B52 Medication Administration Guidelines
B52 injections should be administered at a frequency of 1000 micrograms intramuscularly every 2-3 months for maintenance therapy after initial loading doses. 1
Initial Treatment Protocol for B12 Deficiency
- For patients with severe B12 deficiency or neurological symptoms, administer 1000 micrograms intramuscularly three times a week for 2 weeks as a loading dose 1
- For patients with neurological involvement specifically, administer 1000 micrograms intramuscularly on alternate days until symptoms improve 1
- After the initial loading phase, transition to maintenance therapy 1
Maintenance Therapy
- Monthly administration of 1000 mcg intramuscular (IM) injections is more effective than 3-monthly injections for long-term maintenance 1
- For most patients requiring ongoing supplementation, administer 1000 micrograms IM every 2-3 months 1
- For patients with significant ileal resection (>20 cm of distal ileum), administer 1000 micrograms IM monthly 1
Special Population Considerations
- For pregnant women after bariatric surgery: continue vitamin B12 supplementation at 1000 micrograms every 3 months via intramuscular injection 1
- For elderly patients in skilled nursing facilities: consider more frequent monitoring as they have higher risk of B12 deficiency (prevalence reaching 18.1% in patients over 80 years) 1
- For pediatric patients on parenteral nutrition: administer 0.3 μg/kg/day for preterm and term infants up to 12 months, and 1 μg/day for older children 1
Administration Techniques
- Preferred injection site for intramuscular administration is the vastus lateralis muscle rather than the deltoid muscle 2
- Intramuscular route is preferred over subcutaneous route for vitamin injections 2
- Injection speed does not significantly affect pain perception, so administering at a reasonable speed (10 seconds per cubic centimeter) is appropriate 3
Alternative Options
- Oral supplementation (1000-2000 mcg daily) may be considered after the initial IM loading phase if the patient has no neurological symptoms 1
- For patients with renal dysfunction, methylcobalamin or hydroxycobalamin formulations may be preferable to cyanocobalamin 1
Important Considerations
- Once-daily medication regimens generally show better adherence than more frequent dosing schedules, which supports the use of less frequent B12 injections when clinically appropriate 4
- Folic acid supplementation can mask vitamin B12 deficiency and should not be given before checking vitamin B12 status 1
- When administering multiple injectable vaccines during a single visit, proper spacing between injection sites is important to minimize adverse reactions 2