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B 12 deficiency - omeprazole link?

Hi- I've just posted this on the pernicious anemia area on here to ask for any help or ideas - I'm not sure if it transfers to this nras area so I've copied it onto here- sorry if I've duplicated 😊


I have recently been diagnosed with rheumatoid arthritis and have been taking various drugs before and after diagnosis. A ppi(omeprazole) was prescribed to take before Naproxen (500mg twice daily) and methotrexate (10mg weekly) with 5mg folic acid 3 days later. I also have cocodamol if needed too. I try to avoid cocodamol (which gives me constipation!) and naproxen therefore ppi if I can...because I know it's best to limit their use alongside mtx. I have also had 5 steroid injections plus a week course of prednisolone since late December/January to help the widespread swelling/pain to subside asap!

My last blood test (5 weeks into mtx) revealed slight b12 deficiency -154. I actually asked for this (along with a cholesterol check!) to be tested as my symptoms were a-typical of b12 deficiency! I have been prescribed 50mg cyanocobalamin / day, orally (without actually seeing me and asking about my symptoms!) by my gp. I read the bottle which suggests an adult can take up to 3 a day and understand that these are readily bought over the counter so have decided to take more until I feel the benefit! I'd like to hear if anyone has had a similar experience and when it's best to take these i.e. : with or without food, early in the day, spaced throughout the day etc. ?

I have also read (in many reports) that omeprazole can be a reason to encourage b12 deficiency....even though my clinical nurse and my gp assure me that's not true!!!

I've also read that a low b12 and a raised folates blood test result suggests further tests should be done??

I realise I'm rambling on.....sorry

Last edited by Moomin8

2 Replies

I'm always surprised that doctors don't routinely test for coeliac disease when they discover people have low B12 or folate or iron stores, as coeliac disease is a prime cause of malabsorption problems. I am also often surprised when people get told they have pernicious anaemia without being seen by a haematologist. as I understand it, pernicious anaemia is a very specific disease (not all chronic low B12 is pernicious anaemia) and is diagnosed by a haematologist, not just by blood counts, but by special microscopic examination of your blood.

Interesting your comment about PPIs - the NHS patient information site also says that PPIs can cause low B12

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I have been fortunate in being tested exhaustively for the cause of my low blood count -this included testing for coeliac disease, iron levels, folic acid and B12 and a bone marrow. In the end they concluded that it was auto-immune - "part of the RA complex" ! and put me on high dose steroids which improved it considerably.

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