Drugs Driven Deficiency: Vitamin B12

by Mihaela Gruita, PharmD

The following drugs are documented to deplete Vitamin B12, which is an essential nutrient, mostly available from animal sources, that protects nerve and brain cells from free radical damage. If you have been taking any of these drug long term, chances are you are experiencing Vitamin B12 deficiency:

  • Antacids and Acid Blockers
  • Corticosteroids (inhalers, oral, and topical)
  • Multiple types of oral-dosed antibiotics (aminoglycosides, sulfa drugs, cephalosporins, macrolides, penicillin derivatives, quinolones and tetracycline derivatives)
  • Anti-convulsant medications
  • Metformin
  • Oral contraceptives
  • Potassium chloride
  • Cholesterol lowering medications (bile acid sequestrants)
  • Gout medications

Signs and symptoms that may indicate you have vitamin B12 deficiency are as follows:

  • You can barely stay awake in the afternoon—even if you slept 8 hours. (Oxygen Depletion)
  • That grocery bag feels like a million pounds. (Anemia)
  • You experience strange sensations. (Neuropathy)
  • You put your keys in the fridge. (Memory)
  • You feel wobbly or dizzy. (Oxygenation, Anemia)
  • Your skin looks pale (Anemia)
  • Your tongue is smooth and red. (Loss of Papillae..ie Taste Buds)
  • Every little thing makes you cry or worried. (Loss of Seratonin, Dopamine)
  • Something’s up with your eyes (Optic nerves)

Best sources of vitamin B12 are from animal products although some vegetables and grains might contain some.  Therefore, a supplement form might be necessary if you adhere to a vegan diet.  There are 4 types of Vitamin B12 supplements on the market:

  1. Cyanocobolamin – This synthetic version of vitamin B-12 is created in a lab, which makes it the cheapest supplement option. It offers the most stable form of B-12, although it does require the body to expend energy to excrete it. It also needs intrinsic factor to be absorbed. 
  2. Methylcobalamin is the active form of vitamin B12. It is considered by some as the best forms as it doesn’t need any extra steps for conversion, therefore it is directly used by the body. However, methycobolamin has the ability to latch on  to mercury forming methyl mercury which is toxic to the body.  Therefore, not a good option for people that have mercury toxicity.  Otherwise it is a good option as:
    • It helps protect the cardiovascular system.
    • Also offers overall protection to the nervous system because it can cross the blood-brain barrier–without assistance–to protect brain cells.
    • It key instrument for detoxification
  1. Hydroxocobalamin – Bacteria naturally creates this form of vitamin B-12, making it the main type found in most foods. It is absorbed in the gut regardless of one’s digestive competence.
    • It is recommended worldwide by the World Health Organization (WHO) as a drug of choice for the treatment of vitamin B12 deficiency.
    • It is commonly used as a treatment for cyanide poisoning from cigarette smoking because it is a very effective cyanide catcher.
    • It lasts longer than methylcobolamine (longer half life)
  1. Adenosylcobalamin – is the mitochondrial form of the B12 vitamin found in cellular tissues.
    • May be useful for those with impaired energy production.
    • It is the least stable of the four types of B-12 outside the human body, and does not translate well into a tablet-based supplement.
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