient
- Granulomatous diseases such as sarcoidosis (markedly increased sensitivity to vitamin D leading to hypercalcemia at standard doses)
- Avoid combining with other high-dose vitamin D preparations; always monitor serum calcium and 25-OH vitamin D before repeat injection
DRUG INTERACTIONS
Thiazide diuretics combined with high-dose vitamin D increase the risk of hypercalcemia and hypercalciuria; monitor serum calcium closely. Orlistat, cholestyramine, and mineral oil reduce fat-soluble vitamin D absorption but are not relevant for the injectable form. Antiepileptics including phenytoin, carbamazepine, and phenobarbitone increase vitamin D catabolism and may reduce the duration of effect of the injection. Digoxin toxicity risk is increased by hypercalcemia resulting from excess vitamin D; monitor digoxin levels and calcium in patients on cardiac glycosides.
STORAGE INSTRUCTIONS
Store below 25°C in a dry place away from direct sunlight and heat. Protect from freezing. Keep in original packaging. Keep out of reach of children.
