Side effect of b12 pills: Vitamin B-12 – Mayo Clinic
Vitamin B-12 – Mayo Clinic
Vitamin B-12 (cobalamin) plays an essential role in red blood cell formation, cell metabolism, nerve function and the production of DNA, the molecules inside cells that carry genetic information.
Food sources of vitamin B-12 include poultry, meat, fish and dairy products. Vitamin B-12 is also added to some foods, such as fortified breakfast cereals, and is available as an oral supplement. Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency.
Vitamin B-12 deficiency is not common in the U.S. However, people who follow a vegetarian or vegan diet might be prone to deficiency because plant foods don’t contain vitamin B-12. Older adults and people with digestive tract conditions that affect absorption of nutrients also are susceptible to vitamin B-12 deficiency.
Left untreated, a vitamin B-12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances.
The recommended daily amount of vitamin B-12 for adults is 2.4 micrograms.
Research on the use of vitamin B-12 for specific activities and conditions shows:
- Heart and blood vessel disease. Researchers had previously believed that vitamin B-12, when combined with folic acid (vitamin B-9) and vitamin B-6, might prevent diseases of the heart and blood vessels by reducing the levels of an amino acid in the blood (homocysteine). However, studies show that the combination of these vitamins doesn’t seem to reduce the risk or severity of cardiovascular disease and stroke.
- Dementia. Vitamin B-12 deficiency is associated with dementia and low cognitive function, but it’s not clear whether vitamin B-12 supplements might help prevent or treat dementia.
- Athletic performance. Unless you have a vitamin B-12 deficiency, there’s no evidence that vitamin B-12 supplements will boost your energy or make you a better athlete.
Most people get enough vitamin B-12 from a balanced diet. However, older adults, vegetarians, vegans and people who have conditions that affect their ability to absorb vitamin B-12 from foods might benefit from the use of oral supplements.
Vitamin B-12 supplements also are recommended for women who are pregnant or breastfeeding exclusively and follow vegetarian or vegan diets.
Safety and side effects
When taken at appropriate doses, vitamin B-12 supplements are generally considered safe. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. Your body absorbs only as much as it needs, and any excess passes through your urine.
High doses of vitamin B-12, such as those used to treat a deficiency, might cause:
- Nausea and vomiting
- Fatigue or weakness
- Tingling sensation in hands and feet
Possible interactions include:
- Aminosalicylic acid (Paser). Taking this drug used to treat digestive problems might reduce your body’s ability to absorb vitamin B-12.
- Colchicine (Colcrys, Mitigare, Gloperba). Taking this anti-inflammatory drug used to prevent and treat gout attacks might decrease your body’s ability to absorb vitamin B-12.
- Metformin (Glumetza, Fortamet, others). Taking this diabetes drug might reduce your body’s ability to absorb vitamin B-12.
- Proton pump inhibitors. Taking omeprazole (Prilosec), lansoprazole (Prevacid) or other stomach acid-reducing drugs might decrease your body’s ability to absorb vitamin B-12.
- Vitamin C (ascorbic acid) supplements. Taking vitamin B-12 with vitamin C might reduce the available amount of vitamin B-12 in your body. To avoid this interaction, take vitamin C two or more hours after taking a vitamin B-12 supplement.
Your doctor might recommend changing drugs or timing doses to offset any potential interactions.
July 17, 2021
- Vitamin B12: Fact sheet for professionals. Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional. Accessed Jan. 9, 2021.
- Fairfield KM. Vitamin supplementation in disease prevention. https://www.uptodate.com/contents/search. Accessed Jan. 9, 2021.
- Means RT Jr, et al. Causes and pathophysiology of vitamin B12 and folate deficiencies. https://www.uptodate.com/contents/search. Accessed Jan. 9, 2021.
- Cyanocobalamin. IBM Micromedex. https://www.micromedexsolutions.com. Accessed Jan. 9, 2021.
- Methylcobalamin. Facts & Comparisons eAnswers. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed Jan. 9, 2021.
- Vitamin B12. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Jan. 9, 2021.
Cyanocobalamin (Vitamin B-12) Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing
The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.
To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor’s approval.
Some products that may interact with this drug include: drugs that affect the bone marrow (such as chloramphenicol), vitamins/supplements that contain intrinsic factor.
Certain medications can decrease the absorption of vitamin B12, including: colchicine, metformin, extended-release potassium products, antibiotics (such as gentamicin, neomycin, tobramycin), anti-seizure medications (such as phenobarbital, phenytoin, primidone), medications to treat heartburn (such as h3 blockers including cimetidine/famotidine, proton pump inhibitors such as omeprazole/lansoprazole).
Vitamin B12 is an ingredient found in many combination vitamin and nutritional products. Tell your doctor or pharmacist if you are taking other products that contain cyanocobalamin, vitamin B12, or hydroxocobalamin.
Cyanocobalamin may interfere with certain laboratory tests (including intrinsic factor, blood tests for other types of anemia), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.
Certain drugs may interfere with laboratory tests for vitamin B12 levels, possibly causing false results. Tell laboratory personnel and all your doctors if you take any of the following: antibiotics (such as amoxicillin, erythromycin), methotrexate, pyrimethamine.
This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.
cyanocobalamin (oral) | Michigan Medicine
What is the most important information I should know about oral cyanocobalamin?
You should not use this medicine if you are allergic to cobalt, or if you have Leber’s disease.
What is oral cyanocobalamin?
Cyanocobalamin is a man-made form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.
Cyanocobalamin is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.
Cyanocobalamin may also be used for purposes not listed in this medication guide.
What should I discuss with my healthcare provider before taking oral cyanocobalamin?
You should not use this medicine if you are allergic to cobalt, or if you have Leber’s disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber’s disease.
Tell your doctor if you have ever had:
- heart disease;
- a bleeding or blood clotting disorder;
- an iron or folic acid deficiency;
- low levels of potassium in your blood; or
- an intestinal disorder such as ulcerative colitis.
Tell your doctor if you are pregnant or breast-feeding.
Do not give this medicine to a child without medical advice.
How should I take oral cyanocobalamin?
Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.
Carefully follow instructions about whether to take your cyanocobalamin with or without food.
Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.
Do not swallow a lozenge or sublingual tablet whole. Allow it to dissolve in your mouth without chewing. The sublingual tablet should be placed under your tongue.
Do not crush, chew, or break an extended-release tablet. Swallow it whole with a full glass of water.
You may need frequent medical tests to help your doctor determine how long to treat you with cyanocobalamin.
To treat pernicious anemia, you will have to use cyanocobalamin on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.
Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Take all of your medications as directed.
Store at room temperature away from moisture, heat, and light.
What happens if I miss a dose?
Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking oral cyanocobalamin?
Avoid drinking large amounts of alcohol. Heavy drinking can make it harder for your body to absorb cyanocobalamin.
What are the possible side effects of oral cyanocobalamin?
Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
- shortness of breath (even with mild exertion), swelling, rapid weight gain;
- cough, chest pain; or
- low potassium level –leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.
Common side effects may include diarrhea.
- numbness or tingling;
- joint pain;
- swollen tongue; or
- itching or rash.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What other drugs will affect oral cyanocobalamin?
Tell your doctor about all your other medicines, especially:
- an antibiotic;
- drugs that weaken the immune system such as cancer medicine, or steroids;
- medicine to reduce stomach acid such as cimetidine, omeprazole, lansoprazole, Nexium, Prilosec, or Zantac;
- oral diabetes medicine that contains metformin; or
- seizure medication.
This list is not complete. Other drugs may affect cyanocobalamin, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Where can I get more information?
Your pharmacist can provide more information about oral cyanocobalamin.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.
Copyright 1996-2021 Cerner Multum, Inc. Version: 7.01. Revision date: 7/16/2018.
B12 Shot Side Effects – Do They Outweigh the Risk?
Medically reviewed by Leann Poston, M.D. on 9/29/20
As vitamin B12 continues to gain popularity and attention, many are beginning to wonder what the B12 shot side effects and benefits are? Can this supplement really be as great as everyone keeps saying it is with no risks or side effects? While this treatment still fascinates us today and poses many questions, the history of the development of B12 shots is just as interesting.
