From the Research
Treatment for hyper vitamin B12 is generally not required as excess vitamin B12 is typically excreted in urine, making toxicity rare even with high supplementation. If elevated B12 levels are detected, the primary approach is to identify and address the underlying cause rather than treating the high B12 itself. Common causes include liver disease, certain blood disorders, some cancers, and excessive supplementation. If supplementation is the cause, discontinuing the supplements is usually sufficient. No specific medication exists to lower B12 levels. In cases where high B12 is a marker of underlying disease, treatment focuses on the primary condition. Unlike fat-soluble vitamins, vitamin B12 is water-soluble and has no established upper limit for toxicity. Symptoms sometimes attributed to high B12 (like acne or headaches) are generally related to other factors. Regular monitoring of B12 levels may be recommended for patients with conditions that can cause elevated levels, as seen in a case report where a woman with persistently elevated vitamin B12 was found to have a pancreatic tumor 1.
Some studies have highlighted the importance of looking beyond the serum vitamin B12 levels to diagnose deficiency, especially in patients with myeloproliferative disorders, where normal to elevated serum vitamin B12 levels can mask actual deficiency 2, 3. The use of methylmalonic acid measurement can be helpful in such cases to detect occult vitamin B12 deficiency 3. However, for hyper vitamin B12, the focus remains on identifying and managing the underlying cause, with the most recent study suggesting that hypervitaminosis B12 can be an indicator of potential significant morbidity 1.
Key points to consider in managing hyper vitamin B12 include:
- Identifying the underlying cause of elevated B12 levels
- Discontinuing supplements if they are the cause
- Monitoring B12 levels in patients with conditions that can cause elevated levels
- Focusing treatment on the primary condition if high B12 is a marker of underlying disease
- Recognizing that vitamin B12 toxicity is rare due to its water-soluble nature and excretion in urine.