SEPTEMBER 9, 2014
YOONAH KIM, PHARM.D. CANDIDATE 2015
What is vitamin B12? Got questions? infoRx@BioidenticaRx.com
Vitamin B12, also known as cobalamin, is an essential component of the… (pg.2)
What are the sources of vitamin B12?
What are the forms of vitamin B12?
Human body cannot produce our own… (pg.2)
Bacteria synthesize vitamin B12 in… (pg.2)
VITAMIN B12 What are the causes of B12 deficiency? Vitamin B12 deficiency in healthy individ… (pg.2,3)
Concerns for B12 deficiency in infants? Since vitamin B12 is only found in meat and… (pg.2) BIOIDENTICA Pharmacy carries Metagenics, Designs for Health, Pure Encapsulation, and other high quality dietary supplements. The prescription medications are also available and compounded.
How do we get diagnosed?
What is available in the market?
If vitamin B12 deficiency is suspected, a… (pg.3)
Cyanocobalamin is available in the… (pg.2)
What are the FDAapproved indications and dosage? If vitamin B12 deficiency is suspected, a… (pg.3)
What is recommended daily dose of B12? The recommended dietary allowance (RDA) of… (pg.3)
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SEPTEMBER 9, 2014
WHAT IS VITAMIN B12?
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Vitamin B12, also known as cobalamin, is an essential
YOONAH KIM, PHARM.D. CANDIDATE 2015
WHAT ARE THE SOURCES OF VITAMIN B12? Human body cannot produce our own cobalamin, so it has to be
component of the body to help
consumed from food. It is
synthesize DNA and red blood
exclusively found in animal proteins.
cells. It is critical to have enough in the cells to perform normal brain and nervous functions. It is essential to growth, cell reproduction, hematopoiesis, and nucleoprotein synthesis.
WHAT ARE THE CONCERNS OF B12 DEFICIENCY IN INFANTS?
Since vitamin B12 is mainly found in animal
products such as meat, fish, and dairy products, B12 deficiency may be seen in breastfed babies of strict vegetarian mothers without taking
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Some examples of cobalaminenriched food include meat, fish, shellfish, and dairy products.
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Food
Vitamin B12 (mcg)
%DV
Clams, cooked, 3oz
84.1
1,402
Trout, cooked, 3oz
5.4
90
Tuna can in water, 3 oz
2.5
42
Milk, low fat, 1cup
1.2
18
Egg, boiled, 1
0.6
10
*DV = Daily Value. DVs were developed by the U.S. Food and Drug Administration (FDA). The DV for vitamin B12 is 6.0 mcg. Foods providing 20% or more of the DV are considered to be high sources of a nutrient, but foods providing lower percentages of the DV also contribute to a healthful diet.
sufficient prenatal vitamins containing B12. An infant with B12 deficiency can become anemic, experience retarded growth, and display poor motor function. The recommended daily oral dose of B12 supplement for pregnant and lactating women is discussed in the next page.
WHAT ARE THE MOLECULAR FORMS OF B12? Bacteria synthesize vitamin B12 in form of hydroxocobalamin. When consumed, our body converts hydroxocobalamin into one of
WHAT IS AVAILABLE IN THE MARKET?
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the active forms of vitamin B12, either methylcobalamin or adenosylcobalamin. These two forms can be switched between and make use of it right away in our body. However, the widely used pharmaceutical
The synthetic form of vitamin B12, Cyanocobalamin, is available in nasal spray, oral
form of vitamin B12 is cyanocobalamin, which is synthetic form of B12.
tablets, solutions, lozenges, and intravenous, intramuscular, and subcutaneous injections. Oral forms may not be the best choice for patients
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with absorption problems, thus injections are often used. The injection and nasal form require prescriptions to purchase. The active form of
WHAT ARE THE CAUSES OF B12 DEFICIENCY? Vitamin B12 deficiency in healthy individuals is not very common in the
vitamin B12, Methylcobalamin is available over-
US. However, it is more likely to be seen
the-counter in oral forms. Vitamin B12 can also be
in elderly, strict vegetarians, and patients
compounded to meet patient’s specific needs.
with malabsorptions. The primary cause
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SEPTEMBER 9, 2014
YOONAH KIM, PHARM.D. CANDIDATE 2015
HOW DO WE GET DIAGNOSED?
