Indication & Dosages (FUKKM)
- Prophylaxis of anaemia associated with Vitamin B12 deficiency
- 250-1000 mcg IM everymonth
- Uncomplicated pernicious anaemia or Vitamin B12 malabsorption
- Initial 100 mcg daily for 5-10 days followed by 100-200 mcg monthly until complete remission is achieved.
- Maintenance: up to 1000 mcg monthly. CHILD 30-50 mcg daily for 2 or more
weeks (to a total dose of 1- 5mg). OR AS PRESCRIBED.
- Patients with megaloblastic anaemia and pancytopenia require hospital admission
- An acute regimen of 1000 micrograms cyanocobalamin parenterally is given daily for between 1 and 2 week
- then 1000 micrograms parenterally once a week for up to 1 month, until significant reticulocytosis is seen in the marrow.
- Folic acid supplementation may help reverse the haematological abnormalities
- Acute and maintenance treatment of patients with mild to moderate symptoms of vitamin B12 deficiency (haematological: mild anaemia; neurological: dysaesthesia/paraesthesias, polyneuropathy, depression) is with once-daily oral cyanocobalamin or once-monthly parenteral cyanocobalamin
- In patients treated with oral cyanocobalamin, a response should be seen within 2 months.
- If serum vitamin B12 does not rise significantly after 2 months of daily oral cyanocobalamin, clinicians should switch to intramuscular vitamin B12 or consider other causes
- Parenteral therapy using the IM or SC route is by far the most reliable and most familiar treatment for vitamin B12 deficiency
- oral vitamin B12 in the form of cyanocobalamin in high doses could be absorbed even in patients with pernicious anaemia or significant terminal ileum resection
- Oral cyanocobalamin has been shown in meta-analysis to be as effective, if not more effective, in patients with vitamin B12 deficiency.
- Although absorption occurs at dosages <1000 micrograms/day, there appears to be variable absorption and less than maximal clinical and laboratory response.
- Absorption can be maximised by administering on an empty stomach
- MIMS Gateway
- http://bestpractice.bmj.com/best-practice/monograph/822/treatment/step-by-step.html
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