I see there are three different cobalamin, but which would be best for me? At the moment I am taking sublingual methylcobalamin but though my level of serum B12 has increased many symptoms are still there, and unless I take four or five tablets a day some of the symptoms reappear hours after taking just one tablet a day. I am considering buying injectable cobalamin. I found the info below but makes me no wiser, though the cyanocobalamin is described as the least painful to inject, is it as affective as the others? Cost is also a major deciding factor so help in deciding is required there. Thank you for any advice, Steve. Cyanocobalamin can be given as an intramuscular injection. It should not be given intravenously. However, after injection it will need to convert to methylcobalamin, and then to hydroxocobalamin to be used by the body. Of all the forms of Vitamin B12 it is the least painful for the patient to inject. After introduction into the body it provides a small amount of cyanide. For individuals who are overall very healthy this is a good choice and this is also the least expensive form of injectable Vitamin B12. It is known that some people, such as smokers, are less able to transform cyanocobalamin into methylcobalamin due to toxins and heavy metals in the liver. These individuals need to use other forms of Vitamin B12.
Methylcobalamin is more bioactive and can be given intramuscularly, intravenously, and intraarticularly. It is slightly painful to inject into the muscle. In my practice I also use methylcobalamin when I do Prolozone injections into joints and into subcutaneously (under the skin). This is also a better choice for smokers who are unable to convert cyanocobalamin into methylcobalamin.
Hydroxocobalamin is the most bioactive form of Vitamin B12 and mostly given intravenously as intramuscular injections are very painful. If given intramuscularly it is mixed the local anesthetic procaine. Hydroxocobalamin is retained longer in the body and can be dosed less frequently. An additional application of hydroxocobalamin is that it can be used for patients with cyanide poisoning as it binds cyanide and allows for elimination through the kidneys.
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not sure where your info came from about cyano needing to be converted to methyl and then hydroxo.
There are 4 types of commercially produced B12 - cyano, hydrox, methyl and adenosyl.
There are two types that are used by processes running in your cells - methyl and adenosyl.
The process for getting B12 from blood to cell involves removing the original binder and then the cell recombines it with the methyl or adenosyl part depending on which process it needs to run, which means that generally speaking there isn't any advantage to one form over another, on the basis of being closer to the form used in your cell.
Different forms have different stability - cyano being the most stable and adenosyl being the least - this affects how expensive they are - particularly when talking about injecting.
the main advantage of hydroxo over cyano is that, in theory it is retained longer and it also doesn't have the risks of triggering a reaction in people who have leber's - a rare genetic disorder that you'd probably already know about as it runs in families and is more common in males.
It is true that there are also a number of genetic variants than can affect how efficient the body is in processing different forms of B12 but the impact of these tends to be low. Some people find methyl doesn't suit them. Its an individual thing.
Personally I use a mix of all 4 types of B12 but as a mix of injections, sublinguals and nasal spray.
Personally I'd say go with either hydroxo or cyano and see how you get on.
This is part of a letter from Dr Wilhelmina Reitsema in 'Rapid responses' to the BMJ research document - see her last paragraph - "Is it important which form is used ....."
" There are two active forms of the B12 enzyme in the human cell. First, Methylcobalamin acts as a co-enzyme for the conversion of homocysteine to methionine. Methionine then acts as a methyl-donor to a great number of reactions that need a methyl group, including the synthesis of myelin, serotonin, dopamine, noradrenalin, DNA and phospholipids.
Second, Adenosylcobalamin is a co-enzyme for the conversion of L-methylmalonyl-CoA into succinyl-CoA which feeds into the citric acid cycle.
"Is it important which form is used in treatment? In most people, it does not matter. They can convert cyano- and hydroxo-cobalamin into the active forms needed. However, I have recently reported a case in which it did matter. The severe vitamin B12 deficiency, including dementia and psychosis, responded to treatment with high dose oral methylcobalamin, but not to equally high dose oral hydroxocobalamin. [1]
1. Rietsema WJ. Unexpected Recovery of Moderate Cognitive Impairment on Treatment with Oral Methylcobalamin. Journal of the American Geriatrics Society 2014;62(8):1611-12 doi: 10.1111/jgs.12966[published Online First: Epub Date]|. "
I haven’t heard that Hydroxocobalamin is mostly administered intravenously. I believe it’s mostly given I.M. . That’s how the GPs in the U.K. give it . I use IM and it’s totally painless ( needle gauge 25 and 1inch long )There is no procaine in my ampoules . It is easily obtained from German online pharmacies , and not expensive if purchased in bulk .( 100 of everything you need—- ampoules , needles, syringes and swabs . Makes one shot cost £1.00 . I have tried Methylcobalamin in the past , but I found no advantage over Hydroxocobalamin
As I could see a price difference in the different forms, I have ordered the cheapest, Cyanocobalamin, and just hope it suits me. Which was 43.78 euro delivered to me ( now in France for a couple of months!) Just have to find needles etc. May look in the alleys ?
I did look online in France and as is the case with many things the price was prohibitive! May try the pharmacy for needles if I can't find them in the alleys
From memory and that ain't good, the price was a few euro each ampoule so a packet of ten were close to that of the 100 from Germany which I have ordered. And as it was online I don't think that it included administering the product too. I hadn't tried the local pharmacy as I imagine their prices would be even dearer.
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Does anyone know what Methycobal (Mecobalamin) injections are ?
