This is not a complete list of possible side effects. Pinch a layer of skin with your thumb and index finger, which should be about an inch and a half apart from each other, in the front area of the thigh. Mann BA, Garry PJ, Hunt WC, Owen GM, Goodwin JS. In one of the studies using higher doses of oral vitamin B12 (Bolaman 2003), the authors reported that no adverse events occurred. Vitamin-B 12-Mangel, auch Hypocobalaminämie genannt, bezieht sich auf einen niedrigen Blutspiegel von Vitamin B 12. Failure of long-term oral vitamin B12 therapy to replenish body B12 stores. Many patients receive vitamin B12 injections more often than the recommended three month interval (Cochrane 1971; Fraser 1995; van Walraven 1999). Contact address: Josep Vidal-Alaball, National Public Health Service for Wales, 36 Orchard Street, Swansea, Wales, SA1 5AQ, UK. ANNE MOUNSEY, MD, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, DAVID C. BRENDLE, DO, MAHEC Boone Family Medicine Residency, Asheville, North Carolina, KERWYN FLOWERS, DO, Florida State University, Tallahassee, Florida. Intramuscular injections are a “considerable source of work” for health care professionals, mainly general practitioners and community nurses (Middleton 1985), and can cause significant pain in thin patients (Elia 1998). Patients were recruited from a general practice in the United Kingdom and were 31 to 90 years of age, and 66% were women. When a difference between reviewers arose, we obtained and reviewed a hard copy of the papers and made decisions by consensus. Oral treatment could therefore save considerable Health Service resources. Barrea L, Vetrani C, Verde L, Frias-Toral E, Ceriani F, Cernea S, Docimo A, Graziadio C, Tripathy D, Savastano S, Colao A, Muscogiuri G. Antioxidants (Basel). The two studies compared oral administration of vitamin B12 versus intramuscular administration of vitamin B12. In Sweden, however, in the year 2000, oral vitamin B12 accounted for 73% of the total vitamin B12 prescribed (Norberg 2001; Nilsson 2005). Lederle FA. Vitamin B12 and folate deficiency in later life. Zwei Studien berichteten über Nebenwirkungen. B-12 Compliance Injection Description. Short-term oral cobalamin therapy for food-related cobalamin malabsorption. This content does not have an Arabic version. Sanz-Cuesta T, González-Escobar P, Riesgo-Fuertes R, Garrido-Elustondo S, del Cura-González I, Martín-Fernández J, Escortell-Mayor E, Rodríguez-Salvanés F, García-Solano M, González-González R, Martín-de la Sierra-San Agustín MÁ, Olmedo-Lucerón C, Sevillano Palmero ML, Mateo-Ruiz C, Medina-Bustillo B, Valdivia-Pérez A, García-de Blas-González F, Mariño-Suárez JE, Rodríguez-Barrientos R, Ariza-Cardiel G, Cabello-Ballesteros LM, Polentinos-Castro E, Rico-Blázquez M, Rodríguez-Monje MT, Soto-Díaz S, Martín-Iglesias S, Rodríguez-González R, Bretón-Lesmes I, Vicente-Herrero M, Sánchez-Díaz J, Gómez-Gascón T, Drake-Canela M, Asúnsolo-del Barco Á; OB12 Group. Educational and Psychological Measurement. After consideration of study populations, treatments, outcome measures and follow up, we concluded that meta-analysis was not appropriate. Two studies compared oral and intramuscular vitamin B12: Kuzminski and colleagues (Kuzminski 1998) reported neurologic and haematologic responses. Hintergrund. Vitamin B12 shots may help reduce the risk of the following conditions: heart . How many milliliters should the nurse draw up in the syringe? Use the thumb and forefinger of the non-injection hand to hold skin of injection site tight. selection bias - a) was the randomisation procedure adequate? This has been the norm for the last 50 years despite several non-randomised studies in the early 1950’s demonstrating satisfactory responses to oral treatment and the fact that there is considerable experience in Sweden in using oral vitamin B12. Cochrane Kompakt ist ein Gemeinschaftsprojekt von Cochrane Schweiz, Cochrane Deutschland und Cochrane Österreich. A 2017 prospective, nonblinded, randomized trial from Switzerland, excluded from the 2018 Cochrane review, compared oral cyanocobalamin therapy with intramuscular hydroxocobalamin therapy in 37 patients (mean age = 49.5 years; 60.5% women) with vitamin B12 deficiency (less than 200 pg per mL).3 The oral group received 1,000 mcg of cyanocobalamin per day through an electronically monitored punch card (99.6% adherence by pill count), and the intramuscular group received 1,000 mcg of hydroxocobalamin weekly for four weeks. Enter your medication into the WebMD