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Shortage of Vitamin B12 Injections Causes Consternation

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Q. I take vitamin B12 injections and cannot get the serum from my pharmacy. There is a nationwide shortage, but nobody seems to know why. Even my physician's office is unable to get the cyanocobalamin for injection. I have been on this medication for three years and don't know what I will do without it.

A. The vitamin B12 shortage is real and alarming. Some people cannot absorb this essential nutrient from their food because they lack stomach acid or intrinsic factor. They need supplementation.

Because this vitamin is crucial for nerve function, deficiency can contribute to numbness, tingling or pain of the toes, feet or fingers, trouble walking, memory problems, depression, confusion or burning tongue. Ask your doctor about nasal vitamin B12 (CaloMist, Nascobal) until the injectable form becomes available again.

For some people, high-dose vitamin B12 pills will overcome difficulties absorbing the vitamin and can be substituted for the injection, at least for a time. Ask your doctor whether this would work for you, and what dose you should take.

Many people may have an unsuspected vitamin B12 deficiency because they take a medication such as metformin or omeprazole that prevents absorption. Anyone who takes such a medication and begins to notice symptoms of deficiency should ask to be tested.

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I use the sublingual b12 and it works very well for me. It's convenient and easy to obtain.

Administration of Vitamin B12 is equally effective intramuscularly, orally and sublingually. It costs you and the health care system much more to get an injection of B12 in the office.

If you are uncertain whether the oral route will work for you, levels can drawn after several weeks.

"Discussion: Cobalamin is traditionally administered by intramuscular injections. However, it has recently been shown [9] that the sublingual route is equally effective. In this prospective study of 30 subjects with vitamin B12 deficiency, we found that sublingual and oral administration of 500 µg of cobalamin was equally effective in correcting cobalamin concentrations. "

From this article for more info:

Br J Clin Pharmacol. 2003 December; 56(6): 635–638.
doi: 10.1046/j.1365-2125.2003.01907.x)


How effective is liquid sublingual Vit B12? Isn't this absorbed better than B12 pills?

People's Pharmacy response: Sublingual Vitamin B12 is well absorbed.

The answer to your shortage question, is that there is a great deal of diabetics needing extra B-12. Thanks to Peoples Pharmacy, word is finally getting out about metformin causing the deficiency of B12 which causes the tingling/prickling in toes and feet of diabetics (not the diabetes itself but the medicine!), there can be a shortage of shots which is most effective.

Early on when I started getting the prickling, and my insurance wouldn't cover the shots because no one in the industry wants to admit that a long prescribed medicine can cause it, he suggested I go to Walgreens and get the sublingual Vitamin B-12. It comes in a liquid or small tablet form and it is put under the tongue so it goes directly into the blood stream. Metformin and perhaps the other drug you mentioned, blocks dietary absorption so taking it into the stomach does very little good. The liquid comes in B-Complex with B-12 or just B-12 and the tablet comes in a straight B-12.

Just be careful you get the tablet that is sugar free if you are diabetic or just go for the liquid. It doesn't taste as good as the tablet but is definitely sugar-free. Shout out to all Diabetics on metformin: Get your vitamin B-12 sublingually! (under the tongue!)

I use to take B-12 injections due to the fact that my intestines can not absorb it. A few yrs back it became available in sublingual form (meaning you put it under your tongue till it quickly melts and is absorbed into your system). I tried it and it worked great!

I use to have to give myself a shot once every 3-wks, which I didn't mind at all. What I didn't like was that it was costing me even with insurance $10 each time just for the cyanocobalamin.

The sublinqual works great for me and is a great deal cheaper! It's available just about everywhere, but I would suggest you try getting it from a reputable vitamin store to make sure your getting good quality tablets. I like GNC's, but there are many other reputable stores and sites. Hope this helps some!

Thank you Peoples Pharmacy for the reminder that the diabetes medication Metformin causes the need to take supplementary B12. I had forgotten this and have been having the symptoms you mention.

Missing information:
-Why is there a shortage?
-What needs to be done to alleviate the shortage?
-Is this medication available from foreign sources? Canada, Europe, etc.

People's Pharmacy response: The companies don't always tell why there is a shortage. Two firms supply this product in the U.S. One or both of them may have had manufacturing (possibly quality control?) problems. The other firm cites increased demand. As to why there might be increased demand, we have no idea. Perhaps it is because so many people are now taking PPIs for heartburn and these interfere with vitamin B12 absorption. Speculation!

What are symptoms of B12 deficiency?

Many people need injections rather than tablets (only 1% is absorbed).

There is a shortage of generic type (but not branded type) injections. This is put down to unspecified "production difficulties." pharmacies are apparently unaware that branded types of B12 injections are available. it is probable that the branded types cost more.

I used to get B12 injections from my doctor . . . at a cost of an office visit and equipment used.
Then, I requested to purchase the vial and syringe myself at a cost of pennies each month.
Now, the B12 injections aren't available - a nationwide shortage (they say). BUT, I CAN buy Nascobal SPR for $100 copay from my Caremark CVS pharmacy. Wow, could it be that the pharmaceutical companies aren't making the same kind of money with the old and THAT's why we have a nationwide shortage? I think so.

