How is Vitamin B (Vit B) deficiency treated?

From the Guidelines

Vitamin B deficiency is treated primarily through supplementation of the specific B vitamin that is lacking, with hydroxocobalamin 1 mg intramuscularly being the recommended treatment for vitamin B12 deficiency. The treatment approach varies depending on the severity and underlying cause of the deficiency, as well as the presence of neurological involvement. For vitamin B12 deficiency with possible neurological involvement, treatment should be initiated immediately with hydroxocobalamin 1 mg intramuscularly on alternate days until there is no further improvement, then hydroxocobalamin 1 mg intramuscularly every 2 months 1.

For people with vitamin B12 deficiency and no neurological involvement, hydroxocobalamin 1 mg intramuscularly should be administered three times a week for 2 weeks, followed by maintenance treatment with 1 mg intramuscularly every 2–3 months for life 1. It is essential to treat vitamin B12 deficiency before initiating folic acid treatment to avoid precipitation of subacute combined degeneration of the spinal cord 1. Folic acid deficiency may be treated with oral folic acid 5 mg daily for a minimum of 4 months, but only after excluding vitamin B12 deficiency 1.

Key considerations in treating vitamin B deficiency include:

• Identifying and addressing the underlying cause of the deficiency, such as malabsorption or dietary insufficiency
• Providing maintenance treatment to prevent recurrence of the deficiency
• Monitoring for potential complications, such as subacute combined degeneration of the spinal cord
• Seeking urgent specialist advice from a neurologist and haematologist if there is possible neurological involvement 1.

Overall, the goal of treatment is to replace the missing vitamin and prevent long-term complications, with the specific treatment approach depending on the individual patient's needs and circumstances.

From the FDA Drug Label

Parenteral vitamin B12 is the recommended treatment and will be required for the remainder of the patient's life. A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection. If there is clinical improvement and if a reticulocyte response is observed, the same amount may be given on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks. By this time hematologic values should have become normal This regimen should be followed by 100 mcg monthly for life. Folic acid should be administered concomitantly if needed.

Vitamin B deficiency treatment involves administering parenteral vitamin B12. The recommended dosage is 100 mcg daily for 6 or 7 days, followed by alternate days for seven doses, then every 3 to 4 days for 2 to 3 weeks. After that, 100 mcg monthly is required for life. Folic acid should also be given if necessary 2.

• For patients with normal intestinal absorption, oral B12 preparation is recommended for chronic treatment.
• If other vitamin deficiencies are present, they should be treated.
• Folic acid can be administered orally, with a usual therapeutic dosage of up to 1 mg daily 3.

From the Research

Treatment of Vitamin B Deficiency

• Vitamin B deficiency can be treated with injections of vitamin B12, which are given through the intramuscular route 4
• Oral replacement therapy has also been found to be effective in treating patients with vitamin B12 deficiency 4
• In some cases, vitamin B supplementation may be necessary to prevent the manifestation of certain conditions, such as Wernicke's encephalopathy, cerebral or cerebellar atrophy 5
• Parenteral vitamin B12 substitution has been shown to improve cognitive impairment and psychotic symptomatology in elderly patients with vitamin B12 deficiency 6

Forms of Vitamin B Deficiency

• Vitamin B12 deficiency can cause a wide range of hematological, gastrointestinal, and neurological manifestations 7
• Deficiencies of vitamin B1, B2, and B6 can also occur, particularly in patients with malnutrition, intestinal malabsorption, hepatic failure, or neoplasms arising outside the nervous system 5
• Homocystinuria and megaloblastic anemia can be responsive to vitamin B12 therapy, particularly in cases of inborn errors of metabolism due to defects in cobalamin metabolism 8

Diagnosis and Management

• Early diagnosis and appropriate management of vitamin B deficiency are crucial to avoid severe complications, such as spinal cord degeneration and pancytopenia 4
• Testing for serum vitamin B12 and its metabolites should be done in any distal symmetric neuropathy 7
• A correlation between vitamin B1 and B2 deficiency and signs of cerebellar and/or brainstem lesion has been found, highlighting the importance of vitamin B supplementation in these cases 5