In the 1850s, pernicious anemia was essentially a fatal condition – in today’s medicine, pernicious anemia is easily treated with B12 supplements. However, in the 1850s, patients suffered from abnormal gait, exhaustion, and inevitably they ended up in the hospital before they passed. It wasn’t until the 1920s when Georges Richard Minot and William Parry Murphy determined that certain foods (red meat and liver) effectively treated anemia in dogs. Almost 50 years later, Robert Woodward, an organic chemist, successfully synthesized vitamin B12. From this discovery, modern medicine created treatments based on the discovery of vitamin B12’s role in anemia and the successful synthesis of its complex structure.
Thankfully, conditions caused by vitamin B12 deficiencies are incredibly treatable through vitamin B12 supplements. Understanding the B12 shot side effects and benefits can help you manage your expectations of vitamin B12 as a treatment and whether a B12 shot it the best form of treatment.
Vitamin B12 – What It is and What It Does
Vitamin B12, also known as cyanocobalamin, is an important factor in DNA synthesis, the metabolism of every cell within the body, the maturation of developing red blood cells, and the metabolism of fatty acids and amino acids. Because vitamin B12 is such an integral component in the function of a healthy body, maintaining the proper levels of B12 within the body is absolutely necessary to sustain a properly working nervous system and a healthy red blood cell count.
Vitamin B12 is most commonly sourced through foods that come from animals such as fish, red meat, eggs, dairy, cheese, and other dairy products. Those who are vegan or vegetarian sometimes source their B12 through fortified cereals. While many people can consume and absorb the proper amount of vitamin B12 through their dietary choices, many people cannot sustain the proper levels of B12 within their body, which can lead to dangerous conditions if left untreated.
Vitamin B12 deficiencies are rare in otherwise healthy individuals; however, those at an elevated risk at groups who do not consume a diet with animal-sourced food, as well as those suffering from other health conditions. Groups at an increased risk of developing a vitamin B12 deficiency are:
- Adults over 50
- Those with low gastric intrinsic factor
- Those with a low amount of stomach acid
- Those taking certain medications
- Gastrointestinal disorders like Crohn’s disease and celiac disease
- Those who have had weight loss surgery, bowel resection, or surgery on another part of the digestive tract
- Those who take metformin and acid-reducing medications
- Those with specific genetic mutations, such as MTHFR, MTRR, and CBS
- Those who regularly consume alcoholic beverages (NIH, n.d.)
If someone fits into one of these at-risk groups, it is best to consult your doctor in considering whether or not you should undergo testing to determine if you have a vitamin B12 deficiency. Presently, no one test determines whether or not someone is deficient in vitamin B12. Doctors must consider both lab results and clinical conditions to reach a diagnosis.
Symptoms of B12 Deficiency
Before considering both the B12 shot side effects and the B12 shot benefits, it is important to understand the symptoms of a vitamin B12 deficiency. Individuals cannot procure vitamin B12 without a prescription, and in order to obtain a prescription, you must be deemed deficient. It can be especially tricky to reach this diagnosis as there is no “gold-standard” test, and symptoms can long go unnoticed or be contributed to other causes.
Consider that vitamin B12 is responsible for so many bodily functions; the displayed symptoms and affected body systems can vary greatly. Another problem is that symptoms and their onset tend to increase gradually, again making it hard to connect the dots between symptoms and cause. Listed below are just a few of the symptoms caused by a vitamin B12 deficiency:
- Abnormal reflexes
- Tingling, numbness, or other neuropathies
- Impaired sense of position
- Weakness in arms or legs
- Dizziness, vertigo, or balance issues
- Difficulty walking or abnormal gait
- Confusion or memory loss
- Restless legs
- Vision problems
- Anger and irritability
- Personality changes
- Mania and/or psychosis
- Violent and antisocial behavior
- General weakness
- Shortness of breath or difficulty breathing
- White appearance; pallor
- Fatigue or general tiredness
- Coordination and balance problems while walking
- Difficulty focusing
- Memory loss
- Sleep issues
- Hair loss
- Loss of appetite
- Swollen tongue.
- Fast heart rate
- Shortness of breath
- Mouth pain
- Weight loss
Keeping an eye out and paying close attention to these symptoms can help in accurately diagnosing a vitamin B12 deficiency. If you think you may be deficient in vitamin B12, it is important to contact a health care professional and schedule a consultation.
Also read – How to Buy BPC-157 Online Safely
Treatment for Vitamin B12 Deficiency
Fortunately, there are many options in modern medicine to safely and successfully treat vitamin B12 deficiency. There are three main treatment methods – a change in diet, oral supplements, and vitamin B12 injections. For those who aren’t receiving enough vitamin B12 as a result of food choices may be able to treat their deficiency by incorporating more vitamin B12 rich foods in their diets.
However, for those deficient as a result of age, a genetic mutation, stomach issues, or those taking certain medications, a change in diet may not be enough to treat a vitamin B12 deficiency. These individuals will likely have to supplement their diet with an oral B12 supplement or a B12 injection. Oral supplements are considered inferior to the vitamin B12 injections as they take longer to absorb, and some of the nutritional value is lost during digestion in the stomach.
For those receiving B12 shots as a treatment to a B12 deficiency, there are a few different forms, or vitamers, of synthesized vitamin B12 that can be used to handle the deficiency. These include:
- Cyanocobalamin – This vitamer is used for food fortification, multi-vitamin products, and dietary supplements. Cyanocobalamin is suitable for these methods of treatment because of its stability during processing and storage.
- Hydroxocobalamin – This vitamer is typically found within the pharmacology. Due to its water solubility, it is commonly used for intramuscular or intravenous injections. Also used to reverse the effects of cyanide poisoning, this vitamer is the preferred course of treatment for those with intrinsic cobalamin metabolic disease and those with optic neuropathy as a symptom of pernicious anemia.
- Adenosylcobalamin – This vitamer is an active cofactor form of vitamin B12. It naturally occurs in the liver and is active in the mitochondria.
- Methylcobalamin – This vitamer is an active form of B12 that works with several enzymes to create amino acids, produce red blood cells, repair DNA, and assist with other essential physiological processes. This form of B12 is typically administered through injections and oral supplements.
Determining the right course of treatment for a vitamin B12 deficiency is between the patient and their healthcare provider. Above all, the most important thing is that the deficiency is properly treated, treatment is working well, and the quality of the patient’s life is improving.
Vitamin B12 Shot Benefits
There are both vitamin B12 shot side effects and vitamin B12 shot benefits. Many of the benefits associated with the vitamin B12 shot include better mood, increased energy, alleviating anemia symptoms, weight loss, and many more. Though keep in mind, that these benefits are realized when a vitamin B12 deficiency is reversed. As with any treatment, it is incredibly important to weigh both the risks and benefits associated with the course of treatment. To give you a better idea, listed below are the benefits associated with vitamin B12 shots:
- Helping with red blood cell formation which may boost energy and endurance
- May support heart health by decreasing homocysteine levels
- May help prevent cognitive decline
- Anemia prevention (NIH, n.d.)
- May reduce the risk age-related macular degeneration
- May improve sperm count (Penn State, 2011)
While these are only some of the benefits associate with vitamin B12 shots, it is easy to see that vitamin B12 is responsible for so many functions within the body. Considering a deficiency can cause harm to many systems within the body, understanding the benefits of the B12 shot and know how it could improve the quality of your life is very important to leading a safe and healthy life.
Also read – What is the Right BPC-157 Dosage?
B12 Shot Side Effects
Just as it is important to understand the benefits of the B12 shot, it is also incredibly important to know the B12 shot side effects. Before anyone makes a decision regarding their health, it is imperative that they know the risks and the benefits. Understanding both the B12 shot side effects, as well as the B12 shot side effects at the injection site, is important because it empowers you to make a decision regarding your treatment that is fully informed.
B12 shot side effects include, but are not limited to:
- Swelling at the injection site
- Mild diarrhea
- Swelling in the body
- Low potassium
- Skin rash
- Pulmonary edema and congestive heart failure (in early treatment)
- Vein thrombosis
- Polycythemia vera
- A very rare, but serious allergic reaction causing swelling of the face, tongue, and throat, and difficulty swallowing or breathing (anaphylaxis)
- High blood pressure immediately after injection
- Cold symptoms
- Burning skin
- Pink or red skin discoloration
- Joint and muscle pain
- Facial swelling
- Increase and blood volume and red blood cells
Considering the B12 shot side effects listed above, it is important to understand that some of these side effects are more common, while others are incredibly rare. This is another important discussion topic to bring up with your health care provider when evaluating your diagnosis and considering treatment.
