Vitamin B12 deficiency medical therapy: Difference between revisions
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===Pharmacotherapy=== | ===Pharmacotherapy=== | ||
[[image:6219_thumb.jpg|left|thumb|Moderate filiform taste bud atrophy thought to be due to a vitamin B12, or iron deficiency]] | [[image:6219_thumb.jpg|left|thumb|Moderate filiform taste bud atrophy thought to be due to a vitamin B12, or iron deficiency]] | ||
B | B<sub>12</sub>can be supplemented in healthy subjects by oral pill; [[sublingual]] pill, liquid, or strip; or by injection. B<sub>12</sub> is available singly or in combination with other supplements. B<sub>12</sub> supplements are available in forms including [[cyanocobalamin]], [[hydroxocobalamin]], [[methylcobalamin]], and [[adenosylcobalamin]] (sometimes called "cobamamide" or "dibencozide"). | ||
Vitamin B | Vitamin B<sub>12</sub>can be given as intramuscular injections of [[hydroxycobalamin]], [[methylcobalamin]], or [[cyanocobalamin]]. Body stores (in the liver) are refilled with half a dozen injections in the first couple of weeks and then maintenance with monthly to quarterly injections throughout the life of the [[patient]]. | ||
B | B<sub>12</sub>has traditionally been given [[parenterally]] to ensure absorption in the dosage of 1 mg qd x 1 wk, then qwk x 1month, then monthly. However, oral replacement is now an accepted route, as it has become increasingly appreciated that sufficient quantities of B<sub>12</sub>are absorbed when large doses are given although this is a less efficient path for absorption (1%). This absorption does not rely on the presence of intrinsic factor or an intact ileum. Generally 1 to 2 mg daily is required as a large dose.<ref name="urlEffective Treatment of Cobalamin Deficiency With Oral Cobalamin">{{cite web |url=http://www.bloodjournal.org/cgi/content/full/92/4/1191 |title=Effective Treatment of Cobalamin Deficiency With Oral Cobalamin |format= |work= |accessdate=}}</ref> By contrast, the typical Western diet contains 5–7 µg of B<sub>12</sub>([[Food and Drug Administration]] (FDA) Daily Value <ref>{{cite web| url = http://dietary-supplements.info.nih.gov/factsheets/vitaminb12.asp | title = Dietary Supplement Fact Sheet: Vitamin B12| publisher = National Institutes of Health: Office of Dietary Supplements | accessdate = 2006-06-06 }}</ref>). This method may be more effective than IM Rx, but requires patient compliance. | ||
[[Hypokalemia]], an excessive low [[potassium]] level in the [[blood]], is anecdotally reported as a complication of vitamin B | [[Hypokalemia]], an excessive low [[potassium]] level in the [[blood]], is anecdotally reported as a complication of vitamin B<sub>12</sub>repletion after deficiency. Excessive quantities of [[potassium]] are used by newly growing and dividing hematopoeitic cells, depleting circulating stores of the [[mineral]]. | ||
It has been appreciated since the 1960s that deficiency can sometimes be treated with oral B | It has been appreciated since the 1960s that deficiency can sometimes be treated with oral B<sub>12</sub>supplements when given in sufficient doses. When given in oral doses ranging from 0.1–2 mg daily, B<sub>12</sub>can be absorbed in a pathway that does not require an intact ileum or intrinsic factor. However, with the advent of sublingual and intranasal administration, tablet usage is becoming outdated. <ref>{{cite journal | author= Antoinette M. Kuzminski ''et al''| title= Effective Treatment of Cobalamin Deficiency With Oral Cobalamin| journal= Blood| year= 1998| volume= 92| issue= 4| pages= 1191-1198| id= PMID 9694707}}</ref><ref>{{cite journal | journal=Fam Pract | year=2006 | volume=23 | issue=3 | pages=279-85 | title=Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials | author=Butler CC, Vidal-Alaball J, Cannings-John R, ''et al.'' | id=PMID 16585128 }}</ref> Oral absorption is limited so regular intramuscular injections or sublingual/intranasal administration of a cobalamin (preferably methyl- or hydroxycobalamin) is necessary to restore systemic stores to physiological levels. Recent research indicates that sublingual administration eliminates a deficiency as well as injections with the advantage of evading the allergy risk. | ||
==References== | ==References== | ||
Revision as of 14:10, 24 April 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Pharmacotherapy
B12can be supplemented in healthy subjects by oral pill; sublingual pill, liquid, or strip; or by injection. B12 is available singly or in combination with other supplements. B12 supplements are available in forms including cyanocobalamin, hydroxocobalamin, methylcobalamin, and adenosylcobalamin (sometimes called "cobamamide" or "dibencozide").
Vitamin B12can be given as intramuscular injections of hydroxycobalamin, methylcobalamin, or cyanocobalamin. Body stores (in the liver) are refilled with half a dozen injections in the first couple of weeks and then maintenance with monthly to quarterly injections throughout the life of the patient.
B12has traditionally been given parenterally to ensure absorption in the dosage of 1 mg qd x 1 wk, then qwk x 1month, then monthly. However, oral replacement is now an accepted route, as it has become increasingly appreciated that sufficient quantities of B12are absorbed when large doses are given although this is a less efficient path for absorption (1%). This absorption does not rely on the presence of intrinsic factor or an intact ileum. Generally 1 to 2 mg daily is required as a large dose.[1] By contrast, the typical Western diet contains 5–7 µg of B12(Food and Drug Administration (FDA) Daily Value [2]). This method may be more effective than IM Rx, but requires patient compliance.
Hypokalemia, an excessive low potassium level in the blood, is anecdotally reported as a complication of vitamin B12repletion after deficiency. Excessive quantities of potassium are used by newly growing and dividing hematopoeitic cells, depleting circulating stores of the mineral.
It has been appreciated since the 1960s that deficiency can sometimes be treated with oral B12supplements when given in sufficient doses. When given in oral doses ranging from 0.1–2 mg daily, B12can be absorbed in a pathway that does not require an intact ileum or intrinsic factor. However, with the advent of sublingual and intranasal administration, tablet usage is becoming outdated. [3][4] Oral absorption is limited so regular intramuscular injections or sublingual/intranasal administration of a cobalamin (preferably methyl- or hydroxycobalamin) is necessary to restore systemic stores to physiological levels. Recent research indicates that sublingual administration eliminates a deficiency as well as injections with the advantage of evading the allergy risk.
References
- ↑ "Effective Treatment of Cobalamin Deficiency With Oral Cobalamin".
- ↑ "Dietary Supplement Fact Sheet: Vitamin B12". National Institutes of Health: Office of Dietary Supplements. Retrieved 2006-06-06.
- ↑ Antoinette M. Kuzminski; et al. (1998). "Effective Treatment of Cobalamin Deficiency With Oral Cobalamin". Blood. 92 (4): 1191–1198. PMID 9694707.
- ↑ Butler CC, Vidal-Alaball J, Cannings-John R; et al. (2006). "Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials". Fam Pract. 23 (3): 279–85. PMID 16585128.