What can I give besides Neurobion (Cyanocobalamin) supplement for numbness?

Treatment Options for Numbness Beyond Neurobion

For numbness, particularly when related to peripheral neuropathy, the first-line pharmacologic treatments are pregabalin, duloxetine, or gabapentin, while addressing the underlying cause—especially vitamin B12 deficiency if present—is essential. 1

Immediate Assessment Required

Before adding treatments, you must determine the cause of numbness:

• Check vitamin B12 levels immediately if not already done, as B12 deficiency commonly causes numbness and requires specific treatment before other interventions 1, 2
• Screen for diabetes if not already diagnosed, as diabetic peripheral neuropathy is a leading cause of numbness 1
• Assess for other risk factors: medications (metformin, H2 blockers, pregabalin, phenobarbital), dietary restrictions (vegan/vegetarian), gastrointestinal conditions (celiac disease, atrophic gastritis), or bariatric surgery 2, 3

First-Line Pharmacologic Treatment for Neuropathic Pain/Numbness

The American Diabetes Association recommends pregabalin, duloxetine, or gabapentin as initial pharmacologic treatments for neuropathic symptoms including numbness. 1

These medications directly address neuropathic pain and sensory disturbances, unlike vitamin supplements which only work if deficiency is present.

Vitamin B12 Deficiency Treatment (If Confirmed)

If B12 deficiency is identified as the cause:

For patients WITH neurological involvement (numbness qualifies):

• Hydroxocobalamin 1 mg intramuscularly on alternate days until no further improvement 1, 2, 3
• Then maintenance: 1 mg intramuscularly every 2 months for life 1, 2

For patients WITHOUT neurological involvement:

• Hydroxocobalamin 1 mg intramuscularly three times weekly for 2 weeks 1, 2, 3
• Then maintenance: 1 mg intramuscularly every 2-3 months for life 1, 2

Critical warning: Never give folic acid before treating B12 deficiency, as this can precipitate subacute combined degeneration of the spinal cord. 1, 2

Other Supplement Options (Limited Evidence)

Alpha-lipoic acid:

• May be beneficial for diabetic peripheral neuropathy with some evidence of effectiveness 4
• One small trial suggested it was more effective than vitamin B complex for short-term improvement 5

Acetyl-L-carnitine:

• Shows promise for diabetic peripheral neuropathy 4
• However, may be ineffective or harmful for chemotherapy-induced neuropathy 4

Vitamin D:

• Consider supplementation if levels are low, particularly in diabetic neuropathy 4

Vitamin E:

• Not recommended as evidence is conflicting and insufficient 5, 4

Evidence Limitations for Vitamin B Complex (Neurobion-type products)

The Cochrane review found insufficient evidence to determine whether vitamin B complex is beneficial for peripheral neuropathy. 5 While one small trial showed slight improvement in vibration perception with benfotiamine (a thiamine derivative), and higher doses showed some short-term symptom reduction, the overall evidence remains limited. 5

Common Pitfalls to Avoid

• Do not assume normal B12 levels exclude deficiency—up to 50% of patients with "normal" serum B12 have functional deficiency when measured by methylmalonic acid 2
• Do not discontinue B12 treatment even if levels normalize when malabsorption is the underlying cause 3
• Do not rely solely on supplements when first-line neuropathic pain medications (pregabalin, duloxetine, gabapentin) are indicated 1
• Do not give folic acid before excluding and treating B12 deficiency 1, 2

Practical Algorithm

1. Assess for B12 deficiency with serum B12 plus methylmalonic acid or homocysteine 2, 3
2. If B12 deficient: Start hydroxocobalamin injections immediately as outlined above 1, 2, 3
3. If not B12 deficient or while awaiting results: Consider pregabalin, duloxetine, or gabapentin for symptomatic relief 1
4. If diabetic neuropathy confirmed: Consider alpha-lipoic acid or acetyl-L-carnitine as adjunctive therapy 4
5. Monitor response and adjust treatment accordingly 1, 3