3 monthly injection

[isalou]

My Mum(in her 70’s) has been told she is borderline low B12 (158) with symptoms consistent so the GP agreed to prescribe injections. However she had her first one last week and won’t get another one for 3 months. Is this correct?

[Gambit62 Administrator]

where are you based?

If you are in the UK then normal protocol would be loading doses - at least 3x weekly for two weeks - followed by maintenance every 3 months.

if she has neurological symptom then should be loading 3x weekly until symptoms stop improving followed by maintenance every 2 months.

Protocols in other countries can be very different or even non-existent

[Foggyme Administrator]

Hi isalou. No it’s not. Your mum should have received 6 x loading dose injections of vitamin B12, given on alternate days, to raise her levels quickly.

There are then two different treatment regimes:

1) those without neurolgical symptoms should then have injections every three months.

2) those who do have neurolgical symptoms should continue on every other day injections until no further improvement (sometimes for many month, up to two years). This is an intensive regime of treatment which most GPs have not heard of. It's listed in prescribing guidelines called the BNF - her GP will have a copy on their desk. Here's a link to those prescribing guidelines (neurolgical regime is in the second or third paragraph- GPs rarely read that read that far do you might have to point it out:

bnf.nice.org.uk/drug/hydrox...

(BNF B12 Deficiency: Hydroxocobalamin Treatment Regimes)

Note: BNF refers to this as the treatment for Pernicious Anaemia, so her GP may say...ah ha, but she doesn’t have Pernicious Anaemia. Moot point. The treatment for Pernicious Anaemia is treatment for the B12 deficiency it causes, so the treatment for B12 deficiency is the same, whatever the cause (and there are many).

A tip: GPs usually try to manage B12 deficiency by testing levels following injections. This is wrong (levels will be high because of the injections but this tells you nothing about the efficacy of treatment. about Testing following injections is not required and GP should treat according to symptoms, not serum B12 levels.

Also - many find that the eight weekly or three monthly maintenance regimes are not sufficient to keep symptoms at bay. If your mum finds that her symptoms return before the next injection is due, improve when the injection is given, then get worse again before the next injection...that is a sure indicator that she needs more frequent injections. But that's a 'story' for another day...just post again if this happens to her and we can give more information about that.

So...suggest that she returns to her GP and asks to be treated according to the prescribing guidelines in the BNF (British National Formulary).

There are some some PAS pinned posts to the right of this page (or at the bottom if using a phone) - third and fourth ones down - which give more information about B12 deficiency. If you have a read, they'll help,you understand what your GP should be doing for your mum...so you can help them to do it 😉. Because...

GPs are not always well-informed about B12 deficiency. Plesase post again if you need more help.

Good luck to you both...hope she feels better soon.

👍

[MarsBarKid]

Hi I live in Australia - had Pernicious anemia age 15 (born Uk) moved here 50 years back - no GP ever told me about B12. I got burning pain in left heel - read on USA forum to take B12 - age 70 - so googled and bought supplement. Took it daily. Last year going for op on left hip and current GP (Trained in Ireland)did a test and found B12 was high.

942 (440-700 best he said and to cut it own to 3 times a week which iI did)

BTW- Injections cost more here, have to go get script fm GP, then chemist to fill it , then pay for injection to be done- cost of nurse and dressings they say. The supplement best for me, as it works very well - and on age pension - best option - no having to go to get it etc and control it yourself.

If mum wants it, can get it from Thompsons of Australia - have posted here prior. Never had reply saying can get it locally. Several other do make it here, but found Thompson's best in all their vitamins. Some cheaper but not as efficient in delivery. Hence high reading - but still taking it daily as when I did it 3 times a week - didn't feel as well as I had and burning pain came back in heel during night. It had gone away but came back when I went down to 3 times a week B12 pill.

Thompson's B12

Below Local E Pharmacy or on land, Chemist Warehouse. Cheapest.

Home > Health > Vitamins > Thompson's

B12 1000mcg

$13.49

SAVE $13.50 Don't Pay RRP: $26.99

Same price on E Bay here too.

[isalou]

Thank you all so much. I’ve just arrived home from holiday and found out my Mums level was actually 150 - so lower than I thought. She has had some balance issues (walking to one side) so I think that’s neurological symptoms. I’ve told mum who is worried about speaking again to her GP but intends to make a telephone appointment. I will arm her with the guidelines you mention. Thank you all so much.

[isalou]

Slight update on my original post. Mum has a telephone appointment coming up later this week with her GP. On her medication notes it says the following:

‘Hydroxocobalamin - deep I.m every 10/12 weeks no need for loading’

So, I assume they don’t think 150 is low enough for loading. Any views or advice welcome.

[isalou]

Further update. GP will not give loading as Mum isn’t anaemic.