From the Research
For vitamin B12 levels above 2000 pg/mL in someone on supplementation, the recommended management is to reduce or discontinue the current supplementation. This approach is based on the most recent and highest quality study available, which emphasizes the importance of tailoring treatment to the individual's needs and avoiding unnecessary overtreatment 1. The key steps in managing high vitamin B12 levels due to supplementation include:
- Decreasing the dose of vitamin B12 supplements or increasing the interval between doses
- Considering a switch from high-dose injections to a lower-dose oral form
- Rechecking B12 levels in 3-6 months to ensure they have normalized to the target range of 300-900 pg/mL While high B12 levels from supplementation are generally considered safe, they can lead to unnecessary side effects such as acne, rosacea, or headaches, and represent a waste of resources 2, 3. The body has a limited capacity to utilize extremely high B12 levels, and excess is primarily excreted in urine, making it essential to use the minimum effective dose to maintain levels within the normal range 4, 5. Maintenance therapy should be tailored to the underlying reason for supplementation, whether it's pernicious anemia, malabsorption, or dietary deficiency, to ensure optimal management and minimize potential adverse effects 1.