Comparison of Sublingual and Intramuscular Administration of Vitamin B12 for the Treatment of Vitamin B12 Deficiency in Children

Abstract

Background: In most countries, contrary to some disadvantages, such as pain, relatively higher cost, and poor adherence to treatment, intramuscular (IM) route is still the primary treatment method for Vitamin B12 (VB12) deficiency. In recent years, because of these difficulties, new treatment methods are being sought for VB12 deficiency. Objectives: We aimed to compare sublingual (SL) and IM routes of VB12 administration in children with VB12 deficiency and to compare the efficacy of methylcobalamin and cyanocobalamin therapy in these children. Methods: This retrospective study comprised 129 patients with VB12 deficiency (serum Vitamin 12 level ≤ 200 pg/mL) aged 5-18 years. Based on the formulations of Vitamin 12, we divided the patients into three treatment groups as IM cyanocobalamin, SL cyanocobalamin, and SL methylcobalamin. Results: After Vitamin 12 therapy, serum Vitamin 12 levels increased significantly in all patients, and there was a statistically significant difference between the treatment groups (p < 0.05). Conclusions: SL cyanocobalamin and methylcobalamin were found as effective as IM cyanocobalamin for children with Vitamin 12 deficiency in correcting serum Vitamin 12 level and hematologic abnormalities.

Inherited and acquired vitamin B12 deficiencies: Which administration route to choose for supplementation?

“… Tuğba-Kartal and Çağla-Mutlu (2020) also demonstrated in a retrospective review of 129 paediatric patients that a treatment regimen of sublingual B12 (both CN-Cbl and methyl-Cbl) at 1 mg once daily for 7 days then every other day for 3 weeks was as effective as the same dose schedule of IM B12 at normalising serum B12 levels. Finally, a recent 2021 study performed in a paediatric population (0–3 years) in Turkey found that a sublingual methyl-Cbl treatment regimen, comprising 1 mg daily replacement for a week followed by every other day for 2 weeks, 2 days/week for 2 weeks and once a week for 3 months was as effective as similar dose schedules of IM and oral CN-Cbl at normalising B12 levels ( Orhan Kiliç et al, 2021 ).…”

Consensus of the Brazilian Association of Nutrology on diagnosis, prophylaxis, and treatment of vitamin B12 deficiency

“…Replacement via IM is the most traditional choice for treating vitamin B 12 deficiency, in cases of inadequate dietary intake, pernicious anemia, gastrectomy, ileal resection or other malabsorption syndrome [68]. Its advantages are the effectiveness of the dose and the fact that it does not undergo changes in the effect of passing through the intestinal absorptive pathways.…”

Vitamin B12 in Foods, Food Supplements, and Medicines—A Review of Its Role and Properties with a Focus on Its Stability

“…In addition to intramuscular and oral vitamin B 12 administration, new routes, such as sublingual and nasal administration, have recently become available. In addition to the obvious advantages over the oral and intramuscular routes (patient convenience and good adherence, safety, cost-effectiveness), sublingual and nasal treatments also provide a promising alternative for specific populations (infants, children, and the elderly) and patients with some specific conditions (swallowing disorders or malabsorption due to intestinal surgery, inflammatory intestinal diseases, or short bowel syndrome), for which oral and intramuscular routes are less appropriate [60,63,76,77]. Their efficacy has been extensively evaluated in recent years and has been demonstrated to be comparable to those of oral or intramuscular vitamin B 12 administration.…”