NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Vitamin B12 replacement: COVID-19

The following is practical advice from NHSGGC Haematology for patients with vitamin B12 deficiency who require intramuscular (IM) hydroxocobalamin in primary care. It was written in the context of the need to minimise non-essential patient contact during the COVID-19 pandemic.

Key messages

  • Do not prescribe oral cyanocobalamin as an alternative to IM hydroxocobalamin.
    • Evidence of benefit from oral vitamin B12 in malabsorption syndromes is extremely poor.
    • High doses are required to give any benefit and no suitably licensed products are available in the UK to provide such doses.
  • If IM hydroxocobalamin treatment is delayed, resume patient's usual dose regime as soon as practicable.
  • Consider individual patient circumstances before altering treatment regimes.

Patient Group

Advice

Newly diagnosed with vitamin B12 deficiency

Treat as per NHSGGC Vitamin B12, Treatment of Deficiency in Adults Guideline (on StaffNet)

 

Patients with neurological symptoms

Treat as per BNF and do not stop/interrupt IM hydroxocobalamin

 

Patients on long-term maintenance treatment who experience excessive fatigue prior to next dose

Treat as per BNF and do not stop/interrupt IM hydroxocobalamin

 

Patients on long-term maintenance treatment who do not usually experience excessive fatigue prior to next dose

Consider delaying the next injection for up to 3 months. In these circumstances, patients should be advised to report any excessive fatigue during the interruption in therapy. If excessive fatigue develops during this interruption then continue regular IM regime.

 

Published 08/04/2020. Medicines Update blogs are correct at the time of publication.