Best Form of B12 for Injection - Pernicious Anaemi...

Pernicious Anaemia Society
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Best Form of B12 for Injection

garretttimson
garretttimson
17 Replies

There has been some talk about B12 resistance, so I am writing to give my two cents regarding the form of B12 I use. I had my physician write a Rx for hydroxocobalamin 30 ml vial made by Actavis Pharma, Portugal. This is a bacteriostatic 30 does (1ml = 1,000 mcg b12) vial designed for multiple withdrawals. Always follow aseptic technique. In the U.S. this cost me approximately $20 (I have private insurance). I believe this form to be better utilized by the body over the cyanocobalamin form. The methylcobalamin form is ideal, but it isn't stable for any extended period after it was been reconstitute from powder.

bmj.com/content/349/bmj.g5389

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oldestnewest
fbirder

The BNF recommendation does not mean that they think that hydroxocobalamin is 'better utilised'. It is preferred because it is thought that hydroxocobalamin requires less frequent dosing that does cyanocobalamin. So hydroxocobalamin works out cheaper.

All forms of cobalamin should be equal once they enter the cell.

ncbi.nlm.nih.gov/pmc/articl...

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garretttimson

I don't want to appear argumentative. The term "B12 resistance" was used previously by another individual on this site. When speaking about the various forms of B12, the

hydroxocabalamin is a natural form, where cyanocabalim is not. Some sources suggest that the natural forms are a better choice.

Sources that discuss cyano, hydroxo and methyl

generally put them in the same order if a preference is made. I never recommended open vial or reconstitution of a dry form. One point made was that methylcobalamin is not as stable in liquid form, that is why the other two forms are regularly sold in ready-to-use vials. I also did not recommended using a mutli-use vial beyond the manufacturer's expiration date, or the common 28 day rule. I thought this site was a forum for individuals with PA to share their experiences and provided "food for thought" concerning the journey of living with PA. All kinds of questions and opinions are presented on this site, and each individual should do their own research with regards to their health.

regevelya.com/vitamin-b12-f...

empowerpharmacy.com/drugs/m...

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Foggyme
FoggymeAdministrator

Garretttimson. For clarification...there is no such thing as 'B12 resistance'.

We do not advise the use of any form of B12 powder that has to be reconstituted with normal saline prior to injection, particularly when this is provided in multi-dose medium. Even if this is a available in bacteriostatic form, once the seal on normal saline has been broken to combine the two, the sterility of the normal saline is compromised and may be at risk of contamination. This risk is increased every time a new injection is drawn up from that liquid.

We would therefore always advise that injectable B12 is purchased in sterile single dose ampoules.

Where ready-constituted B12 is sold in sealed multi-dose bottles (the sort with a rubber bung on the top to insert a needle and withdraw B12)...manufacturers state that these MUST be discarded 28 days after opening (the B12 can no longer be guaranteed bacteria free after 28 days).

Please see fbirder comments about hydroxocobalamin/forms of cobalamin. In addition, please be aware that methylcobalamin is not an 'ideal' cobalamin... some people react very badly to it.

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academia
academia
in reply to Foggyme

Hi I want to buy B12 injections online as my B12 is 297. Of course GP says that is fine. What vit B12 is best please. I was told its the methylhydoxocyanacobalamin. I am totally puzzled with all of this. I have tingling. burning in both legs and I am scared. Dr says Vit B12 inj are safe for me but unnecessary.

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Gambit62
Gambit62Administrator
in reply to academia

Manufactured forms of B12 are cyanocobalamin (cheapest and most stable - do not use if family history of lebers syndrome), hydroxocobalamin (most people retain this longer than cyanocobalamin, but some retain cyano longer the hydroxo), methylcobalamin (less stable, very sensitive to temperature and hence more expensive that cyano and hydroxo), adenosylcobalamin (not very stable - at least in liquid form - so not generally available in an injectable form).

methylcobalamin and adenosylcobalamin are analogues of the forms of B12 used in cells. However, the process for transferring them from blood to cell means that it shouldn't really matter which form of B12 is in your blood - methyl and adenosyl are made in your cells from 'plain' B12.

However, people react differently to different forms of B12 - some do find methyl helps them, others find it doesn't. You can't determine which is going to work best for you.

Personally I use a mixture of cyano/hydroxo combined with methyl (nasal) and adenosyl (sublinguals) as different ones help with different symptoms.

And as Foggyme says - there is no such thing as B12 resistance.

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Elijahhawk

Whichever b12 form works best for a person is the one which is best for that person.

I am on Methyl IM and have been. Works great for me.

While I won't or can't say "it's the best" over other forms, neither will I cede that another is proven better than Methyl.

All forms of B12 will treat deficiencies.

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academia
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Catman1

There is definitely a lot of people with a lot of knowledge on this site and different experiences. Personally I have had very good results from methylcobalamin but there are also a lot of people who get on well with hydro. Always used single use ampoules personally but thank you for sharing.

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