What is the treatment for Vitamin B12 deficiency?

From the Guidelines

Treatment for Vitamin B12 Deficiency

Vitamin B12 deficiency should be treated immediately with hydroxocobalamin injections, especially in cases with possible neurological involvement, as indicated by studies referened by 1 and 1.

• For patients with neurological involvement, hydroxocobalamin 1 mg should be administered intramusously on alternate days until there is no further improvement, then hydroxocobalamin 1 mg should be administered every 2 months, as recommended by studies referened by 1 and 1.
• For patients with no neurological involvement, hydroxocobalamin 1 mg should be administered intramusously three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life, as indicated by studies referened by 1 and 1. It is essential to consult a healthcare provider to determine the best course of treatment and to monitor B12 levels to ensure the deficiency is adequately addressed, as suggested by studies referened by 1, 1, and 1. In cases of malabsorption, such as in patients with inflammatory bowel disease or those who have undergone bariatric surgery, parenteral supplementation with vitamin B12 may be necessary, as indicated by studies referened by 1, 1, and 1. Oral therapy may also be effective, but its use is less explored, especially in certain patient populations, as noted by studies referened by 1 and 1. Methylcobalamin may be an alternative to hydroxocobalamin, but its use is less commonly recommended, as indicated by studies referened by 1 and 1. In all cases, it is crucial to follow the guidance of a healthcare provider and to closely monitor B12 levels to ensure the deficiency is properly treated and to prevent any potential complications, as emphasized by studies referened by 1, 1, 1, 1, and 1.

From the FDA Drug Label

Cyanocobalamin is indicated for Vitamin B12 deficiencies due to malabsorption which may be associated with the following conditions: Addisonian (pernicious) anemia Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacterial overgrowth, total or partial gastrectomy Fish tapeworm infestation Malignancy of pancreas or bowel Folic acid deficiency It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption, use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue Requirements of Vitamin B12 in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with oral supplementation.

The treatment for Vitamin B12 deficiency may include:

• Oral supplementation for requirements of Vitamin B12 in excess of normal
• Surgical correction of anatomic lesions leading to small bowel bacterial overgrowth
• Expulsion of fish tapeworm
• Discontinuation of drugs leading to vitamin malabsorption
• Use of a gluten-free diet in nontropical sprue
• Administration of antibiotics in tropical sprue
• Cyanocobalamin injection (such as methylcobalamin) for Vitamin B12 deficiencies due to malabsorption 2 3

From the Research

Treatment Options for Vitamin B12 Deficiency

• Vitamin B12 deficiency can be treated with oral or intramuscular administration of vitamin B12, with both methods showing effectiveness in achieving haematological and neurological responses 4, 5, 6, 7, 8.
• High oral doses of vitamin B12 (1000 mcg and 2000 mcg) have been found to be as effective as intramuscular administration in obtaining short-term haematological and neurological responses in vitamin B12 deficient patients 4.
• Oral therapy with 300-1000 micrograms per day may be therapeutically equivalent to parenteral therapy 5.
• A study in children found that oral cyanocobalamin was effective for the treatment of vitamin B12 deficiency, with significant increases in serum vitamin B12 levels after 1 and 3 months of treatment 6.
• Another study in children compared the efficacy of oral and parenteral treatment for nutritional vitamin B12 deficiency and found that both formulations were effective in normalizing vitamin B12 levels, with no significant difference in the number of patients who still had anemia after 1 month of treatment 8.

Recommended Treatment Regimens

• A recommended regimen for parenteral therapy is 1000 micrograms cyanocobalamin, with 5 or 6 biweekly injections for loading, and once-a-month for maintenance 5.
• For oral therapy, a daily dose of 300-1000 micrograms per day may be effective 5, while another study suggests that 2000 mcg doses of oral vitamin B12 daily and 1000 mcg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration 4.
• It is also suggested that treating vitamin B12 deficiency with a combination of methylcobalamin and adenosylcobalamin or hydroxocobalamin may be effective, as both forms have distinct metabolic fates and functions 7.