2024-11-05 16:01:00
05 November 2024
Some patients can only benefit from vitamin B12 by intramuscular injection. In view of the current shortage, the ANSM therefore asks patients who can to do so to favor vitamin B12 tablets. Objective: to maintain treatment for those who suffer from serious problems with the absorption of this essential vitamin in the body.
The National Medicines Safety Agency is warning of a shortage of vitamin B12 in injectable and oral solution in city pharmacies, a situation which is expected to last until the beginning of 2025. Therefore, it recommends using vitamin B12 in tablets if possible in order to reserve injectable solutions from the Zentiva and Substipharm laboratories for patients who need to be treated intramuscularly. “This will allow patients who require intramuscular vitamin B12 injections to continue their treatment. The absence of this treatment can lead to a serious risk of anemia in these patients, leading to hospitalization, transfusion and life-threatening consequences. explains the ANSM.
Why is vitamin B12 essential to our body?
Vitamin B12, bright red in color, contains cobalt, hence its other name colobamine. It is necessary for the formation and maturation of red blood cells, as well as for the synthesis of DNA, the genetic material of cells. It is also important for nerve function. In food, it is only found in foods of animal origin.
A vitamin B12 deficiency leads to anemia responsible for many symptoms including fatigue, extreme paleness, weakness, shortness of breath and dizziness in severe cases. Severe deficiency can cause nerve damage, tingling or loss of sensation in the extremities, muscle weakness, loss of reflexes, motor difficulties, confusion and dementia.
In which cases should vitamin B12 (cyanocobalamin) be administered by intramuscular injection?
Vitamin B12 deficiency can be linked to an inadequate diet, especially as part of a strict vegan or vegetarian diet. Indeed, the main sources of vitamin B12 are mainly of animal origin: meat, fish, milk. For vegans, oral intake is possible. Just like in Crohn’s disease, celiac disease, certain bariatric surgeries, HIV…
Other patients can only benefit from vitamin B12 by intramuscular injection. These present “serious absorption problems”. Normally, this vitamin is easily absorbed in the last part of the small intestine, leading to the large intestine. But it must be linked to a protein produced in the stomach, called intrinsic factor, to achieve this. Otherwise, the vitamin progresses through the intestine and is excreted in the feces.
Among the causes, we find:
Biermer’s disease: also called pernicious anemia, this is a chronic autoimmune disease that affects the stomach. The immune system attacks the cells in the stomach wall, responsible for the production of the protein called intrinsic factor, which is essential for the absorption of vitamin B12 in the intestine.
A total gastrectomy: Gastrectomy is the surgical removal of the stomach. It is practiced in particular to treat cancer which has spread to the entire stomach or two thirds. Deprived of a stomach, the body no longer produces the intrinsic factor necessary for the absorption of vitamin B12. Supplementation, by intramuscular injection, is then essential for life.
Terminal ileum resection: the ileum is the site of absorption of vitamin B12 by the small intestine. Depending on the size of the intestine removed, short bowel syndrome may occur, the intestine may then lose its vitamin B12 absorption function, injections are then essential.
Imserlund’s disease due to Imerslund-Grasbeck syndrome: or selective cobalamin (vitamin B12) malabsorption is characterized by a vitamin B12 deficiency, a disorder that appears in childhood.
Source: ANSM, MSD Manual, Inca
Written by: Dorothée Duchemin – Edited by Emmanuel Ducreuzet
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**Interview: The Importance of Vitamin B12 and Recent Shortages**
**Host:** Today, we have Dr. Sarah Thompson, a nutrition expert and gastroenterologist, with us to discuss the importance of Vitamin B12, its role in our health, and the current supply challenges we’re facing. Welcome, Dr. Thompson!
**Dr. Thompson:** Thank you for having me! It’s great to be here.
**Host:** Recently, the National Medicines Safety Agency in France announced a shortage of injectable Vitamin B12, suggesting that patients who are able to should switch to oral tablets. Can you explain why this shortage is concerning?
**Dr. Thompson:** Absolutely. Vitamin B12 is crucial for several bodily functions, including the formation of red blood cells and maintaining healthy nerve function. For patients with severe absorption issues—like those suffering from Biermer’s disease or certain gastrointestinal disorders—intramuscular injections are essential. Without this treatment, they risk serious conditions like anemia, which can lead to hospitalization.
**Host:** The agency is recommending that oral tablets be used where possible. Is there evidence that high-dose oral B12 can be as effective as injections?
**Dr. Thompson:** Yes, several studies, including a significant one from 2006, demonstrated that high-dose oral B12 can be as effective as intramuscular injections for achieving neurologic and hematologic response in many patients. However, it’s critical to note that this might not apply to everyone, especially those with serious absorption problems.
**Host:** So, what factors determine whether a patient should receive B12 orally or via injection?
**Dr. Thompson:** It typically comes down to the individual’s ability to absorb Vitamin B12. Those who can absorb the vitamin adequately through their intestines can often take it orally, especially if they have a good dietary intake or are supplementing correctly. However, those with conditions that impair absorption require injections to receive the necessary doses.
**Host:** With the current shortage expected to last until early 2025, what should patients do if they’re reliant on intramuscular injections?
**Dr. Thompson:** It’s crucial for those patients to communicate with their healthcare providers. They might need to explore options for securing their injectable B12 or discuss potential interim solutions. It’s also a good time for patients to review their diet and consider oral supplements if they’re able to absorb them.
**Host:** Should vegans and vegetarians be concerned about Vitamin B12 deficiency?
**Dr. Thompson:** Definitely. Since Vitamin B12 is primarily found in animal products, those following a strict vegan or vegetarian diet must be vigilant. They should consider fortified foods or oral supplements to ensure they’re getting enough of this vital nutrient.
**Host:** Thank you, Dr. Thompson, for shedding light on the importance of Vitamin B12 and the challenges we currently face. Your insights will certainly help many navigate these issues.
**Dr. Thompson:** Thank you for having me! It’s important to spread awareness about this topic, especially during times of shortage.
**Host:** And thank you to our listeners for tuning in. Stay informed and take care of your health!
