BMJ Oral Vitamin B12 can change our Practice

[lesbud1]

Is this article why some of us are being put on oral b12? what do we say to this?

This is what is says

This study confirms that oral 1000 μg cyanocobalamin provides effective maintenance therapy for vitamin B12 deficiency of all causes. General practitioners can be confident that this alternative treatment is both safe and effective in the long term—ongoing monitoring of our patients has substantiated that belief.

An oral treatment can produce substantial savings by removing the necessity for nurse involvement either at home or at the surgery for injection therapy.14

Patients much prefer oral medication and given the opportunity to choose between an injection and a tablet of vitamin B12, clearly demonstrated this preference. Vitamin B12 replacement therapy is ideally suited to a standard monitoring protocol and this should become a regular part of our care.

Patients with the very rare condition of tobacco amblyopia should remain on hydroxocobalamin as there is a theoretical possibility of cyanocobalamin (rather than hydroxocobalamin) increasing the risks of this condition.15

There is now an oral alternative4 to a parenteral treatment and oral vitamin B12 is now a therapy option. The study confirms oral vitamin B12 is effective and acceptable as maintenance therapy in UK general practice for which we advocate its use. “Medicine’s best kept secret”4 is certainly out and the time for change has arrived.Learning points

Oral vitamin B12 is effective in the treatment of vitamin B12 deficiency including pernicious anaemia but is rarely used for this indication in the UK.

The 1000 μg tablet of cyanocobalamin used in this study is safe to use for maintenance therapy in UK general practice.

Patients prefer oral medication to an injection of vitamin B12.

The burden of work undertaken by community nurses and general practitioners in administering injectable vitamin B12 can be substantially reduced.

We need to look at our current practice and move forward with oral vitamin B12 replacement therapy.

Nyholm et al 2003

[EllieMayNot]

All I can say is that no amount of oral or sublingual B12 helped me and I took methylcobalamin not cyano so it should have worked better. I do see that the article referenced is from 2003, hopefully the author(s) have come their senses since then.

[lesbud1 in reply to EllieMayNot]

yes I do hope so but I need to ask my GP what research they are basing their new policy on.

[Gambit62 Administrator]

This is a really old study - 2003

There have been subsequent studies which have not come to the same conclusion

eg

ncbi.nlm.nih.gov/pubmed/284...

Use of high dose oral is not a licensed treatment in the UK. Whilst GPs can use their discretion they should ensure that they are acting on well researched advice.

If there is a large scale trial of oral B12 going on and surgeries are acting on this then they should bear in mind BMA ethical guidance in relation to research, which is that patients should be in a position to make an informed choice as to whether or not they take part in any such study.

[deniseinmilden]

Obviously Nyholm et al never had B12 deficiency.

I wish I could make them have B12d for publishing such nonsense, as only the suffering caused by this miserable deficiency would be fair justice for the suffering that their paper will have inevitably caused so many people.

Hurumph. Usually I am a peaceful soul!

[Midnight_Voice]

Who wouldn’t rather take a tablet, which they can do at home, than have an injection administered? Or rather than an injection done at home, even?

If it worked.

But with only about two inches of your colon able to intercept the oral B12 as it comes thundering by, even in a healthy person let alone one with diverticulosis or other intestinal problems where this collection function is severely compromised, I’d rather see my stash of B12 quietly residing in a muscle or two, from where it can gradually leach directly into the bloodstream where it is needed.

A lot of water has flowed under the bridge since 2003, and if there were any substance in that study, you would think that at least some of it would have made it into the standard BNF guidelines, as revised as recently as last February 2019.

That it hasn’t perhaps says all that needs to be said here.

[Cetus]

I much prefer B12 injections to oral tablets. I notice the well-respected Cochrane organisation recently looked into the equivalence of B12 injections and tablets but the best they could find was nothing more than "low quality" evidence.

cochrane.org/CD004655/ENDOC...

"Low quality evidence shows oral and IM vitamin B12 having similar effects in terms of normalising serum vitamin B12 levels, but oral treatment costs less. We found very low-quality evidence that oral vitamin B12 appears as safe as IM vitamin B12."