Vitamin B12 or folate deficiency anaemia – Treatment

The treatment for vitamin B12 or folate deficiency anaemia depends on what’s causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins.

Treating vitamin B12 deficiency anaemia

Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12, called hydroxocobalamin.

At first, you’ll have these injections every other day for 2 weeks or until your symptoms have started improving.

Your GP or nurse will give the injections.

After this initial period, your treatment will depend on whether the cause of your vitamin B12 deficiency is related to your diet or whether the deficiency is causing any neurological problems, such as problems with thinking, memory and behaviour.

The most common cause of vitamin B12 deficiency in the UK is pernicious anaemia, which is not related to your diet.

Diet-related

If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be advised to take vitamin B12 tablets every day between meals.

Or you may need to have an injection of hydroxocobalamin twice a year.

People who find it difficult to get enough vitamin B12 in their diets, such as those following a vegan diet, may need vitamin B12 tablets for life.

Although it’s less common, people with vitamin B12 deficiency caused by a prolonged poor diet may be advised to stop taking the tablets once their vitamin B12 levels have returned to normal and their diet has improved.

Good sources of vitamin B12 include:

• meat
• salmon and cod
• milk and other dairy products
• eggs

If you’re a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as yeast extract (including Marmite), as well as some fortified breakfast cereals and soy products.

Check the nutrition labels while food shopping to see how much vitamin B12 different foods contain.

Not diet-related

If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you’ll usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of your life.

If you have had neurological symptoms that affect your nervous system, such as numbness or tingling in your hands and feet, caused by a vitamin B12 deficiency, you’ll be referred to a haematologist and may need to have injections every 2 months.

Your haematologist will advise on how long you need to keep taking the injections.

For injections of vitamin B12 given in the UK, hydroxocobalamin is preferred to an alternative called cyanocobalamin. This is because hydroxocobalamin stays in the body for longer.

Treating folate deficiency anaemia

To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels.

They may also give you dietary advice so you can increase your folate intake.

Good sources of folate include:

• broccoli
• brussels sprouts
• asparagus
• peas
• chickpeas
• brown rice

Most people need to take folic acid tablets for about 4 months. But if the underlying cause of your folate deficiency anaemia continues, you may have to take folic acid tablets for longer, possibly for life.

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they’re normal.

This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency.

If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system.

Monitoring your condition

To ensure your treatment is working, you may need to have further blood tests.

A blood test is often carried out around 7 to 10 days after starting treatment to assess whether treatment is working.

This is to check your haemoglobin level and the number of the immature red blood cells (reticulocytes) in your blood.

Another blood test may also be carried out after approximately 8 weeks to confirm your treatment has been successful.

Most people who have had a vitamin B12 or folate deficiency will not need further monitoring unless their symptoms return or their treatment is ineffective.

Page last reviewed: 20 February 2023
Next review due: 20 February 2026

Neo-B12 Injection Drug / Medicine Information

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia.

Consumer Medicine Information (CMI) summary

The full CMI on the next page has more details. If you are worried about using this medicine,
speak to your doctor or pharmacist.

Why am I being treated with Neo-B12 Injection?

Neo-B12 Injection contains the active ingredient hydroxocobalamin. Neo-B12 Injection
is a form of vitamin B12. Neo-B12 Injection is used for the prevention and treatment
of anaemias associated with vitamin B12 deficiency. It is also used to treat diseases
of nerves in the eyes.

For more information, see Section 1. Why am I being treated with Neo-B12 Injection? in the full CMI.

What should I know before treatment with Neo-B12 Injection?

Do not use if you have ever had an allergic reaction to hydroxocobalamin, or any of
the ingredients listed at the end of the CMI or cobalt.
Do not use if you have folate-deficient megaloblastic anaemia (a type of anaemia caused
by the deficiency of another vitamin called folic acid).
Talk to your doctor if you have or have had any other medical conditions, such as
a disease of the spinal cord.
Check with your doctor if you take any other medicines, or are pregnant or plan to
become pregnant or are breastfeeding.
For more information, see Section 2. What should I know before treatment with Neo-B12 Injection? in the full CMI.