(continued from page 2) of deficiency may be due to
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either insufficient dietary intake or impaired absorption of B12. There are several medical conditions that can put patients at greater risk of B12 deficiency. These include gastritis, pancreatic insufficiency, pernicious anemia, Crohn’s disease, Grave’s disease or lupus. If the deficiency is untreated for several months or more, it is possible to have irreversible damages to the nervous system.
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Generally the symptoms of B12 deficiency is nonspecific, including fatigue, soreness of mouth and tongue,
If vitamin B12 deficiency is suspected, a complete
depression and impaired memory, however the long-term
blood count (CBC), peripheral blood smear, and serum
effect of B12 deficiency can be fatal. It can eventually
cobalamin levels are typically ordered as an initial lab
cause anemia, permanent nerve damage, impaired ability
assessment. Falsely low values should be taken into
to sense, peripheral neuropathy, mental confusion,
consideration to rule out true deficiency, which is often
agitation, and hallucination.
associated with multiple myeloma, oral contraceptives,
! ! IS RECOMMENDED DIETARY WHAT ALLOWANCE (RDA) ! ! IN HEALTHY INDIVIDUALS? ! ! Age
Vitamin B12 (mcg/day)
Infants
0-6 months 7-12 months
0.4 0.5
Children
1-3 years 4-8 years
0.9 1.2
Adults
9-13 years > 14 years
1.8 2.4
Pregnancy
any age
2.6
Lactation
any age
2.8
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*The intake recommendations for vitamin B12 are provided in the
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Dietary Reference Intakes developed by the Food and Nutrition Board.
References: Herbert V. Vitamin B12 in Present Knowledge in Nutrition. 17th ed. Washington, DC: International Life Sciences Institute Press, 1996. U.S. Department of Agriculture, Agricultural Research Service. 2011. USDA National Nutrient Database for Standard Reference, Release 24. Nutrient Data Laboratory Home Page, http://www.ars.usda.gov/ba/bhnrc/ndl. Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998. Carmel R, Sarrai M. Diagnosis and management of clinical and subclinical cobalamin deficiency: advances and controversies. Curr Hematol Rep 2006;5:23-33. Healton EB, Savage DG, Brust JC, Garrett TF, Lindenbaum J. Neurological aspects of cobalamin deficiency. Medicine 1991;70:229-44. Andrès E, Federici L, Affenberger S, Vidal-Alaball J, Loukili NH, Zimmer J, et al. B12 deficiency: a look beyond pernicious anemia. J Fam Pract 2007;56:537-42. Clinical Pharmacology: Indications and Dosage. Cyanocobalamin. Accessed Sep. 2014.
folate deficiency, and pregnancy. There are several confirmatory tests available, however the most common and accurate tests are Homocysteine (Hcy) and Methylmalonic Acid (MMA). An elevated serum level of Hcy generally indicates low levels of vitamin B12, since cobalamin uses Hcy to synthesize methionine. MMA levels may also increase in the presence of cobalamin deficiency, because cobalamin is required to convert methylmalonyl coenzyme A to succinyl coenzyme A. Note that false positives can be seen in patients with renal insufficiency.
WHAT ARE THE FDA-APPROVED INDICATION AND DOSAGE? ‣ For the treatment of vitamin B12 deficiency megaloblastic anemia or macrocytic anemia: • Adults: cyanocobalamin 30 mcg IM/SC once daily for 5-10 days, then 100-200 mcg IM/SC once monthly. ‣ For maintenance of vitamin B12 concentrations in patients with no nervous system involvement: • Adults and Adolescents: cyanocobalamin 25 mcg intranasally into each nostril once daily. For patients with an inadequate response to once daily dosing, increase dose to 25 mcg intranasally in each nostril twice daily. ‣ For the treatment of pernicious anemia: • Adults: cyanocobalamin 100 mcg IM/SC once daily for 6 or 7 days is the FDA-approved dosage. After clinical improvement and if a reticulocyte response is seen, give 100 mcg IM/SC on alternate days for 7 doses, then every 3-4 days for another 2-3 weeks, then 100 mcg IM/SC monthly for life. Administer with folic acid, if needed.
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* The statements above are for information purposes only. Bioidentica is not liable for any errors or misprints in harm as a result thereof. Please consult with your provider if you suspect vitamin deficiency.
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