Info that I've gathered is that a plant producing B12 in Quebec has closed incurring this shortage. This morning after my B12 injection, I was told by my G.P. that B12 would be available this April, also some may be found at health spas.
My sister in law in Buffalo is also experiencing the same shortage in the U.S.A.! My G.P. had no explanation himself.

I live in Canada & have been getting B12 injections since 1996. I have Prenicious Anemia which is fatal if B12 can not be found. I have tried sublingual tablets & strips & they do not work for me. Please explain why if a drug is causing a possibly fatal condition that can be prevented by switching to another drug, why that is not done. This is taking away a supply of medication from people with my disease who can not live without it. The shortage of cyanocobalamine is not just in one country, it is definitely North American & possibly may effect more continents. Not only are the drugs mentioned possibly causing the demand for this product but vegetarians may also be increasing this demand as lack of meat can also bring on this defiency.

Knowing that these people can prevent their defiency but that I have no choice in the matter makes me FEEL like I am being cheated out of something that can save my life. Again this is just my opinion!!

Why is b12 injections and other life saving drugs not on the prescription list of Canada Health. Perhaps they have been bought off by marketing agencies promoting recreational use of drugs that should be distributed for life saving first?

I have been getting b12 shots regularly for about 10 years. I have never experienced an absence of this drug in all that time. My doctor told me it is not that difficult to make that there should be a shortage. As for diabetics needing this is there an epidemic? I am in my late sixties, with heart problems. I just missed my second monthly shot. Guess I know where I stand.

I need to have a B12 injections once a month since having gastric bypass surgery at Mayo clinic in 2009. I do my own injections if I can get the prescription filled due to the shortage. I have run to my primary doctor to get a shot when I couldn't fill my prescription because my pharmacy ran out. I recently went almost 3 month and felt so incredibly bad. I had severe fatigue, depression, couldn't sleep and many more problems. I sure wish they wouldn't contribute to the weight lose people and those who can live without instead of putting those who need it at risk.

My doctor suggested I try to purchase it in Canada, but the have none either. It's really sad when the patient can not get something as simple as B12 yet so important. I am worried sick that I won't be able to find it and have to spend the rest of my feeling so badly with chronic fatigue, depression, stress and a general feeling of not being well. I am begging the companies that have control over this problem to think about the well being of the medical patient to get it together and do the right thing PLEASE!!

Another part of the shortage issue stems from the fact that people who don't reall "need" B12 injections are cajoling their doctors into prescribing it for extra energy, weight loss, etc... In the April 2014 Glamour magazine there's an interview with ENews correspondent Jason Kennnedy, who said he goes in for weekly B12 injections as his "only vice." In some major cities it's becoming a popular thing, which infuriates me, as someone close to me needs B12 injections to live (she is a leukemia survivor).

I have had various health problems since my late 20s and I am now in my 70s. When I worked for a physician as a secretary for a number of years, he recommended B12 injections weekly. I give the injections myself in my thighs. I called my new doctor today to renew my B12 injection prescription and he said he was switching me to a B12 tablet that dissolves under the tongue as my blood work does not show that I am deficient in B12.

The question is if I am not deficient in B12, and he is not renewing my prescription, then why would he recommend the tablet to dissolve under my tongue? I have tried the B12 vitamin pills in the past (years ago) and they made me sick. The doctor tells me the new tables that dissolve under the tongue do not have that effect. I depend on the B12 injections to keep me feeling well,considering the problems I have, so am quite disturbed to have this new physician refuse my continued use after being on the shots for 40 plus years. What in the world is going on?

who's cage do I need to rattle to change this?

The demand for B12 has skyrocketed in the last few years. Leaving us with a shortage. The fact is we aren't just in a shortage because of "fad" use. I believe in this age the average person no longer getting what they are needing nutritionally. Poor diet, drugs and malabsorption make the average person B12 deficient. It will be a growing epidemic....

What I find is really sad is the cheap synthetic B12 this country uses that should have been banned. It's synthetic nature makes it a poor choice for health as it doesn't even address neurotically issues.

I think that it's a shame that this has happened, And I feel that Dr. Oz should stop telling people that they can lose weight by using B12 injection this is causing problems for people who really need it. Every time Dr. Oz tells people about these supplements the price goes up.

Could be that the drug companies or pharmacies are after more money? I've been giving myself B12 injections for years, due to a B12 deficiency and resultant neuropathy caused by partial gastrectomy for ulcers, which had cost me about $13 for a 30 ml (dose) bottle. No pharmacy in the area seems to be short of the 1 dose vials, for which they want between $8 and $13 each. Do the math...that's an 18-30 fold price increase if you're forced to use the single dose vials.

I have a 15 yo daughter with a severe B12 deficiency that is NOT resolved by taking OTC sublingual B12. Shame on pharmacies for actually thinking about the fact that they might not be making big profits on a medication that some people desperately need!

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