Sublingual spray treatment of vitamin B12 deficiency in children
More details
Hide details
Ambulatory Pediatric Clinic, Ankara, TURKEY
Department of Social Paediatrics, Faculty of Medicine, Gazi University, Ankara, TURKEY
Publication date: 2022-03-23
Electron J Gen Med 2022;19(4):em382
Vitamin B12 deficiency can lead to serious health problems both in children and adult. Intramuscular injection therapy is applied as the gold standard in the treatment of vitamin B12 deficiency. There are also oral, nasal, and sublingual spray treatment methods. In this study, we aimed to show the efficacy of sublingual spray treatment of vitamin B12 deficiency in children.

Material and Methods:
Forty-five pediatric patients (25 boys, 20 girls), aged 9-36 months with serum cobalamin concentrations less than 200 pg/mL, were treated with sublingual vitamin B12 (methylcobalamin) spray. All patients were treated for four months by giving 500 μg oral spray daily for the first week, every other day for the next one week, two days a week for the next two weeks and then once a week for four months. Vitamin B12 levels were checked after four months.

Post-treatment vitamin B12 values were significantly higher than pre-treatment values (p<0.001). Vitamin B12 levels increased from 161.58±32.98 pg/mL to 427.44±148.58 pg/mL. After the treatment, the vitamin B12 level of all patients was found to be >200 pg/mL, except for only two patients. Vitamin B12 levels returned to normal in 96% of the patients with a sublingual spray treatment.

Data from this study indicate that sublingual vitamin B12(methylcobalamin) spray (500μg) for four months is effective for treatment of children with vitamin B12 deficiency. Sublingual spray that is easier and more practical to use can be preferred for children with vitamin B12 deficiency instead of parenteral and oral vitamin B12 therapy.

Chandra J, Jain V, Narayan S, et al. Folate and cobalamin deficiency in megaloblastic anemia in children. Indian Pediatr. 2002;39(5):453-7. PMid:12037276.
Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-60. https://doi.org/10.1056/NEJMcp... PMid:23301732.
Narang N, Sharma J. Sublingual mucosa as a route for systemic drug delivery. Int J Pharm Pharm Sci. 2011;3(Suppl 2):18-22.
Erduran E. Treatment of nutritional vitamin B12 deficiency. Turkish Pediatric Hematology Society. 2015;30-31.
de Benoist B. Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. Food Nutr Bull. 2008;29 (2 Suppl):S238-44. https://doi.org/10.1177/156482... PMid:18709899.
Sanz-Cuesta T, Escortell-Mayor E, Cura-Gonzalez I, et al. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: A pragmatic, randomised, multicentre, non-inferiority clinical trial (OB12). BMC Open. 2020;10:e033687. https://doi.org/10.1186/1471-2... PMid:32819927 PMCid:PMC7440823.
Castelli MC, Friedman K, Sherry J, et al. Comparing the efficacy and tolerability of a new daily oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low cobalamin levels: A randomized, open-label, parallel-group study. Clin Ther. 2011;33(3):358-71. https://doi.org/10.1016/j.clin... PMid:21600388.
Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular cobalamin treatment in megaloblastic anemia: A single-center, prospective, randomized, open-label study. Clin Ther. 2003;25(12):3124-34. https://doi.org/10.1016/s0149-... PMid:14749150.
Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998;92(4):1191-8. https://doi.org/10.1182/blood.... PMid:9694707.
Nyholm E, Turpin P, Swain D, et al. Oral vitamin B12 can change our practice. Postgrad Med J. 2003;79(930):218-20. https://doi.org/10.1136/pmj.79... PMid:12743340 PMCid:PMC1742688.
Butler CC, Vidal-Alaball J, Cannings-John R, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: A systematic review of randomized controlled trials. Fam Pract. 2006;23(3):279-85. https://doi.org/10.1093/fampra... PMid:16585128.
Vidal-Alaball J, Butler C, Cannings-John R, et al. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2005;3:CD004655. https://doi.org/10.1002/146518... PMid:16034940 PMCid:PMC5112015.
Bahadir A, Gokce Reis P, Erduran E. Oral vitamin B12 treatment is effective for children with nutritional vitamin B12 deficiency. J Paediatr Child Health. 2014;50(9):721-5. https://doi.org/10.1111/jpc.12... PMid:24944005.
Sezer RG, Akoglu HA, Bozaykut A, Ozdemir GN. Comparison of the efficacy of parenteral and oral treatment for nutritional vitamin B12 deficiency in children. Hematology. 2018;23(9):653-7. https://doi.org/10.1080/102453... PMid:29577819.
Estourgie-van Burk GF, van der Kuy PHM, de Meij TG, Benninga MA, Kneepkens CMF. Intranasal treatment of vitamin B12 deficiency in children. Eur J Pediatr. 2020;179(2):349-52. https://doi.org/10.1007/s00431... PMid:31758311.
Journals System - logo
Scroll to top