Thursday, November 19, 2015

Vitamin B for Peripheral Neuropathy


  • can present in a variety of forms and follow different patterns
  • Symptoms vary depending on whether motor, sensory, or autonomic nerves are damaged
Vitamin B related Causes
  • Heavy Alcohol Consumption
    • common cause of peripheral neuropathy
    • Damage to the nerves associated with long-term alcohol abuse may not be reversible when a person stops drinking alcohol, however, doing so may provide some symptom relief and prevent further damage.
    • frequently leads to nutritional deficiencies (including B12, thiamine, and folate) that contribute to the development of peripheral neuropathy
  • Metformin-induced Vitamin B12 Deficiency
    • vitamin B12 deficiency with metformin is undoubtedly due to malabsorption of vitamin B12 at its absorption site in the terminal ileum
    • Thirty percent of patients on metformin malabsorb vitamin B12
    • With an absolute vitamin B12 deficiency, it takes twelve to fifteen years to totally deplete pre-existing vitamin B12 stores
  • Proton Pump Inhibitors and Histamine H2 antagonists
    • H2RAs and PPIs have been documented to interfere with B-12 absorption
    • showing a 53% drop in protein-bound B-12 absorption with H2RA
  • Vitamin B12 Deficiency
    • can cause serious anemia, nerve damage and degeneration of the spinal cord.
    • common for anemia to develop first, but this is not always the case, especially if a person is taking a folate supplement
    • lack of B12 damages the myelin sheath that surrounds and protect nerves.
    • Without this protection, nerves cease to function properly and conditions such as peripheral neuropathy occur
Benefit of Supplementation
  • Insufficient evidence for benefit of vitamin B supplementation, even when extensively used for PN
  • Most treatment guidelines for peripheral neuropathy do not include supplementation as treatment option
  • One small trial in alcoholic peripheral neuropathy reported slightly greater improvement in vibration perception threshold with oral benfotiamine for eight weeks than placebo.
  • In another small study, a higher dose of oral vitamin B complex for four weeks was more efficacious than a lower dose in reducing symptoms and signs.
  • Vitamin B administered by various routes for two to eight weeks was less efficacious than alphalipoic acid, cilostazol or cytidine triphosphate in shortterm improvement of clinical and nerve conduction study outcomes
Recommendations
  • Supplementation confer greatest benefit depending on the cause of disease
  • do not require high doses if patients do not deficiencies or risks
Condition
Choice of Vitamin B
Taking AntiTB medications
B6
Alcoholism
B1, B12
Diabetes, on Metformin
H2RA
PPI
B12

Vitamin
NEUROBION
Individual Tab
RDA / for PN
B1 / Thiamine
100mg
10mg
·  5-30mg daily
·  Up to 300mg in deficiency
B6 / Pyridoxine
200mg
10mg
·  50-300mg
·  1–6 g oral pyridoxine per day for 12–40 months can cause severe and progressive sensory neuropathy characterized by ataxia (loss of control of bodily movements)
B12 / Cyanocobalamin
200mcg
500mcg
[mecobalamin]
·  50-6000mcg/day
·  Bioavailability 25%
References:
  1. http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm
  2. http://www.diabetesincontrol.com/metformin-induced-vitamin-b12-deficiency-presenting-as-a-peripheral-neuropathy/\
  3. http://www.cochrane.org/CD004573/NEUROMUSC_vitamin-b-for-treating-disorders-of-the-peripheral-nerves
  4. Peripheral Neuropathy and Vitamin B6. University of Virginia.
  5. http://askdis.blogspot.my/2015/07/maximum-dose-of-neurobion.html

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