Frequently Asked Questions
Below are some common concerns and questions people have when considering a vitamin deficiency and the B12 shot side effects and benefits associated with this specific treatment. Read below to see if a question you may have is present or use these topics as a way to start a conversation with your health care provider.
Are Vitamin B12 Shots More Effective Than Vitamin B12 Oral Supplements?
Both methods of treatment can deliver the desired results, and the majority of the “success” of treatment is determined on a case-by-case basis and what is most comfortable and effective for the individual patient. Some studies have shown that a high-dose, oral vitamin B12 was as effective as an intramuscular injection; however, other studies have determined that oral B12 supplements aren’t as fully absorbed during the digestive process. It’s best to talk with your doctor to determine which form of treatment is best for you.
Are Vitamin B12 Shots painful?
While this is somewhat dependent on the individual’s tolerance for pain, B12 injections are mostly considered to be relatively painless. Injections given into the muscle typically present some pain, swelling, and itching at the injection site. However, these symptoms are mild and wear off pretty quickly.
Any time we are faced with unfamiliar medical treatments, it is understandable to have questions and concerns. It makes sense to wonder if the benefits outweigh the B12 shot side effects. Considering how important vitamin B12 is to the optimal function of your body; it seems as though the answer would be, yes.
When you’re ready to talk to your doctor about your prescription for your vitamin B12 deficiency, you will want to ensure that you are sourcing your vitamin B12 supplement from the best place possible.
A great place to source your vitamin B12 supplement is through Invigor Medical. This trusted, U.S. Pharmacy provides high-quality methylcobalamin to those deficient in vitamin B12 with a prescription for an injectable supplement.
To learn more about Invigor Medical and how it can treat your possible B12 deficiency visit – https://invigormedical.com/
Also read – How Can You Get a Cellular Regeneration or Healing Boost?
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
- National Heart, Lung and Blood Institute. (n.d.). Pernicious Anemia. Retrieved from https://www.nhlbi.nih.gov/health-topics/pernicious-anemia
- Penn State Hershey. (2011). Vitamin B 12 (Cobalamin). Retrieved from http://pennstatehershey.adam.com/content.aspx?productid=107&pid=33&gid=000332
vitamin B12, Athlete (cyanocobalamin) dosing, indications, interactions, adverse effects, and more
CYANOCOBALAMIN – NASAL
COMMON BRAND NAME(S): Nascobal
USES: Cyanocobalamin is a man-made form of vitamin B12 used to treat low levels (deficiency) of this vitamin. Vitamin B12 helps your body use fat and carbohydrates for energy and make new protein. It is also important for normal blood, cells, and nerves. Most people get enough vitamin B12 in their diet, but a deficiency may occur in certain health conditions (e.g., poor nutrition, pregnancy, stomach/intestinal problems, infection, cancer). Serious vitamin B12 deficiency may result in anemia, stomach problems, and nerve damage.
HOW TO USE: Read the Patient Information Leaflet provided by your pharmacist before you start using this medication and each time you get a refill. Follow the illustrated directions for the proper use of this medication. If you have any questions, consult your doctor or pharmacist.Gently blow your nose before using this drug. If your product needs to be primed, follow the instructions on how to properly prime the bottle.Use this medication in the nose once weekly or as directed by your doctor. Hot food or drinks may produce mucus that can wash away this medication. Avoid hot food or drinks for 1 hour before or after using this medication.For products that contain more than 1 dose, keep track of the number of doses you use from each pump.Dosage is based on your medical condition and response to treatment. Do not increase, decrease, or stop this medication without your doctor’s approval. Use this medication regularly to get the most benefit from it. To help you remember, use it on the same day each week. It may help to mark your calendar with a reminder.
SIDE EFFECTS: Headache, nausea, or runny nose may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may cause low potassium levels in the blood (hypokalemia). Tell your doctor right away if any of these unlikely but serious side effects occur: muscle cramps, weakness, irregular heartbeat.People who have a rare blood disorder (polycythemia vera) may rarely have symptoms related to this disorder while taking cyanocobalamin. Seek immediate medical attention if any of these rare but very serious symptoms occur: chest pain (especially with shortness of breath), weakness on one side of the body, sudden vision changes, trouble speaking.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using cyanocobalamin, tell your doctor or pharmacist if you are allergic to it; or to cobalt; or if you have any other allergies. Your doctor may recommend that you receive a smaller test dose before starting your regular dose. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low potassium blood levels (hypokalemia), gout, a certain blood disorder (polycythemia vera), a certain eye disease (Leber’s disease), other vitamin/mineral deficiencies (especially folic acid and iron).Tell your doctor if you develop a stuffy or runny nose (e.g., due to a common cold or allergies) while using this medication. You may need to use another form of vitamin B12 when these symptoms are present.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Based on information from related drugs, this medication may pass into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: drugs that may affect blood cell production (e.g., chloramphenicol, anti-cancer drugs, HIV drugs), other vitamins/nutritional supplements (especially folic acid).Certain other drugs may interfere with laboratory tests for vitamin B12 levels, possibly causing false test results. Tell laboratory personnel and all your doctors if you take any of the following: anti-infective drugs (e.g., amoxicillin, erythromycin), methotrexate, pyrimethamine.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.
OVERDOSE: Overdose with this medication is very unlikely. However, if someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., serum potassium levels, complete blood count, hematocrit, vitamin B12 levels) should be performed to monitor your progress or check for side effects. Consult your doctor for more details.This product is not a substitute for a proper diet. Remember that it is best to get your vitamins from healthy foods. Vitamin B12 is commonly found in many foods from animals, especially liver, kidney, fish and shellfish, meat, and dairy foods.
MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store the pump upright at room temperature away from light and moisture. Do not freeze. Do not store in the bathroom. Discard the pump after you have used the labeled number of doses on the product package. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Is Taking Too Much Vitamin B-12 Dangerous?
If your B-complex contains 50,000% of the Daily Value (DV), which is 6 mcg for adults, then it has 3,000 mcg of B-12. For people without a severe B-12 deficiency, this is much more than necessary. [Note: In 2016, the FDA lowered the Daily Value for B-12 to just 2.4 mcg for most adults, but this won’t be reflected on all supplement labels until 2021. This means that your supplement actually provides 125,000% of the current daily requirement.]
Although no “Upper Tolerable Intake Level” has been established, there are risks associated with getting too much B-12 from supplements. At a dose of 500 mcg (one-sixth the amount in your supplement), an increased risk of colorectal cancer was reported in a placebo-controlled study of older people. Doses of just 20 mcg per day or higher have caused outbreaks of acne and rosacea. A high-dose B complex supplement (with 1,000 mcg of B-12) hurt, rather than helped, people with type 1 or type 2 diabetes and advanced kidney disease, resulting in a worsening of kidney function and an increase in the risk of heart attack, stroke and death.
In women who are pregnant, excessive blood levels of vitamin B-12 have been associated with an increased risk of autism in their children.
Taking some B-12 is advisable for people over the age of 50 (when you’re less able to extract B-12 from food), as well as for those taking medications that interfere with B-12 absorption (such as Prevacid, Prilosec and metformin), strict vegetarians, alcohol and drug abusers, people recovering from surgery or burns, and those with bowel or pancreatic cancer. But the amount needed to avoid deficiency is small and nowhere near the amount in the supplement you describe in your B-complex.
If you decide to take a B-12 supplement, you may want to choose one that has the right dose for you and has been tested and Approved by ConsumerLab.com. Be aware that sublingual and dissolvable B-12 supplements often contain sugar substitutes that can cause gas, bloating, and diarrhea in some people — particularly if taking multiple pills. You can use the Ingredients listings in CL’s Review to spot and avoid these ingredients.
In general, it’s best to avoid excessive doses of any vitamin if it is not needed.