interaction checker, Treating Opioid Use Disorder With Medications, anemia due to vitamin B12 deficiency-pernicious anemia, prenatal treatment of methylmalonic acidemia, FDA Labeling for Hydro B12 intramuscular on RxList. Medicine’s best kept secret? Most people with vitamin B12 deficiency are treated in primary care with intramuscular vitamin B12 which is a considerable source of work for health care professionals. Members of the network select questions based on their relevance to family medicine. Absorption of vitamin B12 in pernicious anaemia. We obtained a copy of all pre-selected papers and two researchers independently extracted the data from these studies using piloted data extraction forms. DECLARATIONS OF INTEREST We have not received any commercial sponsorship for this review. Again, however, patients with inflammatory bowel disease and coeliac disease appear not to have been included. Clinical trial of the effect of vitamin B12 in elderly subjects with low serum B12 levels. In some countries hydroxocobalamin has completely replaced cyanocobalamin as first choice for vitamin B12 therapy because it is retained in the body longer and can be administered at intervals of up to three months (BNF 2004). When relevant, we planned to repeat the analysis: We planned to test the robustness of the results by repeating the analysis using different measures of effect size (risk difference, odds ratio etc.) Check with your doctor or nurse immediately if any of the following side effects occur: Some side effects may occur that usually do not need medical attention. Comprehensive Approach to Medical Nutrition Therapy in Patients with Type 2 Diabetes Mellitus: From Diet to Bioactive Compounds. The resources and costs are reported in Table 1. We selected 41 abstracts for which the full paper was obtained and two studies met the inclusion criteria. All rights reserved. 31. Vitamin B12 replacement has been traditionally administered intramuscularly. Front Pharmacol. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to four months. Most vitamin B12 deficient individuals in the UK and other countries are treated with intramuscular vitamin B12. None of the studies was conducted in Primary Care where most of the patients with vitamin B12 deficiencies are treated; this makes the generalisability of the results more difficult. Bookshelf A total of 108 patients with vitamin B12 deficiency participated in these studies. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Juli 2017 eine Suche in folgenden Datenbanken durch: CENTRAL, MEDLINE, PubMed, Embase sowie die WHO ICTRP und ClinicalTrials.gov. Benzyl Alcohol, 1.5%, is present as a preservative. Serum methylmalonic acid concentrations decreased to < 3 SD above the normal range in all participants except one in the oral and two in the intramuscular group. The aim of the present study was to compare the efficacy of SL versus the standard IM administration of VB12 in restoring B12 levels. Intranasal (Nascobal): 500 mcg in 1 nostril once weekly; may increase dose if vitamin B 12 levels decline after 1 month of treatment. Pennypacker LC, Allen RH, Kelly JP, Matthews LM, Grigsby J, Kaye K. High prevalence of cobalamin deficiency in elderly outpatients. Eine Studie verwendete 2000 μg Vitamin B12 /Tag und zeigte höhere Vitamin B12-Blutspiegel zugunsten der oralen Verabreichung12. Eingeschlossen wurden randomisierte kontrollierte Studien (RCTs), die untersuchen, wie sich orale Vitamin-B12 -Einnahme im Vergleich zu IM-Injektionen bei Vitamin-B12-Mangel auswirkt. Avoid touching the needle on the glass bottom of the vial, because it might dull its sharpness. Both groups receiving oral or intramuscular vitamin B12 reported improvements of cognitive function, sensory neuropathy and vibration sense but the difference between both groups was not statistically significant. However, if someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Properly discard this product when it is expired or no longer needed. Do not share this medication with others. Drug information provided by: Merative, Micromedex®. All abstracts or titles identified by the electronic searches were independently scrutinised by two reviewers. Nygard O, Nordrehaug JE, Refsum H, Ueland PM, Farstad M, Vollset SE. Review: Limited evidence from 2 randomised controlled trials suggests that oral and intramuscular vitamin B12 have similar effectiveness for vitamin B12 deficiency. All rights reserved. The difference was even greater at four months (1,005 +/− 595 vs. 325 +/− 165 pg/mL; P< 0.0005). Oral cobalamin for treatment of pernicious anemia? The methodological quality of the included studies was independently assessed by two researchers and disagreements were brought back to the whole group and resolved by consensus. Shatalin YV, Shubina VS, Solovieva ME, Akatov VS. Int J Mol Sci. Kwok T, Tang C, Woo J, Lai WK, Law LK, Pang CP. Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Die Gesamtqualität der Evidenz war niedrig oder sehr niedrig, vor allem aufgrund der geringen Anzahl der eingeschlossenen Studien und der geringen Teilnehmerzahlen in diesen Studien. Vitamin B12 helps your body use fat and carbohydrates for energy and make new protein. 1National Public Health Service for Wales, Swansea, UK, 2Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK, 3Department of Haematology, Cardiff and Vale NHS Trust, Cardiff, UK, 4Department of General Practice, Wales College of Medicine, Cardiff University, Wrexham, UK, 5Department of Medical Biochemistry and Immunology, Cardiff University, Cardiff, UK, 6Department of Medicine, McMaster University, Hamilton, Canada. Objectives To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. Absorption of orally administered vitamin B12 in pernicious anaemia. Pure nutritional deficiency is rare and usually occurs only in strict vegans (EVM 2002). (control$ or prospectiv$ or volunteer$).tw. Benefits. Journal of the American Geriatrics Society. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. PMC Wir verwendeten methodische Verfahren, die von Cochrane standardmäßig erwartet werden. We assumed that a physician visit to explain to patients the benefits of oral therapy and instructions for use would take place on . US residents can call their local poison control center at 1-800-222-1222. While serious adverse reactions are rare, injections can be dangerous in anticoagulated patients. The first study was carried out in USA by Kuzminski and colleagues (Kuzminski 1998) and the second in Turkey by Bolaman and colleagues (Bolaman 2003). Wir danken unseren Sponsoren und Unterstützern. If you are using this medicine to treat vitamin B12 deficiency caused by pernicious anemia, you will need to use the medicine for the rest of your life. Ungley CC. Maintenance therapy of pernicious anaemia. Den meisten Menschen mit Vitamin-B12-Mangel, wird in der Primärversorgung Vitamin B12 intramuskulär (IM) injiziert. and transmitted securely. A very serious allergic reaction to this drug is rare. For example, Glass and co-workers showed that 69% of a dose of 1000 mcg of cyanocobalamin given as injection was recovered in the urine over 72 hours. Here are four recommended spots: Although not depicted in the image above, the buttock is also a viable spot for B12 shots. Search strategy: After 10 days, once a week for 4 weeks and after that patients were asked to continue treatment once a month indefinitely, Newly diagnosed cobalamin deficient patients, 1000 mcg intramuscular cyanocobalamin on days 1, 3, 7, 10, 14, 21, 30, 60 and 90, Randomised, placebo-controlled double-blinded study assessing the effectiveness of a product mixture containing cyanocobalamin in the treatment of age-dependent psychic regression. Author disclosure: No relevant financial relationships. Dosage is based on your medical condition and response to treatment. The bioavailability of the water solution of cyanocobalamin used is much lower than that of more usual injectable preparations such as hydroxocobalamin. Dr Andrew McCaddon is a Scientific Consultant for, and shareholder of, COBALZ LIMITED - a private company developing ’glutathionylcobalamin’ as an alternative orally available form of vitamin B12. Martin DC, Francis J, Protetch J, Huff FJ. Middleton J, Wells W. Vitamin B12 injections: considerable source of work for the district nurse. Comparative evaluation of the therapeutic effectiveness of Cobamamide at high doses by intramuscular injection and by iontophoresis. Bastrup-Madsen P. Comparison between the durations of the effects of the vitamin B12 preparations Betolvex and Vibeden [Summenligning mellen varigheden af virkingen af B12–vitamin praeparaterne Belolvex of Vibeden]. Prevalence of cobalamin deficiency in the Framingham elderly population. With the introduction of automated assays for measuring serum cobalamin levels over the last decades, the hematological manifestations related to cobalamin deficiency have been changed from the description reported in 'old' studies or textbooks. The length of follow