Vitamin B12 + Elemental Iron + Folic Acid

• Treatment and prevention of nutritional anemias caused by deficiencies of vitamin B12, iron, and folic acid.
• Vitamin B12 deficiency anemia (including pernicious anemia and dietary deficiency).
• Iron deficiency anemia due to blood loss, malnutrition, pregnancy, or chronic diseases.
• Folic acid deficiency anemia and prevention of neural tube defects during pregnancy.
• Supportive therapy in malabsorption syndromes, chronic blood loss, post-surgical recovery, and chemotherapy-induced anemia.
• Off-label: General fatigue and weakness related to combined vitamin and mineral deficiencies.

• Adults:
• Vitamin B12: 1000 mcg daily orally or 1000 mcg intramuscularly monthly after initial correction.
• Elemental Iron: 60–120 mg daily divided into 2-3 doses.
• Folic Acid: 400–1000 mcg orally once daily.
• Pregnant women:
• Iron: 30–60 mg elemental iron daily.
• Folic Acid: 400–800 mcg daily (higher doses for high-risk pregnancies).
• Vitamin B12 as per clinical need.
• Pediatrics: Dosage adjusted based on age, weight, and severity of deficiency; typically 3–6 mg/kg/day of elemental iron.
• Elderly: Standard adult dosing with monitoring; dose adjustments as needed for renal/hepatic impairment.
• Administration:
• Oral preferred for maintenance and mild deficiency.
• Vitamin B12 parenteral injections for severe deficiency or malabsorption.
• Iron taken on empty stomach for better absorption but may be taken with food to reduce GI upset.
• Avoid concomitant calcium or antacids with iron.
• Duration: Until anemia correction; maintenance dosing as recommended.

Vitamin B12 functions as a coenzyme essential for DNA synthesis and neurological function by facilitating the conversion of homocysteine to methionine and methylmalonyl-CoA to succinyl-CoA, critical for myelin production and red blood cell formation. Elemental iron is a vital component of hemoglobin and myoglobin, enabling oxygen transport and storage. Folic acid acts as a methyl donor in nucleotide synthesis necessary for DNA replication and cell division. Together, these agents restore effective erythropoiesis and correct macrocytic and microcytic anemias by replenishing deficient cofactors.

• Absorption:
• Vitamin B12 absorption requires intrinsic factor in the terminal ileum; high oral doses allow passive absorption.
• Iron is absorbed primarily in the duodenum and upper jejunum via active transport.
• Folic acid is absorbed in the proximal small intestine.
• Distribution:
• Vitamin B12 is stored mainly in the liver.
• Iron circulates bound to transferrin and is stored as ferritin.
• Folic acid is distributed to tissues including liver and bone marrow.
• Metabolism:
• Vitamin B12 converted intracellularly to active forms (methylcobalamin, adenosylcobalamin).
• Iron incorporated into hemoglobin or stored.
• Folic acid metabolized to tetrahydrofolate derivatives.
• Excretion:
• Vitamin B12 eliminated via bile with enterohepatic recirculation.
• Iron lost through sloughing of intestinal mucosa and blood loss.
• Folic acid excreted mainly in urine.
• Half-life:
• Vitamin B12: weeks (due to storage).
• Folic acid: approximately 3–4 hours.

• Vitamin B12, iron, and folic acid are considered safe and essential during pregnancy and lactation.
• Recommended for prevention of maternal anemia and fetal neural tube defects.
• Secreted in breast milk; safe for breastfeeding infants.
• Caution advised in case of excessive iron intake due to gastrointestinal discomfort.

• Hematinics and Nutritional Supplements
• Vitamin B12: Water-soluble vitamin (cobalamin)
• Iron: Mineral supplement
• Folic Acid: Water-soluble vitamin (B9)

• Hypersensitivity to any component (vitamin B12, iron, folic acid)
• Hemochromatosis or iron overload disorders
• Unexplained anemia without proper diagnosis
• Severe liver dysfunction precluding iron use

• Monitor for iron overload during prolonged therapy.
• Differentiate vitamin B12 deficiency from folate deficiency to avoid masking neurological symptoms.
• Use caution in infections due to possible iron promotion of bacterial growth.
• Monitor hematologic parameters regularly.
• Discontinue if hypersensitivity reactions occur.

• Common:
• Gastrointestinal upset (nausea, constipation, diarrhea) mainly due to iron.
• Injection site reactions with vitamin B12 IM injections.
• Mild allergic skin reactions.
• Serious (rare):
• Anaphylaxis with parenteral vitamin B12.
• Iron toxicity or overload.
• Peripheral neuropathy if vitamin B12 deficiency untreated.

• Iron absorption decreased by antacids, calcium, tetracyclines, and proton pump inhibitors.
• Vitamin B12 absorption reduced by metformin, proton pump inhibitors, and H2 blockers.
• Folic acid may mask vitamin B12 deficiency symptoms.
• Vitamin C enhances iron absorption.
• No significant CYP450 interactions.

• Emphasis on folic acid supplementation during pregnancy to prevent neural tube defects by WHO and CDC.
• Increased screening and treatment of vitamin B12 deficiency in at-risk populations recommended.
• Iron dosing protocols updated to balance efficacy and minimize side effects.
• Combined supplementation supported for mixed anemia treatment.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture, heat, and light.
• Keep oral forms in tightly closed containers.
• Injectable vitamin B12 protected from freezing and excessive heat.
• Keep out of reach of children.