Get more information, including the Recommended Daily Allowance for B-12 (by age and gender), differences in the forms of B-12, potential side-effects and drug interactions, plus ConsumerLab.com’s tests of popular products, in the B Vitamin Supplements Review >>
You can check the recommended intakes of other vitamins and minerals here.
Does Vitamin B12 Have Side Effects?
Side effects are possible for any food, supplement, or medication, and everyone reacts differently to different products. Vitamin C, for example, may promote loosening of the bowels if taken in excess, and too much niacin (B3) may cause a disagreeable flushing. Experiencing unpleasant side effects of a supplement is by no means enjoyable, and it’s best for consumers to do their research before diving into any supplement approach. Generally, the worst side effects for vitamins – including B vitamins – are diarrhea, nausea, rashes, and vomiting.  Does vitamin B12 have any side effects? Here’s what you need to know.
Let’s quickly give a brief overview of how vitamin B12 is absorbed. High doses of vitamin B12 have a low absorption rate when taken orally. To survive the digestive process, B12 must connect with intrinsic factor before it can enter the system. The amount of B12 that does get absorbed is directly related to the amount of intrinsic factor available.  Oral ingestion of large amounts of B12 is highly unlikely to cause an issue, as not all B12 survives this process. Even sublingual absorption (absorption through tissues of the mouth) doesn’t reach levels which would be of cause for concern.
Symptoms of Deficiency
Deficiency can result for a couple of reasons. Inadequate dietary consumption of foods containing B12 such as red meat, fish, or dairy products – an issue for many vegetarians and vegans – can lead to deficiency. An inability to digest B12 as a result of low levels of intrinsic factor – for either genetic reasons or a result of physical damage to the stomach or small intestine – can also cause deficiency.
Common symptoms include numbness in the hands and feet, moodiness, memory concerns, dementia, poor red blood cell formation, impaired DNA function, and fatigue.
B-12 Side Effects
B-12 occurs naturally in three forms: methylcobalamin, adenosylcobalamin, and hydroxocobalamin. Cyanocobalamin was created years ago in a lab using cyanide as a means for stabilization, and many low-quality supplements include this form. Injections are commonly used for individuals suffering from an inability to digest and absorb B12. Many individuals who have chosen a vegetarian or vegan lifestyle become B12 deficient as a result of eliminating natural dietary sources; still, many meat eaters today are also surprisingly deficient.
Some side effects have been reported for patients receiving cyanocobalamin injection. These include itching, acne, nausea, diarrhea, vascular thrombosis, headache, nervousness, and dizziness. Based on studies involving individuals, it appears 1 mg of cyanocobalamin via injection does not create any notable side effects. 
No Upper Limit Safety Recommendations Exist
No adverse or toxic reactions for vitamin B12 have occurred in individuals through dietary consumption or supplement use. The US Food and Nutrition Board have not established any upper safety limits for B12 in healthy people. Although you should always check with your doctor before starting a new supplement routine, supplementation with B12 is considered safe. If you’re in the market for a safe, natural B12 supplement, I highly recommend Global Healing’s own B12. It’s a vegan-safe formula that contains methylcobalamin and adenosylcobalamin, but also contains hydroxocobalamin for long-lasting, sustained support with 5,000 mcg of B12 per serving. It even contains Energized Trace Minerals™ for amplified bioavailability.
Watch an In-Depth Video on Everything You Need to Know About Vitamin B12
Length: 51 minutes
- Chawla J1, Kvarnberg D2. Hydrosoluble Vitamins. Handb Clin Neurol. 2014;120:891-914. doi: 10.1016/B978-0-7020-4087-0.00059-0.
- Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008 Sep 15;112(6):2214-21. doi: 10.1182/blood-2008-03-040253.
- Kuzminski AM1, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998 Aug 15;92(4):1191-8.
†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. If you have a severe medical condition or health concern, see your physician.
This entry was posted in Energy, Foods, Health, Micronutrients, Nutrition, Supplements, Vitamins, Whole Body Wellness
Cyanocobalamin (Vitamin B12) instructions for use: indications, contraindications, side effects – description Cyanocobalamin (Vitamin B12) solution for injection. 500 mcg / 1 ml: amp. 10 pieces. (10448)
Method of application and dosage regimen of a particular drug depends on its form of release and other factors. The optimal dosage regimen is determined by the doctor. It is necessary to strictly observe the compliance of the used dosage form of a particular drug with the indications for use and the dosage regimen.
Administered orally, subcutaneously, intramuscularly, intravenously and intralumbar. The dosage regimen is set individually, depending on the indications, the clinical situation, the patient’s age and the dosage form used.
In case of anemia associated with vitamin B deficiency 12 , 100-200 mcg is administered every other day. For anemia with symptoms of funicular myelosis and for macrocytic anemias with diseases of the nervous system – 400-500 mcg in the first 7 days daily, then once every 5-7 days.During remission, in the absence of funicular myelosis, the maintenance dose is 100 μg 2 times / month, in the presence of neurological symptoms – 200-400 μg 2-4 times / month.
For acute post-hemorrhagic and iron deficiency anemia – 30-100 mcg 2-3 times a week. For aplastic anemias (especially in children) – 100 mcg before the onset of clinical improvement. With alimentary anemia in young children and premature babies – 30 μg / day for 15 days.
For diseases of the central and peripheral nervous system, neurological diseases with pain syndrome, it is administered in increasing doses – 200-500 mcg, with improvement of the state – 100 mcg / day.The course of treatment is 2 weeks. With traumatic lesions of the peripheral nervous system – 200-400 mcg every other day for 40-45 days.
For hepatitis and cirrhosis of the liver – 30-60 mcg / day or 100 mcg every other day for 25-40 days.
For dystrophies in young children, Down’s disease and infantile cerebral palsy – 15-30 mcg every other day.
With funicular myelosis, amyotrophic lateral sclerosis, 15-30 mcg can be administered into the spinal canal, gradually increasing the dose to 200-250 mcg.
For radiation sickness, diabetic neuropathy, sprue – 60-100 mcg daily for 20-30 days.
In case of vitamin B deficiency 12 for prophylaxis – i / m or i / v 1 mg 1 time / month; for treatment – 1 mg intramuscularly or intravenously, 1 mg daily for 1-2 weeks, a maintenance dose of 1-2 mg intramuscularly or intravenously – from 1 time per week to 1 time / month. The duration of treatment is set individually.
Vitamin B12 in ampoules: instructions for use
- The role of vitamin B12 in the body
- Indications for the use of cyanocobalamin
- How to inject
- Storage conditions for vitamin B12 in ampoules
- Dosage of vitamin B12 in ampoules
- Contraindications and side effects
Lack of vitamin B12 leads to a number of diseases.It 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 have 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 doctors, as a result of which it was possible to establish its effect on the body:
- blocking the stress hormone;
- improved blood clotting;
- synthesis of amino acids;
- decrease in the amount of cholesterol in the blood;
- detoxification of the body with alcoholism;
- improved liver function.
Cyanocobalamin helps athletes withstand heavy loads, accelerates weight loss and prevents the development of cardiovascular diseases.
Plays a special role in the work of the central nervous system. Vitamin supplements the main therapy for cerebral palsy in children, Down’s disease, intercostal neuralgia, etc.
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Indications for the use of cyanocobalamin
Vitamin B12 in ampoules is used as adjunctive 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.
Indications for the use of vitamin B12:
- chronic migraine;
- Down syndrome;
- cerebral palsy;
- radiation sickness;
- alcohol poisoning;
- diseases of the pancreas and liver;
Reception of cyanocobalamin is indicated for vitamin deficiency, frequent respiratory diseases. Lack of substance in the body leads to a deterioration in the condition of hair, nails and teeth. For this reason, taking the drug in ampoules is performed not only for therapeutic, but also for cosmetic purposes.
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Cyanocobalamin treatment regimen
When vitamin B12 is prescribed, the Instructions for Use will help to 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 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.
Take vitamin B12 only in the dosage recommended by your doctor.It is not recommended to use the drug on your own, since it is rather difficult to determine an individual treatment regimen.
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How to inject
Vitamin B12 injections can be done in different ways:
- into the spinal cord.
The instructions say that cyanocobalamin cannot be used simultaneously with drugs that increase blood clotting, as well as vitamins B1 and B6. If you are allergic to B1, then B12 can make it worse.
