Dawaa Reference

Clinical reference

Vitamin B12 Deficiency Anaemia

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here. · BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014

Verified against2 documents
  • BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here.
  • BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Red flags (2)

  • Left untreated the neurological damage becomes severe and disabling, and may not fully recover
  • Do not give folic acid with, or instead of, B12 when B12 deficiency is suspected - folate masks the anaemia while the neurological damage continues

Symptoms — what the patient reports (4)

  • Fatigue and pallor from macrocytic anaemia are the usual presenting symptoms [anaemia · fatigue · pallor]
  • Jaundice can be a presenting symptom, from the increased haemolysis of poorly formed red cells [haemolysis · jaundice]
  • Other presenting complaints are peripheral neuropathy, glossitis, diarrhoea, headache and neuropsychiatric disturbance [diarrhoea · headache]
  • Ask about gastrectomy, gastric bypass or ileal resection, Crohn or coeliac disease, and a strict vegan diet kept for about 3 years

Signs — what you find (2)

  • A full neurological examination should look for dementia, peripheral neuropathy, unsteadiness and loss of proprioception [unsteadiness]
  • Subacute combined degeneration affects the dorsal columns, the lateral corticospinal tracts and the spinocerebellar tracts

Tests (7)

  • Start with a full blood count and film, plus serum B12 and serum folate together
  • Serum B12 above 300 pg/mL is normal, 200 to 300 borderline, below 200 deficient
  • MCV above 100 with a fall in haemoglobin and haematocrit; the film shows hypersegmented neutrophils with 5 or more lobes
  • For a borderline B12, methylmalonic acid and homocysteine are both raised in B12 deficiency
  • In folate deficiency homocysteine rises but methylmalonic acid stays normal - that is how the two separate
  • Anti-intrinsic-factor antibodies diagnose pernicious anaemia once surgical, gastrointestinal and dietary causes are excluded
  • A low serum B12 does not name the cause; the cause still has to be worked out

If not this — what else fits (4)

  • Folate deficiency also gives a macrocytic anaemia and is the commonest confusion
  • Lead toxicity, syphilis, HIV myelopathy and multiple sclerosis
  • Causes: pernicious anaemia, gastrectomy or gastric bypass, ileal resection, Crohn, coeliac, Diphyllobothrium latum, strict vegan diet, metformin, nitrous oxide
  • Among patients with an MCV over 100, 18% to 20% are due to B12 deficiency

SourceStatPearls "Vitamin B12 Deficiency" (NBK441923) - disease-level clinical article; the folate-masking warning is from StatPearls "Vitamin B12 (Cobalamin)" (NBK559132)

Presentation findings are traced to the source above.

1

HYDROXOCOBALAMIN

1st line

Strength1 mg

Forminjection

Adult dose and duration

1 mg IM 3 times a week for 2 weeks (without neurological symptoms), then 1 mg IM every 3 months for life - lifelong maintenance

Paediatric dose

1 mg IM on alternate days until improvement, then 1 mg IM every 2-3 months

Dose source

BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014 for the schedule, with the dose from Egyptian National Drug Formulary - Blood disorders 2025, hydroxocobalamin monograph (endf-blood-2025.txt): "Addisonian pernicious anemia and other macrocytic anemias with neurological involvement Initial: IM: 1 mg every other day for as long as there is improvement. Maintenance: IM: 1mg every 2 months." The formulary's maintenance interval is 2 to 3 months against the 3 months used here.

Why

Hydroxocobalamin given intramuscularly is the preferred formulation. The BSH 2014 guideline states it as practice rather than as a comparison: "Current clinical practice within the UK is to treat cobalamin deficiency with hydroxocobalamin in the intramuscular form."

Cautions
  • IF NEUROLOGICAL SYMPTOMS PRESENT (paresthesias, ataxia, subacute combined degeneration): Give 1 mg IM on alternate days until no further improvement, then 1 mg every 2 months.
  • There is a hypokalemia risk: monitor serum potassium during the initial phase of rapid reticulocytosis.
  • Check folate levels — giving folate alone in B12 deficiency precipitates severe irreversible subacute combined degeneration of spinal cord.
Egyptian brands
Egyptian brandManufacturerIndicative price
DEPOLVIX B12 1MG/ML 2 I.M. AMP.SIGMA TEC10.50 EGP
NEW ECAVIT B12 1MG/2ML 6 AMP. I.MEL NILE.19.50 EGP
B12 DEPOT 1000 MCG 5 AMP.ARAB DRUG COMPANY (ADCO)26.25 EGP
LONGAVIT B12 1MG/ML 3 AMP. FOR IM INJ.MEMPHIS36.00 EGP
DEPOVIT B12-1000MCG/ML 3 I.M. AMPS.AMRIYA51.00 EGP
COBALAMIN DEPOT 1000MCG/ML 5 I.M. AMP.PHAROPHARMA55.00 EGP
DEPOFORT B12 1MG/ML 5 AMP.PHARCO55.00 EGP
DEPOVIT B12-1000MCG/ML 5 I.M. AMPS.AMRIYA85.00 EGP
2

CYANOCOBALAMIN

2nd line

Strength1 mg

Formoral.solid

Adult dose and duration

1000-2000 mcg (1-2 mg) orally once daily - long-term

Paediatric dose

50-100 mcg daily orally for dietary deficiency

Dose source

BSH Guideline for Diagnosis and Treatment of Cobalamin and Folate Disorders 2014

Why

High-dose oral cyanocobalamin alternative for dietary B12 deficiency (vegans) or when IM injection is refused

Cautions
  • The oral route is unreliable in severe pernicious anaemia or ileal resection.
  • Requires compliance with high daily oral dose.
Egyptian brands
Egyptian brandManufacturerIndicative price
B12 SR 1000MCG 20 CAPS.INTERNATIONAL DRUG AGENCY (IDI) > NOVELL PHARMA30.00 EGP (1.50/unit)
LIPOSOM-B12 1000 MCG 20 SUBLINGUAL TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES60.00 EGP
DELTAVIT B12 - 1 MG 30 SUBLINGUAL TABS.DELTA PHARMA75.00 EGP
DEVART B12 1000 MCG 30 SUBLINGUAL TABSDEVARTLAB > BIOERA80.00 EGP
LIPOSOM-B12 1000 MCG 30 SUBLINGUAL TABS.HOCHSTER PHARMACEUTICAL INDUSTRIES90.00 EGP
JOVEMED B12 - 1000 MCG 30 SUBLINGUAL TABS.MEDIZEN PHARMACEUTICAL INDUSTRIES120.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.