State of the art review: oral and nasal vitamin B12 therapy in the elderly

Abstract

Summary The objective of this narrative review was to provide an update on oral and nasal vitamin B12 (cobalamin) therapy in elderly patients. Relevant articles were identified by ‘PubMed’ and ‘Scholar Google’ search from January 2010 to July 2018 and through hand search of relevant reference articles. Additional studies were obtained from references of identified studies, the ‘Cochrane Library’ and the ‘ISI Web of Knowledge’. Data retrieved from international meetings were also used, as was information retrieved from commercial sites on the web and data from ‘CARE B12’ research group. For oral vitamin B12 therapy, four prospective randomized controlled trials, eight prospective studies, one systematic and four reviews fulfilled our inclusion criteria. The studies included mainly or exclusively elderly patients (≥65-year-olds). In all of the studies, the mean age of the patients was at least 70 years except for two. The present review documents that oral vitamin B12 replacement at 1000 μg daily proved adequate to cure vitamin B12 deficiency, with a good safety profile. The efficacy was particularly marked when considering the noticeable improvement in serum vitamin B12 levels and haematological parameters, such as haemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented. For nasal vitamin B12, only a few preliminary studies were available. We conclude that oral vitamin B12 is an effective alternative to intramuscular vitamin B12 injections in elderly patients. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.

Vitamin B12 Status and Optimal Range for Hemoglobin Formation in Elite Athletes

“…The available data on treatment with vitamin B 12 show that oral cyanocobalamin at the doses of 1000-2000 µg daily is sufficient and as effective as intramuscular injections, regardless of the etiology of the deficiency [70][71][72]. Alternatively, the nasal route of cobalamin administration can also be considered [73,74]. Although the aforementioned data refer to the sedentary population (mainly older people), regularly monitored and orally supplemented athletes should not have any problems achieving the target zone of approx.…”

A case of B 12 deficiency anemia with pancytopenia

“…Ancak Andres ve ark. (9) tarafından yapılan ve Bolaman ve ark. (10) tarafından yapılan çalışmalarda uygulanan oral ve intramüsküler vitamin B12 tedavisine alınan yanıtta anlamlı bir fark saptanmamıştır.…”

Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population

“…B12 can be administered orally and parenterally (intramuscularly). Other methods include subcutaneous, transdermal, sublingual and nasal formulations [28], although their role in clinical practice appears marginal, because of their variable effectiveness and higher costs [131]. As reported in a Cochrane review [27], oral vitamin B12 or vitamin B12 administered intramuscularly might have similar effects in normalizing B12 serum levels, but oral treatment costs less [27].…”