What if I am taking other medicines?

Some medicines may interfere with Neo-B12 Injection and affect how it works.
A list of these medicines is in Section 3. What if I am taking other medicines? in the full CMI.

How is Neo-B12 Injection given?

Neo-B12 Injection is given as an injection into a muscle. It must only be given by
a nurse or doctor.

Your doctor will decide what dose you will receive and how often you will receive
it. This depends on your condition and other factors, such as your weight.

More instructions can be found in Section 4. How is Neo-B12 Injection given? in the full CMI.

What should I know during treatment with Neo-B12 Injection?

Things you should do	Tell any other doctors, dentists, and pharmacists who treat you that you are being given Neo-B12 Injection. If you become pregnant while being treated with Neo-B12 Injection, tell your doctor immediately.
Driving or using machines	Be careful before you drive or use any machines or tools until you know how Neo-B12 Injection affects you.
Looking after your medicine	Neo-B12 Injection is usually stored in the doctor’s surgery or clinic, or at the pharmacy. If you need to store Neo-B12 Injection, keep it in the original pack until it is time for it to be given. Store below 25°C and in a cool dry place.

For more information, see Section 5. What should I know during treatment with Neo-B12 Injection? in the full CMI.

Are there any side effects?

Less serious side effects include: diarrhoea, nausea, headache, vomiting, dizziness, acne, skin rash, itching pain
or redness at the injection site, feeling hot or cold, fever, shivering, changes to
the skin pigment, changes to colour of urine or faeces, general feeling of weakness
or unwell, increased blood pressure or change in electrolytes.

Serious side effects include: signs of an allergic reaction (which may include shortness of breath, wheezing or
difficulty breathing, swelling of the face, lips, tongue or other parts of the body,
rash, itching or hives on the skin), breathlessness (which may be very severe and
usually worsens on lying down due to a build-up of fluid in the lungs), changes in
heart rate (fast, slow or irregular), chest tightness or pain, swelling or pain in
a body part (due to clots in the blood vessels). For more information, including what
to do if you have any side effects, see Section 6. Are there any side effects? in the full CMI.

 

Active ingredient(s):
hydroxocobalamin (hye-drox-oh-koe-BAL-a-min)

Consumer Medicine Information (CMI)

This leaflet provides important information about using Neo-B12 Injection. You should also speak to your doctor or pharmacist if you would like further information
or if you have any concerns or questions about being treated with Neo-B12 Injection.

Where to find information in this leaflet:

1. Why am I being treated with Neo-B12 Injection?

2. What should I know before treatment with Neo-B12 Injection?

3. What if I am taking other medicines?

4. How is Neo-B12 Injection given?

5. What should I know during treatment with Neo-B12 Injection?

6. Are there any side effects?

7. Product details

Why am I being treated with Neo-B12 Injection?

Neo-B12 Injection contains the active ingredient hydroxocobalamin. Neo-B12 Injection is a form of vitamin B12. Neo-B12 Injection is used for the prevention
and treatment of anaemias associated with vitamin B12 deficiency. It is also used
to treat diseases of nerves in the eyes.

Your doctor may have prescribed it for another reason.

Ask your doctor if you have any questions about why this medicine has been prescribed
for you.

”>What should I know before treatment with Neo-B12 Injection?

Warnings

Do not use/ you must not be given Neo-B12 Injection:

to treat megaloblastic anaemia of pregnancy (a type of anaemia usually caused by the
deficiency of another vitamin called folic acid).

If you are allergic to hydroxocobalamin, or any of the ingredients listed at the end
of this leaflet.

If you are allergic to cobalt.

Symptoms of an allergic reaction may include:

shortness of breath

wheezing or difficulty breathing

swelling of the face, lips, tongue or other parts of the body

skin rash, itching or hives.

Always check the ingredients to make sure you can use this medicine.