up ranged from 90 days to four months. Participants 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm . Effects of vitamin B12, folate, and vitamin B6 supplements in elderly people with normal serum vitamin concentrations. Pathy MS, Pippen CA, Kirkman S. Free and intrinsic factor bound radioactive cyanocobalamin. This is not a complete list of side effects and others may occur. * Indicates the major publication for the study, National Library of Medicine Die Ernährung sollte - sowohl bei Veganern als auch bei Nicht . Under normal circumstances it is essential that they are present in a person’s diet because, with few exceptions, the human body is unable to manufacture them. Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption. Chalmers JN, Shinton NK. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. High oral doses of B12 (1000 mcg and 2000 mcg) were as effective as intramuscular administration in achieving haematological and neurological responses. Spies T, Stone R, Lopez G, Milanes F, Toca R, Aramburu T. Vitamin B12 by mouth in pernicious and nutritional macrocytic anaemia and sprue. Evaluated outcomes were vitamin B12 levels (two RCTs) and normalization of vitamin B12 levels (two RCTs). A nurse or other trained health professional will give you this medicine. The site is secure. Oral administration without source of intrinsic factor. Evidenz von niedriger Qualität zeigt, dass oral verabreichtes und IM- injiziertes Vitamin B12 ähnliche Effekte in Bezug auf die Normalisierung des Vitamin-B12-Spiegels im Serum haben; allerdings sind die Kosten bei einer oralen Therapie niedriger. Time dependency of cognitive recovery with cobalamin replacement: report of a pilot study. This is consistent with previous studies (Hathcock 1991). The true prevalence of vitamin B12 deficiency in the general population is still uncertain but there is evidence that it is common, especially amongst the elderly. Mean concentrations of the metabolites were not significantly different between the oral and the intramuscular groups, except at four months, when the value was higher in the intramuscular group (P< 0.05). Why did her NP prescribe vitamin B12 by intramuscular injection rather than orally?. Everybody involved in the administration of Vitamin B12 Injections sho. A deep understanding of patient’s preferences, explaining possible psychotropic effects of intramuscular vitamin B12 therapy, and developing effective ways of reaching shared decisions with patients is probably the way forward. These side effects may go away during treatment as your body adjusts to the medicine. No evidence that patients were vitamin B12 deficient, Review of treatments of diabetes. Ahmed SS, El-Hafez HAA, Mohsen M, El-Baiomy AA, Elkhamisy ET, El-Eshmawy MM. van Walraven C, Austin P, Naylor CD. All rights reserved. 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). JVA and DP assessed the three French studies. Im Hinblick auf den Vitamin B12 -Spiegel im Blut zeigte sich hierdurch kein relevanter Unterschied im Vergleich zu intramuskulär injiziertem Vitamin B12. Most of the publications were written in English (88%), but we found seven papers that we felt warranted closer scrutiny written in other languages: Italian (Aguzzi 1985; Migliorini 1979), French (Brassinne 1974; De La Fourniere 1997; Kaltenbach 2003), Danish (Bastrup-Madsen 1973) and Czech (Bezdickova 1997). attrition bias - a) were withdrawals and dropouts completely described? A controlled investigation [Confronto dell’efficacia terapeutica tra la somministrazione per via intramuscolare e via jonoforetica della Cobamamide a forti dosi. Eine Überdosierung an Vitamin B12 ist aber möglich bei: Lebermetastasen. There are several methods to treat vitamin B12 deficiency (VB12d): intramuscular (IM), oral, sublingual (SL), and intranasal vitamin B12 (VB12) preparations. Disclaimer. In one of the studies (Kuzminski 1998) the method of randomisation it is not described. We aimed to evaluate equivalence between the oral and intramuscular routes of vitamin B12 administration. Chalmers JN, Shinton NK. eCollection 2022. Randomised controlled trials examining the use of oral versus intramuscular vitamin B12 to treat vitamin B12 deficiency. In addition, there are methodological limitations to both studies identified by our search strategy. Thorne's B12 supplement contains the natural form of B12, methylcobalamin, unlike others that include the synthetic form, cyanocobalamin.
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