You can enter the drug intramuscularly and intravenously on your own. For injection into the spinal cord, consult an experienced physician.
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Storage conditions for vitamin B12 in 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 refrigeration. This point must be specified in the instructions.
Do not use the substance after the expiration date printed on the package.
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Dosage of vitamin B12 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.
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Contraindications and side effects
Subject to the instructions for use and the doctor’s recommendation, the drug has no side effects. In exceptional cases, unpleasant symptoms may occur:
- nervous overexcitement;
- pain in the region of the heart;
- increased blood pressure;
If there is an individual intolerance to the drug, then an allergic reaction occurs in the form of itching, rash, runny nose. In the event of side effects, the injection is stopped, the treatment method is reviewed with the doctor.
Before starting the injection, you should study the list of contraindications:
- angina pectoris;
- varicose veins;
- pregnancy and lactation;
- oncological diseases.
Another contraindication is individual intolerance to cyanocobalamin.
It is important to follow the instructions for use so that there is no vitamin B12 overdose. In this case, the following conditions are observed:
- heart failure;
- pulmonary edema;
- anaphylactic shock.
Cyanocobalamin makes an invaluable contribution to the functioning of the body. With its lack, various diseases develop, the appearance and general well-being deteriorate. But you need to take it only after consulting a doctor and determining an individual dosage.
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Vitamin B12 – instructions, use, analogues of the drug, composition, indications, contraindications, side effects in the reference book of medicines from UNIAN
Application of Vitamin B12
Vitamin B12 – composition and release form of the drug
Vitamin B12: how to take the drug
Vitamin B12 – contraindications and side effects
Vitamin B12 analogs
Vitamin B12 is an antianemic drug.
Application of Vitamin B12
Indications for use
Vitamin B12 deficiency, leading to impaired maturation of red blood cells and manifested by megaloblastic anemia and neurological disorders such as funicular myelosis (spinal cord injury).
Application during pregnancy and lactation
The recommended daily intake of vitamin B12 during pregnancy and lactation is 4 μg. Vitamin B12 is excreted in breast milk.The experience gained to date does not indicate the development of adverse effects when taking vitamin B12 in higher doses for the fetus or breast-fed child.
Vitamin B12 – composition and form of the preparation
Active ingredient : cyanocobalamin, 1000 mg
Excipients: lactose monohydrate, povidone K30, stearic acid, croscarmellose sodium.
Composition of the shell: gum arabic, calcium carbonate, macrogolglycerol hydrostearate, macrogol 6000, sucrose, talc, titanium dioxide, kaolin, sodium lauryl sulfate, aquapolish P white (hypromellose, hydroxypropyl cellulose, stearic acid, tricyclic acid) , Montan glycol wax.
Vitamin B12: how to take the drug
The drug is taken orally, preferably in the morning on an empty stomach. The tablets are swallowed without chewing, with a small amount of liquid.
In the presence of severe neurological symptoms, it is preferable to start parenteral administration of vitamin B12.
Dosage depends on symptoms.
For children over 14 years of age, the use of vitamin B12 in daily doses of up to 1000 mcg is recommended as an alternative to parenteral therapy for vitamin B12 deficiency.
Vitamin B12 – contraindications and side effects
From the skin and subcutaneous tissues: infrequently – severe hypersensitivity reactions that can manifest as hives, rash or itching over large areas of the body; frequency unknown – acne in the form of a rash on the skin.
Other: frequency unknown – fever.
Contraindications to use
- increased individual sensitivity to the active substance or auxiliary components of the preparation;
- high risk of developing Leber’s optic atrophy;
- tobacco and alcoholic amblyopia.
Vitamin B12 analogs
Source: State Register of Medicines of Ukraine. The instructions are published with abbreviations for information only. Before use, consult your doctor and read the instructions carefully. Self-medication can be harmful to your health.
If you are pregnant, plan to become pregnant or breastfeeding, seek the advice of your doctor or pharmacist before taking any medicine.
If your doctor has told you that you have an intolerance to some sugars, contact your doctor before taking this medication as it contains lactose.
How to take Folic acid
Always take Folic Acid exactly as prescribed by your healthcare professional. If in doubt, you should consult your doctor or pharmacist.
Swallow the tablets with water.
Adults (including the elderly):
- For the treatment of folate deficiency anemia: 5 mg per day (5 1 mg tablets) for 4 months, which can be increased to a maximum of 15 mg per day.
- To prevent folate deficiency caused by certain drugs: 5 mg per day (5 1 mg tablets) for 4 months, which can be increased to a maximum of 15 mg per day.
- To prevent folate deficiency caused by prolonged destruction of red blood cells (hemolytic anemia) or renal dialysis: 5 mg (5 1 mg tablets) every 1 to 7 days.
- To prevent the development of fetal neural tube defects (eg, spina bifida) in women at increased risk of developing it in the fetus: 5 mg (5 1 mg tablets) the day before the intended pregnancy, continue during the first trimester pregnancy.
- For the treatment of folic acid deficiency during pregnancy: 5 mg (5 1 mg tablets) per day to continue until the baby is born.
For small children, it is recommended to use a more convenient dosage form of the drug.
- For the treatment of folate deficiency anemia: Children 1-18 years old: 5 mg daily (5 1 mg tablets) for 4 months.The maintenance dose is 5 mg every 1 to 7 days.
- For the treatment of hemolytic anemia and metabolic disorders: Children 1-12 years old: 2.5 mg – 5 mg once a day (2.5 – 5 tablets of 1 mg).
Children 12-18 years old: 5 mg – 10 mg once a day (5 – 10 tablets of 1 mg).
- To prevent folate deficiency in renal dialysis: Children 1-12 years old: 250 mcg / kg body weight (up to a maximum of 10 mg) (up to 10 1 mg tablets) per day.
Children 12-18 years old: 5-10 mg (5-10 1 mg tablets) per day.
If you take more folic acid than recommended
If you (or someone else) have taken a large number of pills at the same time, or if you think your child has accidentally swallowed pills, contact the nearest hospital emergency room immediately or tell your doctor.
If you forget to take Folic acid
If you forget to take another dose of the drug, take it as soon as you remember, then take the next dose at the usual recommended time.Do not take a double dose to make up for a missed appointment.
instructions for use, analogs, composition, indications
Pharmacotherapeutic group: antianemic agents, vitamin B12
ATC code: B03BA01
Vitamin B12 is part of the prosthetic group methylmalonil, a coenzyme of A-isomerase, which is necessary for the conversion of propionic acid to succinic acid. In addition, Vitamin B12, along with folic acid, participates in the formation of labile methyl groups, which are transferred to other methyl acceptor proteins through transmethylation processes.Vitamin B12 affects the synthesis of nucleic acids, especially in the processes of hematopoiesis and cell maturation in general.
Occurrence and demand
For therapeutic purposes, vitamin B12 is used in the form of cyanocobalamin and / or hydroxocobalamin (α-acetate). Both of these forms are prodrugs that are converted in the body into active forms – methyl- and 5-adenosylcobalamin. The human body is unable to synthesize vitamin B12 and must meet its need for food composition.Liver, kidney, heart, fish, oysters, milk, egg yolk and meat are rich in vitamin B12.
Vitamin B12 is absorbed primarily in the small intestine. There are two known suction mechanisms. One active, in which vitamin B12 binds to the glycoprotein formed in the stomach, an internal factor, which ensures the absorption process; another mechanism is passive, which, in the absence of an intrinsic factor, ensures the absorption of large doses delivered by the oral route. Vitamin B12 is deposited in the body.The daily requirement is about 1 mcg.
Manifestations of vitamin B12 deficiency
An inadequate intake of vitamin B12, which lasts for years, leads to manifestations of its deficiency, when its content in the blood plasma falls below 200 pg / ml. The hematological manifestation of insufficiency is megaloblastic anemia. Neurological manifestation of vitamin B12 deficiency – disorders of the peripheral and central nervous system. The phenomena of polyneuropathy can be accompanied by damage to the long spinal tracts and be combined with mental disorders.
Vitamin B12 deficiency is most often manifested by nonspecific symptoms such as weakness, pallor, tingling and numbness in the arms and legs, unsteadiness in gait, and decreased exercise tolerance.
