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Table 6: Examples of Treatment Regimens for Clinical Vitamin B12 Deficiency.

Due toInitial CyanocobalaminMaintenance Cyanocobalamin
Pernicious anemia

Varies, not limited to:

  • 1 mg intramuscularly (IM) or subcutaneously (SQ) every (q) week X 8

OR

  • 1 mg IM or SQ X 7 in one month
  • 1 mg IM or sq q month for life

OR

  • 1 mg - 2 mg orally (PO) everyday (QD) for life

Other foodbound B12 malabsorption problems

Varies, not limited to:

  • 1 mg IM or SQ q week x 8

OR

  • 1 mg IM or SQ x 7 in one month

OR

  • 1 mg-2mg PO QD
  • 1 mg IM or SQ q month possibly for life

OR

  • 1 mg PO QD possibly for life
Rarer malabsorption problems (tape worms, bacterial overgrowth)
  • Treat underlying condition

AND

Cyanocobalamin varies, not limited to:

  • 1 mg IM or SQ q week x 8

OR

  • 1 mg IM or SQ x 7 in 1 month
  • 1 mg IM or SQ q month

OR

  • 1 mg PO QD

Treating underlying condition might resolve B12 deficiency. If cyanocobalamin is d/c'd, follow up with regular assessment of metabolites

Approaches suggested by Stabler and Allen and Carmel

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