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B12 deficiency Vitamin B12 is water-soluble and is naturally found in some foods, such as meat, fish, and dairy products

Parenteral cyanocobalamin (J3420) or hydroxocobalamin administration receives favourable coverage because intrinsic factor deficiency prevents oral absorption

In blood plasma, it binds to proteins by 50-80%, is metabolized in the liver, and excreted after 4-5 hours by the kidneys, mainly in the form of metabolites

61 In practice, some patients may be able to switch to very high dose (ie, 2000 mcg daily) oral supplementation instead of continuing parenteral administration, but it is impossible to predict in whom this can be done safely, and many are at risk of worsening symptoms which may become permanent

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