Symptoms caused by vitamin B12 deficiency can only be alleviated with supplemental vitamin B12 intake. To date, it has been proven that high oral doses of vitamin B12 (1000 mcg / day) can be used successfully to achieve and maintain remission of symptoms caused by vitamin B12 deficiency.
Vitamin B12 is absorbed in two ways:
• in a state associated with an internal factor, vitamin B12 is actively absorbed in the duodenum and small intestine. The subsequent entry of vitamin B12 into the tissues is carried out with the help of transcobalamin, which belongs to the group of plasma beta globulins.
• vitamin B12 can enter the bloodstream independently of intrinsic factor by passive diffusion through the gastrointestinal tract mucosa.1-3% of orally ingested vitamin B12 enters the systemic circulation, and this intake is dose-dependent. When taking high doses (1000 mcg / day), even in patients with no intrinsic factor, sufficient absorption occurs. The physiological intake of vitamin B12 in a way independent of intrinsic factors is dose-dependent. The absolute amount of vitamin B12 received increases with increasing dose (table).
Table. The amount of absorbed vitamin B12 depending on the dose taken
The amount of absorbed vitamin B 12 (μg)
Vitamin B12 in the body is stored in a depot, of which the liver is the most important.The daily intake of vitamin B12 is very low at about 1 mcg, with a turnover rate of about 2.5 mcg. The biological half-life is about a year. At the same time, 2.55 μg of vitamin B12 is consumed daily, or 0.051% of that contained in the body.
Vitamin B12 is excreted mainly in the bile; about 1 μg is reabsorbed by the enterohepatic route. The excess of supplied and not deposited vitamin B12 is excreted in the urine. The half-life of vitamin B12 from blood plasma is about 5-10 hours.After taking 1 mg of vitamin B12, about 5% of the dose taken is excreted in the urine. From the liver, vitamin B12 enters the intestines with bile, where it undergoes enterohepatic circulation.
The main site of vitamin B12 deposition is the liver. The total reserves of vitamin B12 in the body of an adult are about 2-5 mg. Due to the enterohepatic circulation, the metabolism of vitamin B12 is very slow. The half-life of vitamin B12 from the liver is about 12 months. For the development of vitamin B12 deficiency with a reduced intake of it into the body, it takes about 3-5 years.
In case of insufficient intake of vitamin B12 in a healthy body, clinical manifestations of vitamin B12 deficiency appear after 3-5 years.
Preclinical Safety Data
Animal studies with vitamin B12 supplementation, even in very high doses, have not shown any toxicity. There are no reports of adverse reactions regarding the use of vitamin B12 in pre- and postnatal development and no reports of teratogenic, mutagenic or carcinogenic effects.
Composition of excipients
Lactose monohydrate, povidone K 30, stearic acid, croscarmellose sodium; Shell composition: gum arabic, calcium carbonate, macrogolglycerol hydrostearate, macrogol 6000, sucrose, talc, titanium dioxide, kaolin, sodium lauryl sulfate, aquapolish® P white *, montanglycol wax.
(* The composition of Aquapolish® P is white: hypromellose, hydroxypropylcellulose, stearic acid, talc, medium-chain triglycerides, titanium dioxide.) 90,000 21 reviews, instructions for use
Cyanocobalamin or vitamin B12 is the only one of all water-soluble vitamins capable of in particular, it is stored in the liver, kidneys, spleen and lungs).It is a crystalline powder of brownish-red color, odorless. Cyanocobalamin is available exclusively as a solution for injection. The active form of cyanocobalamin is cobamamin (or adenosylcobalamin). This vitamin is endowed with high biological activity. Without it, it is impossible to imagine the normal course of the hematopoiesis process (it accelerates the maturation of erythrocytes from erythroblasts). Cyanocobalamin takes part in hydrogen transfer, transmethylation processes, formation of choline, creatine, methionine, nucleic acids.It “helps” erythrocytes to accumulate substances containing sulfhydryl groups. It has a positive effect on the functioning of the liver and central nervous system. Activates the blood coagulation system. It has a powerful lipotropic effect, prevents fatty hepatosis (fatty degeneration of the liver), provides oxygen saturation of cells under conditions of hypoxia. Cyanocobalamin stimulates protein synthesis and promotes its accumulation in the body, thereby providing an anabolic effect. Favorably affects the immune status, increasing the ability of leukocytes to phagocytosis and “turning on” the reticuloendothelial system at full capacity.A lack of cyanocobalamin doubles the risk of illness in AIDS patients. The emotional state of a person, the level of his cognitive abilities, to a certain extent, depends on the content of vitamin B12 in the body. Pharmacotherapy with cyanocobalamin can prevent depression, slow down the development of senile dementia, maintain clarity of thinking, and prevent mental deterioration in AIDS patients. Cyanocobalamin helps to overcome insomnia, adapt to changes in sleep and wakefulness, and normalize excessively low blood pressure.
B12 is necessary for the normal functioning of the reproductive system in both sexes. The following symptoms can serve as an alarm bell (and in some cases – and a rolling alarm), indicating a lack of this vitamin in the body: dyspeptic symptoms, enlarged liver, persistent fatigue, irritability, depression, dizziness, headaches, tinnitus, disturbed breathing, disorders vision and memory; at a more serious level – immunodeficiencies, neurological disorders, pernicious anemia, stomach and duodenal ulcers.Even a slight deviation in the concentration of cyanocobalamin in the blood from the norm can cause serious harm to the brain and the nervous system as a whole. But “a lot” is not always a synonym for “good”. If you consume cyanocobalamin in “horse” doses, you can earn hypervitaminosis. Signs of drug overdose are: pulmonary edema, blockage of peripheral vessels, congestive heart failure, urticaria, less often – anaphylactic shock. Cyanocobalamin is not a relatively harmless ascorbic acid: its use requires regular medical monitoring.So, patients suffering from angina pectoris should not take more than 100 mcg of this vitamin at a time, and during treatment it is very important to control the blood picture and clotting indices. Solution B12 should not be mixed in the same syringe with solutions B1, B6 and ascorbic acid. When used in conjunction with oral contraceptives, it is possible to reduce the content of cyanocobalamin in the blood plasma. Anticonvulsants impair the absorption of the drug in the intestine. The same can be said for neomycin, ranitidine, cimetidine, potassium preparations.Cyanocobalamin can potentiate allergic reactions provoked by thiamine. Chloramphenicol, when injected, can neutralize the hematopoietic activity of cyanocobalamin.
“B vitamins help to better endure mental stress”
– Hello, the program “About health and not only with Dr. Faradzhov” is on air. I am Huseyn Farajov. Today we will talk about vitamins and minerals.We have a very interesting guest in our studio, a scientist who has an impeccable reputation in the scientific world in matters of vitamins and pharmacology. We are always looking forward to the performances of Evgenia Valerievna Shikh, for us she is the standard of scientifically proven and correct modern approaches in any matter, especially in vitamins.
So, Evgenia Valerievna Shikh – Doctor of Medical Sciences, Professor, Head of the Department of Clinical Pharmacology and Propedeutics of Internal Diseases of the Sechenov University, Director of the Institute of Professional Education of the Sechenov University.
We all now take vitamins, but I am concerned about another question, that there are too many of those who talk about these vitamins and microelements, and this is not always scientifically substantiated, and there is a very light attitude towards them in society. Are we overly addicted to supplements, vitamins, micronutrients, and what are vitamins?
– Vitamins are substances that are not synthesized in the body or are synthesized in extremely small quantities, but are responsible for a large number of vital reactions.Nothing is built from the vitamins themselves in the body, but they themselves are participants in many important reactions. B vitamins are responsible for the body’s energy supply, other micronutrients for other functions. Many are fascinated by vitamins, and there was a period in our life when people did not really take care of their health, and the medical community, among other things, set itself the goal of drawing people’s attention to a healthy lifestyle, and then we talked a lot about the fact that you need to take vitamins, vitamin supplements.We did not differentiate them then, that some micronutrients can prevent some diseases, other micronutrients can prevent other diseases. And now we have already entered another stage, we understand that all vitamins and micronutrients are needed by the body, but there are states in which a certain group of vitamins is needed by the body.