Check with your doctor if you:

have or have had any other medical conditions, especially the following:

a disease of the spinal cord

folate-deficient megaloblastic anaemia (a type of anaemia caused by the deficiency
of another vitamin called folic acid)

take any medicines for any other condition

have allergies to any other medicines, foods, preservatives or dyes.

If you have not told your doctor about any of the above, tell them before you are
given Neo-B12 Injection.

During treatment, you may be at risk of developing certain side effects. It is important
you understand these risks and how to monitor for them. See additional information
under Section 6. Are there any side effects?

Pregnancy and breastfeeding

Check with your doctor if you are pregnant or intend to become pregnant.

Talk to your doctor if you are breastfeeding or intend to breastfeed.

Your doctor can discuss with you the possible risks and benefits involved.

What if I am taking other medicines?

Tell your doctor or pharmacist if you are taking any other medicines, including any
medicines, vitamins or supplements that you buy without a prescription from your pharmacy,
supermarket or health food shop.

Some medicines may interfere with Neo-B12 Injection and affect how it works. These
include:

chloramphenicol, a medicine used to treat infections

the contraceptive pill (birth control pill)

folic acid.

These medicines may be affected by hydroxocobalamin, or may affect how well it works.
You may need different amounts of your medicine, or you may need to take different
medicines.

Check with your doctor or pharmacist if you are not sure about what medicines, vitamins
or supplements you are taking and if these affect Neo-B12 Injection.

Your doctor and pharmacist may have more information on medicines to be careful with
or avoid while being treated with Neo-B12 Injection.

How is Neo-B12 Injection given?

How is it given

Neo-B12 Injection is given as an injection into a muscle.

It must only be given by a nurse or doctor.

How much is given

Your doctor will decide what dose you will receive and how often you will receive
it. This depends on your condition and other factors such as your weight.

If you receive too much (Overdose)

As Neo-B12 Injection is given to you under the supervision of your doctor, it is very
unlikely that you will receive too much.

Symptoms of an overdose may include the side effects listed under Section 6. Are there any side effects? but are usually of a more severe nature.

If you experience severe side effects or if you think that you have been given too
much Neo-B12 Injection, you may need urgent medical attention.

You should immediately:

phone the Poisons Information Centre
(by calling
13 11 26), or

contact your doctor, or

go to the Emergency Department at your nearest hospital.

You should do this even if there are no signs of discomfort or poisoning.

What should I know during treatment with Neo-B12 Injection?

Things you should do

Tell any other doctors, dentists, and pharmacists who treat you that you are being
given Neo-B12 Injection.

If you are to be started on any new medicine, remind your doctor and pharmacist that
you are being given Neo-B12 Injection.

If you become pregnant while you are being treated with Neo-B12 Injection, tell your
doctor immediately.

If you are going to have surgery, tell the surgeon or anaesthetist that you are being
given Neo-B12 Injection. It may affect other medicines used during surgery.

If you are about to have any blood tests, tell your doctor that you are being given
Neo-B12 Injection. It may interfere with the results of some tests.

Keep all of your doctor’s appointments so that your progress can be checked. Your doctor may do some tests from time to time to make sure the medicine is working
and to prevent any unwanted side effects.

Driving or using machines

Be careful before you drive or use any machines or tools until you know how Neo-B12
Injection affects you.

Looking after your medicine

Neo-B12 Injection is usually stored in the doctor’s surgery or clinic, or at the pharmacy.

If you need to store Neo-B12 Injection, keep it in the original pack until it is time
for it to be given.

Store below 25°C. Store in a cool dry place away from moisture, heat or sunlight;
for example, do not store it:

in the bathroom or near a sink, or

in the car or on window sills.

Do not use this medicine after the expiry date.

Keep it where young children cannot reach it.

Getting rid of any unwanted medicine

Neo-B12 Injection should not be given to you if the packaging is torn or shows signs
of tampering.

If your doctor tells you to stop using Neo-B12 Injection or it is out of date, take
any ampoules that are left over to a pharmacy for safe disposal.

Are there any side effects?

All medicines can have side effects. If you do experience any side effects, most of
them are minor and temporary. However, some side effects may need medical attention.

