Pernicious Anaemia Society

is 3 loading injections enough

for the past 10 months I have had pins and needles ( numb sensation) across the bridge of my nose and down the right side of my face. I also have severe neck pain at the back of my neck and down the right side into my shoulder. The doctor said it was sinusitis for which I have been prescribed antibiotics and nasal sprays both and referred me for physio for my neck which had no effect. She then prescribed amitriptyline for the nose, this also had no effect. When I told her that the had been a change to the sensation of heat when eating she suggested B12 deficiency ( it runs in my family my aunt and great grandmother had it). I had a blood test in December b12 level was 125, folate 3.2, she would not consider injections until my folate levels were in the normal range and prescribed 5mg folic acid. newyears eve I was diagnosed with diverticulitis. I had a repeat blood test 2 weeks ago my B12 had dropped to 94 and folate was >25 so was offered loading injections every other day for a week and then 1 every 3 months. I questioned this as I thought it should have been 2 weeks but she insisted a week. I had my 3rd injections yesterday and feel absolutely no different. When I expressed my concern she said could have vitamin d deficiency as well to come back next week for further blood tests. if my b12 is still low will offer me another week of loading injections. If my levels are ok she will refer my to a nuerologist. Surely this is a waiste of to have further b12 tests. Is 3 loading injections enough when should they have any sort of effect.

2 Replies

The loading regime varies a bit depending on where you are and what form of B12 is being used to treat you.

If you are UK based then your GP is treating you very badly - but no guarantee another GP would be any better.

BCSH guidelines are that you should have loading shots every other day until your symptoms stop improving. On a practical note it mentions reviewing the situation after 3 weeks. This protocol applies (rather than just 6 shots over 2 weeks) because you have neurological symptoms (the tingling etc). Maintenance shots should then be once every 2 months. See p8

A B12 test after a loading shot is going to mean absolutely nothing unless a considerable amount of time has lapsed - a low result at 3 months would be the only significant result.

Unfortunately it can take a while before you really start to feel the effects of the B12 as your levels imply that the body is going to need to put a lot of things right. Some people even find that they feel worse in terms of pain before things start to improve. There isn't any hard and fast way of predicting what is going to happen for you as people vary so much with B12 but if any of your relatives can remember how they responded to starting on B12 that would probably be your best guide.

I didn't notice any really change until my 3rd maintenance shot.


I'd suggest contacting the PAS (Pernicious Anaemia Society). They are helpful and sympathetic and can probably point you to useful info. If you leave a message they will get back to you.


01656 769 717

Office open from 8am till 2pm every day except Sundays

Useful books

"Could it Be b12" by Sally Pacholok

"What You Should Know About Pernicious Anaemia and Vitamin B12 Deficiency" by Martyn Hooper

"she would not consider injections until my folate levels were in the normal range"

This might be due to reasons outlined in this link below. See Management section.

Other useful links

"so was offered loading injections every other day for a week and then 1 every 3 months"

This sounds like the standard UK treatment for B12 deficiency without neurological symptoms. According to the BNF (British national formulary) Chapter 9 section 1.2

patients with B12 deficiency and neurological symptoms should receive more intensive treatment. see link below for info similar to BNF.

See Management section.


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