Can be divided by registration status. There are dietary supplements, no one said that this is bad, this is a special registration status and it contains vitamins, macro- and micronutrients at the level of nutritional or physiological daily requirements, that is, this is what a person lacks in nutrition.There is another registration status – a drug, and it already contains higher doses, and they may contain therapeutic doses of vitamins. And there is no need to confuse these two directions. There is a preventive direction, where there are enough dietary supplements, where the doses are low, and there are vitamin-mineral complexes that contain vitamins in higher dosages, and they have therapeutic use.
Vitamins are not easy. When I started my scientific career, I was faced with the question on what topic to write my doctoral dissertation, my teacher academician Kukis said: “You will write about the clinical pharmacology of vitamins.”Apparently, he didn’t like the expression on my face, because I was upset, it seemed to me that I was such a serious specialist, I wanted to write about acute coronary syndromes, something so unusual, and he said to me: “Remember my word, that time will pass, and there will be only a few such specialists, because it is the clinical pharmacology of vitamins, in order to understand what doses, what regimes, what indications, contraindications, requires in-depth study. ”
– We are faced with the fact that very often patients are prescribed a huge number of tests, including for many vitamins.Does a patient need to determine all vitamins in a row in the blood without any specific symptoms?
– It depends on what purpose is being pursued. We determine the level of vitamins in the blood plasma in exceptional cases, if we suspect some pronounced hypovitaminosis, if it is necessary in order to prescribe high doses.
Let’s take a look at the situation that is now happening with vitamin D. In the world, there is a pandemic of insufficient supply of vitamin D, but on the other hand, to determine the level of vitamin D to the left and to the right, there is no point in spending the finances of our patients on this in such a difficult time, because if we we will take the vitamin in a dose at the level of the daily food requirement, that is, preventive doses, these are the majority of drugs in the territory of the Russian Federation.You do not need to measure your vitamin D level for this.
On the other hand, there are special recommendations of the endocrinology center and it clearly states that screening for the level of vitamin D is indicated only for certain categories of patients. These are patients who suffer from severe resorptive bone diseases, these are all patients with malabsorption symptoms, who have impaired absorption or who have been operated on after diseases of the gastrointestinal tract, that is, this is a clearly limited category of patients.Women in preconception training. If a woman is doing well, it is enough for her to take vitamin D at the level of her daily nutritional requirement. If she has fertility problems, that is, she has infertility and she goes for this examination, then the level of vitamin D in the blood plasma can also be determined, because there are such interesting works that say that fertility increases when the level of vitamin D is good. a significantly higher percentage of successful outcomes during assisted reproductive technologies, that is, IVF, ICSI.
– 2000 international units is the daily requirement for vitamin D. When a patient comes to you without analysis, how much do you prescribe?
– I prefer a dose of 1000 if this is a patient without analysis, without obvious problems associated with vitamin D. On the territory of the Russian Federation, the norms established by the Institute of Nutrition are still in force, and these are 200 international units.According to our regulatory approaches, we can prescribe vitamins in a daily dose of 200%, that is, this is already 400 international units, and a dose of 1000 is allowed in our country, and 2000 is the maximum allowable dose at the level of the daily nutritional requirement. Everyone says that 3000, 4000, 10,000 are needed – in fact, we do not have enough studies that would say what dose can be prescribed, how long to take in order to eliminate the deficit, we do not know this.
Now, in connection with the situation with COVID, very interesting foreign publications have appeared, where the association of vitamin D levels with the severity of the disease is being studied.There are works published in Thailand, it shows that those who have a sufficient supply of vitamin D are sick in a milder form, that is, they have a mild to moderate severity of the course, and vice versa, insufficient provision is associated with a severe course of COVID.
In one of the foreign articles it is proposed that now it is necessary to pay attention to the provision of vitamin D, they propose to raise the level, if we considered more than 30 nanograms per milliliter to be provided, then they now propose to raise it to 40, and they recommend a dosage of 10,000 international units for 5 days , and then we switch to maintenance doses.But again, the recommendation is speculative. There must be studies of pharmacokinetic parameters, we must look at the concentration in order to work out such a dosage. According to the current clinical guidelines on the territory of the Russian Federation, we cannot prescribe more than 10,000 international units without regular laboratory monitoring in blood plasma. There is another normative approach, we can prescribe therapeutic doses, that is, more than 2000, only for those who have laboratory confirmed low vitamin D levels.
–The patient comes, we prescribe 1000 or 2000, he takes, passes the test, and the level of vitamin D remains low. Is it worth looking at vitamin D at the first dose and a little more, for example, 10000 5 days or 10 days and then reduce the dose, suddenly do we prescribe a small dose and do not achieve the result?
– Vitamin D still does not resolve extreme conditions and it makes no sense to strive for the minimum time to reach this high concentration.I am against high doses, because this substance is fat-soluble and has undesirable effects, including, and an overdose is possible due to the fact that it is rather slowly excreted from the blood plasma, and side effects can be manifested by increased pressure, headaches. I would not risk it, this is not an emergency drug. We should prescribe a dose of 1000, 2000, 3000 to a patient for 6-8 weeks, and only after that one cannot count on an earlier recovery of the vitamin D level.
And I also ask you to pay attention to two aspects. Firstly, we have active metabolites of vitamin D – this is 25 OH, dihydroxy, and so on, and we determine a completely different form of vitamin D in the blood plasma, because this form is a transport form, and by this transport form we judge the supply of the body with vitamins … There are more active forms of vitamin D in the body, we do not determine them, therefore this indicator is rather indirect.
We have a number of drugs that cause iatrogenic vitamin D deficiency, and we need to make a donation here.These are antiepileptic drugs, not all, but the overwhelming majority, h3 histamine blockers, anti-tuberculosis drugs, all of which need an additional supplement of vitamin D.
Some patients ask the question: the doctor recommended taking 10,000-15,000 times a week, but you need to understand that such special dosage forms of sustained-release vitamin D are not registered in the territory of the Russian Federation, and if we take a regular dosage form in such a dose, we will first have a large peak, rise in concentration, then fall and residual concentration.And our task is to ensure that the supply in blood plasma is approximately the same at the level of the daily nutritional requirement throughout the day. Therefore, we need a regular intake of a nutritional dose into the body, and in this way we will make up for the defect.
This question always raises a debate – is it necessary to add vitamin K to vitamin D or not?
– It depends on what goal we are pursuing.If we take vitamin D and normalize the moments of fertility, then it is not necessary. If we prevent various osteoporotic moments, then it is advisable to prescribe vitamin K. I believe that vitamin K is absolutely undeservedly forgotten and not as advertised as vitamin D. What does vitamin K do, in simple terms? It contributes to the fact that osteoclasts are special cells, they are located in the bone in accordance with the architectonics of the bone, that is, it significantly strengthens the strength of the bone.And if we prescribe in this regard (prevention of senile osteoporosis, menopausal osteoporosis, bone damage), then it is advisable to combine it with vitamin K.
– We started talking about covid, and Americans still recommend taking zinc in their studies, and now zinc even disappears in many pharmacies. Tell us about this element.
Zinc is one of the micronutrients that most strongly stimulates the immune system, it affects the thymus and changes the concentration of thymulin.Repeatedly, even on the territory of our country, attempts were made to register medicines that contain zinc with other components, and vitamin A is a synergist, for the prevention of acute respiratory viral diseases. But it’s hard enough to prove prevention. But in European countries, such additives exist and it is believed that zinc can prevent the incidence of acute respiratory viral infections.
In general, the micronutrients that most affect the immune system are ascorbic acid, vitamin D, A, zinc, and necessarily selenium.We have special guidelines that were approved by the chief physician on April 14, just when we began to self-isolate, this is nutrition in conditions of covid infection, and for the first time in the guidelines it appeared that absolutely all categories of the population are recommended to take dietary supplements. And just these micronutrients that affect nonspecific immunity were listed as components that should be part of dietary supplements.
With regard to zinc, there is experimental data that show that it reduces the ability of the virus to replicate, it affects thymulin, the production of interferon. But there is not a sufficient evidence base for it to be a drug and for 100% to count on it. And vitamins are not a panacea, this is our minimum chance to use minimally invasive methods to try to maintain our health in order to withstand an extreme situation, but to say that I take vitamins, I have good immunity and I will not get sick, is not unambiguous.Now there is a very interesting publication that shows that almost all obese people have hypovitaminosis.