See the information below and, if you need to, ask your doctor or pharmacist if you
have any further questions about side effects.

Less serious side effects	What to do
diarrhoea nausea headache vomiting dizziness acne skin rash or discolouration itching pain or redness at the injection site feeling hot or cold, fever, shivering general feeling of weakness or unwell change in urine or faeces to a red/reddish colour increased blood pressure and change in electrolytes	Speak to your doctor if you have any of these common side effects and they worry you. These side effects are usually mild.

Tell your doctor or pharmacist if you notice anything else that may be making you
feel unwell.

Other side effects not listed here may occur in some people.

Reporting side effects

After you have received medical advice for any side effects you experience, you can
report side effects to the Therapeutic Goods Administration online at www.tga.gov.au/reporting-problems . By reporting side effects, you can help provide more information on the safety of
this medicine.

Always make sure you speak to your doctor or pharmacist before you decide to stop
taking any of your medicines.

Product details

What Neo-B12 Injection contains

Active ingredient (main ingredient)	Hydroxocobalamin (as chloride)
Other ingredients (inactive ingredients)	sodium chloride acetic acid water for injections

Do not use this medicine if you are allergic to any of these ingredients.

This medicine does not contain lactose, sucrose, gluten, tartrazine or any other azo
dyes.

What Neo-B12 Injection looks like

Neo-B12 Injection is a clear, dark red solution in a glass ampoule. It is available
in packs of 3 ampoules.

1000 micrograms/1 mL ampoules x 3 (AUST R 121709)

Who distributes Neo-B12 Injection

Pfizer Australia Pty Ltd

Sydney NSW

Toll Free Number: 1800 675 229

www.pfizermedinfo.com.au 

This leaflet was prepared in June 2022.

Vitamin B12 ampoules: instructions for use

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• Vitamin B12 in ampoules: instructions for use

Content:

1. The role of vitamin B12 in the body
2. Indications for use of cyanocobalamin
3. Treatment regimen with cyanocobalamin
4. How to inject
5. Storage conditions of vitamin B12 in ampoules
6. Dosage of vitamin B12 in ampoules
7. Contraindications and side effects

Lack of vitamin B12 leads to a number of diseases. This is an important substance for the functioning of all systems, which reduces susceptibility to infections, increases endurance, physical and mental activity.

The role of vitamin B12 in the body

Cyanocobalamin (vitamin B12) was first discovered in 1948. Scientists isolated a new substance from raw liver and prescribed it to treat pernicious anemia.

Over the past 70 years, cyanocobalamin has been well studied by scientists and physicians, as a result of which it was possible to establish its effect on the body:

• blocking the stress hormone;
• improvement of blood clotting;
• synthesis of amino acids;
• decrease in the amount of cholesterol in the blood;
• detoxification of the body with alcoholism;
• improvement of liver function.

Cyanocobalamin helps athletes withstand heavy loads, accelerates weight loss and prevents the development of cardiovascular diseases.

It plays a special role in the functioning of the central nervous system. Vitamin complements the main therapy for cerebral palsy in children, Down’s disease, intercostal neuralgia, etc.

Back to article content

Indications for use of cyanocobalamin

Vitamin B12 in ampoules is used as an additional therapy. It enhances the effect of drugs, helps the body to overcome many diseases. In rare cases, it is prescribed as the only remedy for the prevention of anemia.

Indication for vitamin B12:

• chronic migraine;
• Down syndrome;
• cerebral palsy;
• neuralgia;
• radiation sickness;
• alcohol poisoning;
• dystrophy;
• anemia;
• radiculitis;
• diseases of the pancreas and liver;
• gastritis;
• photodermatosis;
• sclerosis.

Reception of cyanocobalamin is indicated for beriberi, frequent respiratory diseases. The lack of a substance in the body leads to a deterioration in the condition of hair, nails and teeth. For this reason, the drug is taken in ampoules not only for medical purposes, but also for cosmetic purposes.

