Contributes to normal energy-yielding metabolism
Contributes to normal functioning of the nervous system
Contributes to normal homocysteine metabolism
Contributes to normal psychological function
Contributes to normal red blood cell formation
Contributes to the normal function of the immune system
Contributes to the reduction of tiredness and fatigue
Has a role in the process of cell division

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Vitamin B12

There is four types of parenteral Vitamin B12 available:
Cyanocobalamin 100 mcg/ml and 1000 mcg/ml – best used as IM to prevent rapid loss via kidneys
Hydroxycobalamin IM (compounded 1000 mcg/ml or more) – known as long acting B12 (binds better to plasma proteins than cyanocobalamin)
Methylcobalamin IV (compounded 1000 mcg or more – up to 5000 mcg/ml)
Adenosylcobalamin IV
Common dose is 1000 mcg IM or IV
Vitamin B12 as hydroxycobalamin is synthesized exclusively by microorganisms and is found in the liver of animals bound to protein as methylcobalamin =
metabolically active form of Vitamin B12
Hydroxycobalamin is a chelator of cyanide and is used in cyanide poisoning

Hydroxocobalamin is most generally used for vitamin B12 replacement therapy and is considered the “drug of choice” for vitamin B12 deficiency by the Martindale Extra
Pharmacopoeia (Sweetman, 2002) and the World Health Organization (WHO) Model List of Essential Drugs.

This preference for hydroxocobalamin in many countries is due to its long retention in the body.
Furthermore, IM administration of hydroxocobalamin is also the preferred treatment for

  • pediatric patients with intrinsic cobalamin metabolic diseases;
  • vitamin B12-deficient patients with tobacco amblyopia due to cyanide poisoning;
  • and patients with pernicious anemia who have optic neuropathy

COBALAMIN (Vitamin B12) Deficiency
– Vegetarians (dietary deficiency)
– Older adults: atrophic gastritis affects 10% – 30% and leads to decrease in hydrochloric acid secretion in the stomach and decreased absorption of Vitamin B12
– The liver can store up to six years worth of Vitamin B12 so deficiencies are rare

Effects of deficiency
– Megaloblastic anaemia (pernicious anaemia)
– Progressive demyelination of nerve cells
– Elevation in levels of circulating homocysteine that leads to production of defective collagen and elastin with a negative impact on arteries, bone and skin
– Deep vein thrombosis is associated with homocysteinemia that causes the activation of the intrinsic coagulation cascade
– Symptoms include fatigue, weakness, constipation, loss of appetite and weight loss Numbness, tingling of the feet imbalance, depression, confusion, dementia, poor memory and glossitis.

Vitamin B12 Medicine Interactions

• Chloramphenicol: bacteriostatic antibiotic can interfere with red blood cell response to supplemental Vit B12
• Proton pump inhibitors: omeprazole and lansoprazole, etc., slow gastric acid release and may interfere with VIt B12 absorption from food
• H2-receptor antagonists: cimetidine, famotidine and ranitidine slow the release of hydrochloric acid into the stomach and interfere with Vitamin B12 absorption from food

• Metformin: might reduce absorption of Vitamin B12 due to altered intestinal motility, increased bacterial overgrowth, etc.
• Toxicity: non-toxic at doses exceeding daily allowance by 10,000 times. Preservatives can result in hypersensitivity reactions. Sign of toxicity include diarrhoea and generalised body oedema


The most common dosage is 1000mcg which is 1 ml per treatment every 4-6 weeks
This can be given via IM injection in the arm or the bum.
You can also administer a loading dose this is a 1ml injection every second day for 3 injections total and then the normal dose of 1ml every 4 to 6 weeks .
Side effects are:
Red rash
Increase skin acne
Bruising and bleeding at the injection site

Vitamin D

Vitamin D contributes to normal absorption/utilisation of calcium and phosphorus
Contributes to normal blood calcium levels
Contributes to the maintenance of normal bones
Contributes to the maintenance of normal muscle function
Contributes to the maintenance of normal teeth
Contributes to the normal function of the immune system
Has a role in the process of cell division
Helps to reduce the risk of falling associated with postural instability and muscle weakness.
Falling is a risk factor for bone fractures among men and women 60 years of age and older.

• Promotes calcium absorption in the of bone and prevent hypocalcaemic tetany.
• Needed for bone growth and bone remodeling by osteoblasts and osteoclasts
• Prevention of rickets in children and osteomalacia in adults
• Together with calcium, vitamin D also helps protect older adults from osteoporosis.
• Cell growth modulation, neuromuscular and immune function and reduction in inflammation

• More prevalent in dark skinned people – less UV activation of Vitamin D in the skin but people of African American ancestry, for example, have reduced rates of
fracture and osteoporosis compared with Caucasians

• Also prevalent in Caucasians
• Estimated 29% of cancer mortality in males
• Strong evidence that Vitamin D has a protective effect against colon and breast cancer
• In smokers risk of pancreatic cancer may be threefold higher in patients with high Vitamin D levels (> 40 ng/ml)
• Cognitive dysfunction
• Obese individuals may become vitamin D deficient over time post gastric bypass surgery without a sufficient intake from food or supplements, since part of the
upper small intestine where vitamin D is absorbed is bypassed and vitamin D mobilized into the serum from fat stores may not compensate over time

Decreased by:

– Corticosteroids (prednisone): impair calcium absorption and vitamin D metabolism leading to osteoporosis in long term use
– Orlistat (brand names Xenical® and alliTM) and the cholesterol-lowering drug cholestyramine
(brand names Questran®, LoCholest®, and Prevalite®) can reduce the absorption of vitamin

D and other fat-soluble vitamins

– Phenobarbital and phenytoin (brand name Dilantin®), for prevention and control of epileptic seizures, increase the hepatic metabolism of vitamin D to inactive compounds and
reduce calcium absorption

Your body must have vitamin D to absorb calcium and promote bone growth. Too little vitamin D results in soft bones in children (rickets) and fragile,
misshapen bones in adults (osteomalacia). You also need vitamin D for other important body functions. Vitamin D deficiency has now been linked to breast cancer, colon cancer,
prostate cancer, heart disease, depression, weight gain, and other maladies. These studies show that people with higher levels of vitamin D have a lower risk of disease, although they do not definitively prove that lack of vitamin D causes disease — or that vitamin D supplements would lower risk. The Vitamin D Council — a scientist-led group promoting vitamin D deficiency awareness — suggests vitamin D treatment might be found helpful in treating or preventing autism, autoimmune disease, cancer, chronic pain, depression,
diabetes, heartdisease, high bloodpressure, flu, neuromuscular diseases, and osteoporosis. However, there have been no definitive clinical trials.

injection is a shot given in large muscle groups, typically shoulder (deltoid), thigh (vastus lateralis) and/or butt (gluteus). Vitamin d is a vitamin which is a kind of nutritional agent (nutritional or metabolic agent).

The IOM’s safe upper limit for daily vitamin D intake is 4,000 IU. A person who ingests too much vitamin D may feel nauseated, weak and lose their appetite. Getting 10,000 to 40,000 IU of vitamin D in a day could lead to acute toxicity. Accurate dosage is 1ml which is 5mg every 4 weeks