Injectable medicines commonly used in primary care during COVID-19: Vitamin B12

This page summarises the advice of the British Society for Haematology on the administration of hydroxocobalamin (vitamin B12) injections during COVID-19 for patients already established on therapy.

Advice on other injectable medicines commonly used in primary care is available here.

Non-dietary vitamin B12 deficiency (such as pernicious anaemia etc.)

Normal administration: administer hydroxocobalamin 1 mg intramuscularly every 2–3 months for life

During the COVID-19 pandemic, options include:

  • Alternatives to attending the GP surgery such as local pharmacies or home administration by district nurses should be explored
  • Oral cyanocobalamin can be offered at a dose of 1 mg per day until regular IM hydroxocobalamin can be resumed

Dietary Vitamin B12 deficiency

Normal administration: NICE CKS advise people either to take oral cyanocobalamin tablets 50–150 micrograms daily between meals or have a twice-yearly hydroxocobalamin 1 mg injection. In vegans, treatment may need to be life-long, whereas in other people with dietary deficiency replacement treatment can be stopped once the vitamin B12 levels have been corrected and the diet has improved.

During the COVID-19 pandemic, options include:

  • Replace IM hydroxocobalamin injection with cyanocobalamin tablets, 50–150 micrograms, daily between meals. The British Society for Haematology recommend reassessing serum B12 prior to recommencing IM hydroxocobalamin.
  • Many of these patients may be vitamin B12 replete with adequate levels within the liver, and therefore may be able to safely stop taking vitamin B12 supplements possibly for up to a year
  • Dietary advice should be given to all patients
  • Patients on vegetarian and especially vegan diets should continue taking oral supplements

Patients should be advised to monitor their symptoms and should contact their GP if they begin to experience neurological or neuropsychiatric symptoms such as pins and needles, numbness, problem with memory or concentration or irritability

For more information on what oral vitamin B12 (cyanocobalamin) preparations are available and associated prescribing considerations click here.