Recommended Dosage of Injection Vitcofol (Vitamin B Complex)
The recommended dosage of Injection Vitcofol (Vitamin B complex) is 1000 μg administered intramuscularly, with an initial loading dose given every other day until improvement is seen, followed by a maintenance dose of 1000 μg monthly for life. 1
Dosing Recommendations Based on Clinical Scenario
Initial Treatment (Loading Dose):
- For vitamin B12 deficiency with neurological involvement: Administer 1000 μg intramuscularly on alternate days until no further improvement is observed 1
- For vitamin B12 deficiency without neurological involvement: Administer 1000 μg intramuscularly three times a week for 2 weeks 1
Maintenance Therapy:
- Standard maintenance dose: 1000 μg intramuscularly every month for life 1, 2
- Alternative maintenance schedule: 1000 μg intramuscularly every 2-3 months for life 1
Special Clinical Scenarios
Post-Surgical Patients:
- Patients with more than 20 cm of distal ileum resected should receive prophylactic vitamin B12 injections of 1000 μg monthly for life 3, 1
- Following bariatric surgical procedures, especially those affecting the ileum, patients require regular vitamin B12 injections 1
Patients with Inflammatory Bowel Disease:
- Patients with ileal Crohn's disease involving more than 30-60 cm of ileum are at risk for B12 deficiency even without resection 3, 1
- CD patients with ileal involvement and/or resection should be screened yearly for vitamin B12 deficiency 3
Patients with Thrombocytopenia:
- For moderate thrombocytopenia (platelet count >50 × 10⁹/L): Standard IM administration can be safely performed 1
- For severe thrombocytopenia (platelet count 25-50 × 10⁹/L): Use smaller gauge needles (25-27G) and apply prolonged pressure at injection site 1
- For critical thrombocytopenia (platelet count <10 × 10⁹/L): Consider platelet transfusion support before IM administration 1
Alternative Administration Routes
Oral Administration:
- Oral vitamin B12 at doses of 1000-2000 μg daily has been shown to be as effective as IM injections in normalizing serum B12 levels 4, 5
- Oral therapy may be more cost-effective than IM injections, with potential savings to healthcare systems 5
- However, oral administration may not be suitable for patients with malabsorption issues, such as those with pernicious anemia, ileal resection, or following bariatric surgery 1
Intranasal Administration:
- Intranasal hydroxocobalamin spray has shown effectiveness in treating vitamin B12 deficiency in children 6
- This route may be considered as an alternative to reduce the burden of injections, particularly in pediatric populations 6
Clinical Pearls and Precautions
- Never administer folic acid before treating vitamin B12 deficiency, as it may mask underlying B12 deficiency and precipitate subacute combined degeneration of the spinal cord 1
- Monitor injection sites for hematoma formation after administration, especially in patients with bleeding disorders 1
- Evaluate neurological symptoms regularly during treatment, as improvement indicates effective therapy 1
- The 1000 μg dose is preferred over smaller doses (e.g., 100 μg) as greater amounts of the vitamin are retained with no disadvantage in cost or toxicity 2