Back to article content

Cyanocobalamin regimen

When vitamin B12 is prescribed, the instructions for use will help calculate the correct dosage. The treatment regimen looks like this:

• For the prevention of anemia and vitamin deficiency – from 200 to 500 mcg per day. The course of treatment is from 7 to 15 days.
• For the treatment of diseases of the central nervous system – 200 mcg per day daily for the first 3 days. Then 300 mcg daily for 4 days.
• If cyanocobalamin is used in complex therapy, then the dosage is from 200 to 500 mcg per day.

Vitamin B12 should only be taken at the dosage recommended by your doctor. It is not recommended to use the drug on its own, since it is rather difficult to determine an individual treatment regimen.

Back to article content

How to inject

Vitamin B12 shots can be given in different ways:

• subcutaneously;
• intramuscularly;
• intravenously;
• into the spinal cord.

The instructions say that cyanocobalamin cannot be used simultaneously with drugs that increase blood clotting, as well as with vitamins B1 and B6. If there is an allergy to B1, then B12 can exacerbate it.

You can administer intramuscularly and intravenously on your own. For injection into the spinal cord, you should consult an experienced doctor.

Back to article content

Storage conditions for vitamin B12 ampoules

Vitamin B12 in ampoules should be stored in a dry, dark place, at an air temperature of no more than 25 degrees. Some complex preparations require storage in the refrigerator. This point must be specified in the instructions.

Do not use the substance after the expiry date stated on the packaging.

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Vitamin B12 dosage in ampoules

The dosage of vitamin B12 is determined individually and depends on the age of the patient. The maximum daily dose is:

• children – 400 mcg;
• adults – 1000 mcg.

The dosage increases gradually, you need to start with a small portion of the drug. This is necessary to exclude allergic reactions.

Back to article content

Contraindications and side effects

Subject to the instructions for use and the doctor’s recommendations, the drug has no side effects. In exceptional cases, unpleasant symptoms may occur:

• nervous excitement;
• tachycardia;
• headache;
• pain in the region of the heart;
• increased blood pressure;
• dizziness.

If there is an individual intolerance to the drug, then an allergic reaction occurs in the form of skin itching, rash, runny nose. In the event of side effects, the injection is stopped, the treatment method is reviewed together with the doctor.

Before starting injections, you should study the list of contraindications:

• angina;
• erythrocytosis;
• thrombosis;
• varicose veins;
• pregnancy and lactation;
• haemorrhoids;
• oncological diseases.

Another contraindication is individual intolerance to cyanocobalamin.

It is important to follow the instructions for use so that there is no overdose of vitamin B12 . In this case, the following conditions are observed:

• heart failure;
• arrhythmia;
• pulmonary edema;
• rash;
• anaphylactic shock.

Cyanocobalamin makes an invaluable contribution to the functioning of the body. With its deficiency, various diseases develop, the appearance and general well-being deteriorate. But you need to take it only after consulting a doctor and determining the individual dosage.

Return to the content of the article

09/21/2018

VITAMIN B12 “BioChemPharm Firm LLC

for the use of the drug Vitamin B ₁₂ for veterinary medicine

(Developer organization: BioChemPharm Firm LLC, Raduzhny, Vladimir region)

I . General information

1. Trade name: Vitamin B ₁₂ (Vitamin B ₁₂ ).

International non-proprietary name: Cyanocobalamin (Cyanocobalamin).

2. Dosage form: solution for injection.

Vitamin B ₁₂ 1 ml contains 500 mcg of cyanocobalamin (vitamin B ₁₂ ) as an active substance, as well as sodium chloride and water for injection – up to 1 ml. Produce Vitamin B ₁₂ for injection packed in 5, 10, 20, 50 and 100 ml glass vials of appropriate capacity, sealed with rubber stoppers reinforced with aluminum caps.

3. Each vial is labeled with the name of the medicinal product, batch number, volume, expiration date. Each vial or bottle is labeled with the indication of: the manufacturer, its address and trademark, the purpose of the medicinal product, the name and content of the active substance, the method of application, the batch number, the date of manufacture, the expiration date, the volume in the vial or bottle, storage conditions, inscriptions “Sterile”, “For veterinary use”, state registration numbers, information on confirmation of conformity, TU designations and provide instructions for use.

