What is the recommended approach for Vitamin B2 (Riboflavin) repletion?

From the Guidelines

The recommended approach for Vitamin B2 (Riboflavin) repletion is oral supplementation with 5-10 mg of riboflavin daily until deficiency is corrected, as stated in the espen micronutrient guideline 1. This approach is based on a strong consensus of 96% and is considered a good practice point (GPP).

Key Considerations

• The supplement should be taken with food to enhance absorption.
• Treatment duration typically ranges from 1-3 months for correction of deficiency, with clinical improvement often seen within days to weeks.
• Patients should be advised that riboflavin supplements may cause urine to turn bright yellow, which is harmless and simply reflects excretion of excess vitamin.
• Riboflavin is water-soluble and generally considered safe even at higher doses, as excess is excreted in urine.

Special Considerations

• In cases of clinical riboflavin deficiency, IV administration of 160 mg of riboflavin for four days may be necessary, as recommended in the espen micronutrient guideline 1.
• Patients at risk of deficiency, such as those with malabsorption, thyroid dysfunction, or renal disease, should be closely monitored and considered for supplementation 1.

Dietary Recommendations

• Dietary sources rich in riboflavin, such as dairy products, eggs, lean meats, green vegetables, and fortified cereals, should be encouraged alongside supplementation to maintain adequate levels long-term.
• Riboflavin is essential for energy metabolism, serving as a precursor for flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN), which function as coenzymes in numerous oxidation-reduction reactions throughout the body.

From the FDA Drug Label

Dosage and Administration: Usual adult dose is 2 dropperfuls or 2 mL daily. The recommended approach for Vitamin B2 (Riboflavin) repletion is to take the usual adult dose of 2 dropperfuls or 2 mL daily 2.

• The product should be taken daily for the best results.

From the Research

Vitamin B2 Repletion

The recommended approach for Vitamin B2 (Riboflavin) repletion is not explicitly stated in the provided studies. However, the following points can be considered:

• Riboflavin deficiency can be caused by inadequate dietary intake, and certain groups such as the elderly and adolescents may be at higher risk 3.
• Biochemical signs of depletion can arise within a few days of dietary deprivation, and poor riboflavin status can have various health consequences, including impaired iron handling and increased risk of anemia 3.
• Riboflavin supplementation has been shown to be effective in preventing migraine and may have therapeutic potential in other neurological diseases, such as mitochondrial diseases and riboflavin transporter deficiency 4.
• High doses of riboflavin may be necessary for the treatment of certain conditions, such as Brown-Vialetto-Van Laere syndrome and Fazio-Londe disease 4.

Food Sources and Supplementation

Some key points to consider regarding food sources and supplementation are:

• Milk and dairy products are significant contributors to riboflavin intake in Western diets, while meat, fish, and certain fruits and vegetables are also good sources 3.
• Riboflavin can be obtained through dietary sources or supplementation, and some lactic acid bacteria (LAB) can produce this vitamin and be used for in-situ fortification of foods 5.
• The combination of riboflavin with other compounds or drugs may have various effects and protective properties, and diminish the toxic effect of drugs in several treatments 6.

Health Benefits and Deficiency Consequences

The health benefits and consequences of riboflavin deficiency are:

• Riboflavin has antioxidant, anti-aging, anti-inflammatory, anti-nociceptive, and anti-cancer properties, and may contribute to the reduction in the risk of some forms of cancer in humans 6.
• Riboflavin deficiency can impair cell proliferation in adult human duodenum, and may have implications for gastrointestinal function 7.
• Riboflavin depletion can cause irreversible loss of proliferative potential of cells, and may have consequences for gastrointestinal morphology in adults 7.