– There are people who live far from Moscow, they do not get tested for vitamin D, but they can buy, they heard somewhere, and no one says the dosage. Now everyone has decided that it is necessary to take zinc. What dosage is safe for the average person?
– To an ordinary person, I will say this – you want to buy something, take the packaging in your hands, read it carefully, and it will definitely indicate the content of the components, for example, zinc as a percentage of the daily requirement.And you do not need to know how much, 7 mg, 5 mg, before you buy, you need to look at the packaging and it will say how many percent of the daily value of zinc will be in one capsule that you will take today. Usually it is 60, 80, 100, 120%, but no more, more and is not needed by an ordinary person who lives far from Moscow. Labeling on dietary supplements, medicines, labels, packaging, everything is so worked out that if a person can read, he will read and be safe. In general, before you put something in your mouth, you need to develop the habit of reading the composition of what you want to eat.
– But now we live in such a time that one thing can be written on the packaging, and the composition there will be completely different. Therefore, we stopped trusting the inscriptions.
Dietary supplements are a very good idea, but due to the fact that there is aggressive advertising, attempts to replace drugs with dietary supplements, that dietary supplements help with diseases – dietary supplements do not help. Even the most active pharmacological substances in dietary supplements are contained in those doses in which they cannot have a pharmacological effect, this must be remembered.Dietary supplements can be equated with medical nutrition, but not with medicines. Dietary supplements can be used in the treatment of a disease, but according to the doctor’s prescription and in complex therapy with drugs, that is, dietary supplements are a preventive thing, it is a nutritional supplement that helps to replenish the necessary micronutrients, to make the composition of the diet optimal. And unscrupulous manufacturers advertise some properties, and lay others, but let’s think about the good, after all, we have bodies that regulate the circulation of dietary supplements, they exercise good control, and it seems to me that if you buy in pharmacies, not from your hands, I am against shopping on the Internet, I am for buying in pharmacies in trusted places where you can see documents confirming the quality, this is also an opportunity to protect yourself.
Many questions arise, but these are not only questions of a person, these are questions of the state. The state is trying to create regulatory documents in this way in order to perform this function, the control bodies monitor this, and they work actively. But there are unscrupulous people everywhere.
– You said about vitamin C, and now there is also a certain passion for large doses of vitamin C.
– Ascorbic acid has long attracted the attention of people and specialists, once the Nobel Prize was awarded for the use of ascorbic acid in the treatment of influenza.After that, a fairly large number of evidence-based studies were carried out, which did not confirm that ascorbic acid can significantly affect the incidence of influenza, the duration of the illness, but it has certain positive properties, it increases exercise tolerance, reduces viral replication, and in combination it is very helpful. Ascorbic acid more than 300-400 mg is not absorbed, the use of high doses of ascorbic acid, 500 and 1000, if it is ascorbic acid, then it can be dangerous from the point of view of irritating effects on the gastrointestinal tract, kidney stones.
But by vitamin C we can mean not only ascorbic acid, there is a compound that is ascorbate, this also refers to ascorbic acid, and this compound has great advantages, it has a neutral pH, therefore it does not cause pain in the gastrointestinal tract, stone formation, it is retained in the body longer, this is important for ascorbic acid, because the deficiency of ascorbic acid can be eliminated very quickly – you ate a few oranges, and you have a good concentration, but it is not retained in the body for long, it has a very short half-life, and ascorbate is more lingers in the body for a long time, and this is also a form of vitamin C.Higher doses can already be used, 500 and 1000 can be used if needed. It is a rare situation when very high doses of ascorbic acid must be used.
Now we can return to covid again. These schemes of detoxification using parenteral administration of ascorbic acid are used, these schemes are used in America, now a very large study has been launched in China on the use of parenteral ascorbic acid for detoxification, it has not yet ended, they are talking about large doses, from 15 to 30 g per day.We also have a coronavirus hospital at Sechenov University, and ascorbic acid is also used in detoxification topics.
– In the form of tablets, how long can a person safely take, because I know people who take vitamin C from month to month?
– Such a classic recommendation for taking vitamins is the following: this is 2-3 months, then a 2-3 week break and another 2-3 months, but it is recommended to change the vitamin-mineral complexes, you do not take the same all your life, you can change them according to composition, you can change the manufacturer.
– How do you feel about multivitamins? To what extent are they valid and how effective and safe are they?
– If we are talking about prevention, then absolutely complex drugs have a place to be. If we are talking about the treatment of an identified deficiency of a clinically significant vitamin, then we must give preference to a monopreparation, and this approach is traditional, it must be adhered to. Now the technologies for the production of vitamin and mineral complexes have made great strides forward.And technologies of microgranulation, microencapsulation prevent these interactions, which we used to be afraid of, these interactions mainly occur at the stage of storage. And if we use it for the purpose of prophylaxis, then there will be no pronounced malabsorption, you can absolutely safely take complex drugs, but I will not quite like it if there are 100 components, 50 components. Today, we have a total of 13 vitamins, the rest are vitamin-like substances, useful micronutrients, but we have only 13 vitamins.
Nowadays, taking vitamins of group B is popular. How important and necessary are they?
– These are basic vitamins, they provide all the processes of energy supply to the body, absolutely nowhere without B vitamins. These are thiamine, riboflavin, and pyridoxine. Such a B vitamin as B12 cyanocobalamin is a substance that has extremely low bioavailability, so it is most difficult to adjust its concentration in blood plasma.B vitamins are very important for the conduction of nerve fibers, so if a person has some kind of disease, for example, type 2 diabetes mellitus or diseases associated with visual impairment, it is imperative to take B vitamins to prevent the onset, development and progression of polyneuropathy, because usually our patients are caught very late, when the polyneuropathy progresses, when there are already pains, in this situation it is very difficult to do something. The main task is prevention, it is easier.Here B vitamins are absolutely irreplaceable.
B vitamins are very important for cognitive function. If a person has an intense mental load, a stressful regimen, a lot of work, then B vitamins are those vitamins that contribute to concentration of attention, help a person to transfer mental stress more. Patients who have behavioral deviations, impulsive, not very adequate, and in psychiatric practice, as part of complex therapy, B vitamins are used very often.And every older person who had back pain, leg pain, had a pronounced pain syndrome, along with non-steroidal anti-inflammatory drugs, B vitamins are prescribed, because they enhance the effect of non-steroidal anti-inflammatory drugs by influencing their metabolism, and B vitamins have and its own antinociceptive effect, it is an analgesic effect at the level of the cerebral cortex. This combination began to be used many years ago, and then they found scientific confirmation why non-steroidal anti-inflammatory drugs are better for pain relief with B vitamins, because B vitamins slow down their metabolism and there is a higher concentration in blood plasma.B vitamins are very often used in neurology.
Vitamins of group B are still used for hypercysteinemia, but these are already large doses, medicinal, also in preparation for transplantation, but this is a purely medical use.
– I can’t help but ask about calcium. How justified is calcium intake in old age?
– Calcium at the level of daily nutritional requirements, in combination with vitamin D, K to prevent bone damage, because with age, bones become brittle, fragile, we are afraid of falls and fractures in elderly patients, but this is prevention.And not only in elderly patients. There was a very interesting study: despite the fact that children take a large amount of dairy products – cottage cheese, kefir, milk – the supply of calcium is still low, and calcium forms the skeleton, the human skeleton, therefore, calcium intake at the level of daily requirement is recommended. But calcium is an interesting substance, it interacts with iron, zinc, so in order to take it for the benefit, and not uselessly, if a person takes iron supplements, then it must be diluted in time.
– Huseyn Farajov:
– Let’s finish the program with your wishes.
– I wish everyone good health and not get sick. And in addition to such restrictive measures as self-isolation, social distancing, wearing masks, there is also the world of public health, when everyone must take care of their health, they need to go in for sports, take micronutrients, including those that will help increase the body’s defenses.And I wish everyone health, health and health again, and, of course, a happy holiday, but so that the holiday does not spoil your health.
– Good luck, see you.