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New modes of vitamin B12 (cobalamin) administration: efficacy and safety of oral and nasal therapies Volume 24, issue 4, Juillet-Août 2018

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Authors
1 Service de médecine interne, diabète et maladie métaboliques, hôpitaux universitaires de Strasbourg, France
2 Service de gériatrie, CHRU de Rouen, France
3 Service de gériatrie et de médecine interne, hôpitaux universitaires de Strasbourg, France
* Tirés à part
  • Key words: Vitamin B12, cobalamin, oral vitamin B12 therapy, nasal vitamin B12 therapy, Biermer's disease, food-cobalamin malabsorption
  • DOI : 10.1684/hma.2018.1394
  • Page(s) : 264-78
  • Published in: 2018

Objective : The objective of this narrative review is to provide an update on the effectiveness of oral and nasal vitamin B12 (cobalamin). Method : Relevant articles were identified by PubMed and Scholar Google search from January 2010 and June 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 gleaned from international meetings were also used, as information gleaned from commercial sites on the web and data from CARE-B12 research group. Results : For oral vitamin B12, four randomized controlled trials, one systematic and four reviews, three prospective papers, and thirteen prospective studies fulfilled our inclusion criteria. The present review documents that oral vitamin B12 replacement at 1,000 μg daily was adequate to cure mainly clinical manifestations related to vitamin B12 deficiency, with safety profile. The efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B12 levels and hematological parameters, for example hemoglobin level, mean erythrocyte cell volume, 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 few preliminary studies were available. Conclusions : We conclude that oral vitamin B12 is an effective alternative to vitamin B12 IM injections. Oral vitamin B12 treatment avoids the discomfort, inconvenience and cost of monthly injections.