Condition

Vitamin B12 Deficiency

Deficiency causing anemia and neurological problems

800M
People Affected
100
Active Trials
80M
New Cases/Year
5,000
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Intramuscular Cobalamin (Cyanocobalamin/Hydroxocobalamin)
99% Effectiveness• 98% Confidence• 85% Safety• 9 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 1000 mcg IM daily/EOD for 1-2 weeks, then 1000 mcg IM monthly
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
85
DangerousModerateSafe

Time to Effect

Hematologic: 2-3 days; Symptomatic: 1-2 weeks; Neurological: Weeks to months

Duration

Initial loading then lifetime maintenance

Response Rate

99%

Remission Rate

95%

Common Side Effects:

Injection site pain/redness/swelling: 15%
Itching, mild diarrhea: 3%
Allergic reactions (anaphylaxis): 0.05%

Annual Cost of Care

Drug Cost

$100

Monitoring

$150

Side Effects

$10

Total Annual

$260

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.9

Cost per Remission

$273.68

Cost per Responder

$262.63

Treatment Outcomes
Primary Outcomes
Serum Vitamin B12 Levels80 pg/mL
+525% (+420 pg/mL)
Mean Corpuscular Volume (MCV)115 fL
-15.65% (-18 fL)
Hemoglobin (Hb) Levels9.5 g/dL
+36.84% (+3.5 g/dL)
Methylmalonic Acid (MMA) Levels800 nmol/L
-68.75% (-550 nmol/L)
Secondary Benefits
Fatigue (FACIT-Fatigue Scale)FACIT-Fatigue score: 25/52
+60% (+15 points)
Neuropathic Symptoms (Visual Analog Scale for Paresthesia)VAS for paresthesia: 7/10
-57.14% (-4 points)
Homocysteine Levels25 µmol/L
-48% (-12 µmol/L)
Common Side Effects
Injection site pain/redness/swelling
+15%
Itching, mild diarrhea
+3%
Allergic reactions (anaphylaxis)
+0.05%

Clinical Trial Phases:

Phase 4
2
Oral Cobalamin (Cyanocobalamin/Methylcobalamin)
98% Effectiveness• 95% Confidence• 90% Safety• 11 trials• 10K participants
HIGH EvidenceExcellent ValueDose: 1000-2000 mcg daily initially, then 1000 mcg daily for maintenance
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

Hematologic: 5-7 days; Symptomatic: 1-4 weeks; Neurological: Weeks to months

Duration

Lifetime for chronic deficiency

Response Rate

98%

Remission Rate

90%

Common Side Effects:

Diarrhea/mild GI upset (at very high doses): 1.5%
Allergic reactions: 0.05%

Annual Cost of Care

Drug Cost

$30

Monitoring

$100

Side Effects

$5

Total Annual

$135

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

Cost per Remission

$150

Cost per Responder

$137.76

Treatment Outcomes
Primary Outcomes
Serum Cobalamin150 pg/mL
+200% (+300 pg/mL)
Serum Methylmalonic Acid (MMA)800 nmol/L
-62.5% (-500 nmol/L)
Serum Homocysteine25 µmol/L
-40% (-10 µmol/L)
Mean Corpuscular Volume (MCV)110 fL
-9.1% (-10 fL)
Neuropathy Symptom Score (e.g., MNSI)10/30 points (MNSI)
-40% (-4 points)
Secondary Benefits
Fatigue Severity Score (FSS)5.5/7 points
-30% (-1.65 points)
Cognitive Function Score (MoCA)24/30 points
+12.5% (+3 points)
Hemoglobin10.0 g/dL
+20% (+2.0 g/dL)
Common Side Effects
Diarrhea/mild GI upset (at very high doses)
+1.5%
Allergic reactions
+0.05%

Clinical Trial Phases:

Phase 4
3
Sublingual Cobalamin (Cyanocobalamin/Methylcobalamin)
97% Effectiveness• 90% Confidence• 90% Safety• 2 trials• 5K participants
MODERATE TO HIGH EvidenceExcellent ValueDose: 1000-2000 mcg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
90
DangerousModerateSafe

Time to Effect

Hematologic: 5-7 days; Symptomatic: 1-4 weeks; Neurological: Weeks to months

Duration

Lifetime for chronic deficiency

Response Rate

97%

Remission Rate

90%

Common Side Effects:

Mild GI upset: 1%
Allergic reactions: 0.05%

Annual Cost of Care

Drug Cost

$50

Monitoring

$100

Side Effects

$5

Total Annual

$155

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.8

Cost per Remission

$172.22

Cost per Responder

$159.79

Treatment Outcomes
Primary Outcomes
Serum Vitamin B12 Levels150 pg/mL
+200% (+300 pg/mL)
Methylmalonic Acid (MMA) Levels0.75 umol/L
-50% (-0.375 umol/L)
Homocysteine Levels25 umol/L
-40% (-10 umol/L)
Hemoglobin Levels9.0 g/dL
+22.2% (+2.0 g/dL)
Neuropathy Symptom ScoreNeuropathy Symptom Score (0-10): 7
-42.8% (-3 points)
Secondary Benefits
Fatigue Severity ScoreFatigue Severity Scale (1-7): 5.5
-27.2% (-1.5 points)
Cognitive Function (MoCA score)MoCA score (0-30): 21
+14.2% (+3 points)
Depressive Symptoms (PHQ-9 score)PHQ-9 score (0-27): 15
-33.3% (-5 points)
Common Side Effects
Mild GI upset
+1%
Allergic reactions
+0.05%

Clinical Trial Phases:

Phase 4
4
Intranasal Cobalamin (Cyanocobalamin)
90% Effectiveness• 75% Confidence• 80% Safety• 20 trials• 1K participants
MODERATE EvidenceExcellent ValueDose: 500 mcg once weekly
Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
80
DangerousModerateSafe

Time to Effect

Hematologic: 5-7 days; Symptomatic: 1-4 weeks

Duration

Lifetime for chronic deficiency (maintenance)

Response Rate

90%

Remission Rate

80%

Common Side Effects:

Rhinitis, nasal irritation, headache: 7%
Allergic reactions: 0.05%

Annual Cost of Care

Drug Cost

$500

Monitoring

$100

Side Effects

$20

Total Annual

$620

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.7

ICER

$5,000/QALY

Cost per Remission

$775

Cost per Responder

$688.89

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+90%
Response Rate
+90%
Remission Rate
+80%
Common Side Effects
Rhinitis, nasal irritation, headache
+7%
Allergic reactions
+0.05%

Clinical Trial Phases:

Phase 4