The shelf life of the medicinal product under the conditions of storage in a closed package is 2 years from the date of manufacture.

Do not use Vitamin B ₁₂ after the expiration date of the expiration date.

4. Store the medicinal product in the closed packaging of the manufacturer in a dry, dark place at a temperature of 0 ⁰ C to 25 ⁰ C.

5. Vitamin B ₁₂ should be stored in places inaccessible to children.

6. Unused drug with an expired expiration date is disposed of in accordance with the law.

II. Pharmacological properties

7. Pharmacotherapeutic group: Vitamin B ₁₂ (cyanocobalamin and its analogues).

Vitamin B ₁₂ belongs to the water-soluble vitamins of group B. A characteristic chemical feature of the cyanocobalamin molecule is the presence of a cobalt atom and a cyano group in it, forming a coordination complex. In the body, cyanocobalamin is converted to a coenzyme form – adenosylcobalamin, which is the active form of vitamin B ₁₂ . Cyanocobalamin is a growth factor necessary for normal hematopoiesis and maturation of red blood cells; participates in the synthesis of labile methyl groups and in the formation of choline, methionine, creatine, nucleic acids; contributes to the accumulation in erythrocytes of compounds containing sulfhydryl groups. It has a beneficial effect on the function of the liver and nervous system. Cyanocobalamin activates the blood coagulation system: in high doses it causes an increase in thromboplastic activity and prothrombin activity.
Vitamin B ₁₂ improves the acid-base balance of the body, increases the content of total protein in the blood serum, increases the amount of gamma globulins, stimulates the production of antibodies. The drug promotes the growth and development of animals. When administered intramuscularly, cyanocobalamin quickly enters the bloodstream. Most of the vitamin is excreted from the body in the urine within 24 hours. With intravenous administration, the half-life of cyanocobalamin is from 20 to 50 minutes.

Vitamin B ₁₂ for injection according to the classification of GOST 12.1.007-76 refers to substances of the 4th hazard class – substances of low hazard. The drug in recommended doses is not toxic to warm-blooded animals.

III. How to use

8. The drug is used for the prevention of vitamin B deficiency ₁₂ and the treatment of anemia, as well as for neuritis, paresis, osteoarthritis, liver disease, chronic poisoning with salts of heavy metals, organic dyes, in violation of the function of the digestive system, pancreas , to stimulate the growth and development of animals.

9. Contraindications: hypersensitivity, hypercoagulation (including acute thrombosis), erythremia, erythrocytosis.

10. The drug is administered subcutaneously or intramuscularly 1-2 times a day in the following doses (per 1 animal):

Animals

µg vitamin B ₁₂

ml of preparation

Cows, horses, camels, sheep

1000-2000

2-4

Pigs

500-3000

1-6

Weaned piglets

10-50

0.02-0.1

Suckling pigs

3-5

0.006-0.01

Dogs up to 5 kg and cats

250

0.5

Dogs 5 to 15 kg

500

1

Dogs over 15 kg

1000

2

Chickens

3-5

0. 006-0.01

Doses and duration of application of Vitamin B ₁₂ depend on the weight of the animal and the course of the disease.

11. Symptoms of overdose when using the drug in accordance with the instructions for use have not been identified.

12. Features of the drug’s action at the beginning of use or when it is canceled have not been established.

13. Failure to follow the recommended interval for repeated administration of the drug may lead to a decrease in its effectiveness. If you miss the next dose of the drug, its use is resumed as soon as possible in the same dosage and according to the same scheme.

14. In recommended doses Vitamin B

₁₂ for injection does not cause side effects and complications in animals.

15. Vitamin B ₁₂ is incompatible with ascorbic acid, salts of heavy metals (inactivation of cyanocobalamin), thiamine bromide, pyridoxine, riboflavin (because the cobalt ion contained in the cyanocobalamin molecule destroys other vitamins).