Not really an answer to your question; instead an answer to a different question: is IM therapy needed? Several studies showing oral therapy to be effective:

Brody EA, Estren S, Wasserman LR. Treatment of pernicious anemia by oral administration of vitamin B12 without added intrinsic factor. N Engl J Med 1959;260:361-7.

Berlin H, Berlin R, Brante G. Oral treatment of pernicious anemia with high doses of vitamin B12 without intrinsic factor. Acta Med Scand 1968;184:247-58.

McIntyre PA, Hahn R, Masters JM, Krevans JR. Treatment of pernicious anemia with orally administered cyanocobalamin (vitamin B12). Arch Intern Med 1960;106:280-92.

Waife SO, Jansen CJ, Crabtree RE, Grinnan EL, Fouts PJ. Oral vitamin B12 without intrinsic factor in the treatment of pernicious anemia. Ann Intern Med 1963;58:810-7.

One study demonstrating its cost-effectiveness:

van Walraven C, Austin P, Naylor CD. Vitamin B12 injections versus oral supplements. How much mony could be saved by switching from injections to pills? Can Fam Physician 2001;47:79-86

Allen F. Shaughnessy, PharmD
Director of Research
Associate Residency Director
Harrisburg Family Practice Residency
Harrisburg, PA 17101

-----Original Message-----
From: Jon Brassey [mailto:[log in to unmask]]
Sent: Friday, August 17, 2001 10:25 AM
To: [log in to unmask]
Subject: Pernicious Anaemia (PA) and Frequency of B12 Injections

I've been asked by a number of clinicians about the frequency of B12 injections in patients with PA.  The current UK consensus appears to be injections every 3 months.  However, I've found one guideline (Canadian) that states every month.

I hear the usual story from the clinicians - "we give injections every 3 months but the patients come back before 3 months is up asking for new injections".

I've looked at the literature and can find very little 'evidence' to support either position.  I suppose a couple of questions:

1)  Anyone got any 'evidence'?

2)  Has anyone else come across this problem?

I hope you can help - it's starting to 'bug' me!

jon

Jon Brassey
TRIP, Support Manager
Director, ATTRACT Wales
http://www.tripdatabase.com
Phone: 01495 765105
Mamhilad House,
Mamhilad Park Estate
Pontypool NP4 0YP
Wales

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