Pernicious Anaemia Society
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Problems with sublingual methyl. Should I take hydroxocobalamin?

Hi, everyone. I've already written for you once. I'm Brazilian and have B12 deficiency. There are some questions I'd like to make. I started the treament 2 months ago ( injecting 1000 mcg of cyano daily for one week) and felt really good. All the symptoms disappeared, including the neurologic. After that, as I probably need more doses for the maintenance, I got bad again. It's not too easy to take the injections like I would. Firstly, because that's very hard to find this vitamin in Brazil (here we just have cyano, all the other need to be brought from other countries). Secondly, I take it in a pharmacy, so can't take many of them because they'd not let me. Besides that, in the injection there are B6 and B1. B1 isn't a problem, but B6 can be toxic for the nerves if I take it for big periods. To fix that, I bought Jarrows sublingual methylcobalamin 1000 mcg, but it's not working. I've already taken 4 and can't feel any improvement. When I take one cyano injection I actually feel some changes in the next day. Is there any probability of sublingual not work for me or it's because of methylcobalamin doesn't work for some people cause they can't convert it? Should I buy sublingual hidroxo? Remembering that I can't find this form here in Brazil to take injections and I have ways to buy sublingual hidroxo. Will it work for me? I'm feeling bad again and need some advices to get better. Thanks all of you.

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If you can find sublingual hydroxo then I'd give it a try.

From a quick search it seems that the cyanocobalamin for injection contains 1000 ug of B12 and 100 mg of B6 (and the same of B1). For adults the maximum dose of B6 is 100 mg per day (neuropathy starts at 10 times that amount). I would think that injecting once per week should be absolutely fine.

As the cyano seems to work for your B12 deficiency then I'd be very tempted to try and find a frequency of injections that keeps the symptoms at bay and stick to that. Try once a month and, if that doesn't work then try it more often.


one study showed memory problems occuring at doses of 500mg a day.


Some people find they have little or no response to methyl so as fbirder says it is worth trying hydroxo. It helps me with a few symptoms but is useless for the ones that really make life hell.

Unfortunately it isn't possible to say if you are one of those who doesn't find sublingual a useful way of delivering B12 short of trying another form of b12.

If the sublinguals don't work then there are other options like nasal sprays and skin patches that you might be able to look at.

Have you tried asking at the pharmacy if they do other forms of B12 that don't have B1 and B6 in them?

Another posibility might be falling folate levels. Do you supplement folate/folic acid at all


You will need more than four to make a difference. Not all will be absorbed unlike injections where it goes directly into your bloodstream and into cells. I took 1mg jarrows but changed to 5mg which is enough to keep me going between injections but not an injection replacement.

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