B12 switch to oral medication
Due to the extraordinary circumstances of coronavirus, face to face appointments have been reduced as far as possible for the health and safety of our staff and patients here at the Palms Surgery.
B12 injections have been classified as non-essential and will be delayed until coronavirus has settled. We recommend you switch to b12 tablets that have been shown to be equally as effective. The recommended dose is 1000-2000mcg a day. These are widely available from health food shops and online.
We understand that you may have concerns about this recommendation and so we have put together some questions and answers which may help reassure you.
The Palms Surgery is following guidance issued by the ICGP and also the position statement of the British Society of Haematology here.
Q) Why are you asking me to move from injection to tablets?
A) We have many patients with vitamin B12 deficiency registered at the practice who all need a face to face appointment at least every 3 months for their injections.. The main reasons for the change are:
- Many of the patients on B12 are themselves high risk and we do not want to put such patients at further risk by asking them to come and visit the practice.
- We are trying to protect our own front line staff from unnecessary contact to help keep our essential services going
- Moving to tablets frees up valuable time for our nurses to treat patients who absolutely must be seen in person and allows a little extra capacity if some of our nurses have to self-isolate.
Q) Will the tablets work as well?
A) There is evidence to say tablets work as well as injections if taken at the right dose (1000-2000mcg per day). Cochrane Study 2018
Q) I cannot absorb B12 so will the tablets work for me?
A) We cannot make B12 in our bodies; it has to be obtained from our diet. B12 mostly gets into our body because of a ‘carrier’ called intrinsic factor (IF). This IF binds to B12 and takes it into the blood. People can develop low levels of B12 because of a lack of IF or because they don’t take enough B12 in their diet. 95% of our B12 is carried into the body by IF. HOWEVER, there is another 5% which is absorbed without IF. If you take enough B12 (through supplements) then the body can manage to absorb enough B12 even if you do not have IF. We recommend you take a vitamin B12 supplement containing 1000-2000mcg per day. This is 400-800 times the normal recommended amount. This recommendation has come about because this is the dose that has been used in studies which have looked at the tablets versus injections for replacing low B12. There is no danger of overdose as the body will naturally dispose of excess B12 in urine.
Q) I have pernicious anaemia. Is it safe for me to switch to tablets?
A) Some people will have had a diagnosis of pernicious anaemia. The loading doses which everyone has to begin with have effectively treated the pernicious anaemia. The 3 monthly injections which follow are simply a precaution to stop the pernicious anaemia coming back through low B12 levels. As stated above, the tablets have been shown to be just as effective as the injections at treating low B12.
Anyone who is newly diagnosed with low B12 will still have the loading dose. The oral treatment is for patients who are on maintenance B12.
Q) What will happen once the concern about coronavirus passes?
A) We will get in touch with all the people affected by the suspension of B12 injections once the current pandemic has passed to invite them to consider how they wish to move forward. It may be that some people prefer to continue on tablets as they prefer not having to attend the surgery regularly for appointments and they prefer not having to have regular injections. It may be that some people would like some reassurance that their B12 level is OK on the tablets as opposed to the injections and we may consider doing some blood tests for reassurance. It may be that others prefer to go back onto injections.
If you have any further questions please feel free to contact the surgery here and discuss with a GP. Thank you for your understanding and help during this difficult time.
B12 1000mcg tablets can be bought from these suppliers
Your Local Pharmacy – please discuss with your pharmacist if they can access the tablets and you can get them with your monthly script. They are not currently covered by the GMS service and so you will have to pay for them.
These are just some of the online providers who sell vitamin B12. You need to ensure it is the stronger version of the vitamin and take 1-2 per day until such time as we resume injections.