Anaemia, vitamin B12 or folate deficiency - Treatment 

Treating vitamin B12 or folate deficiency anaemia 

The treatment for vitamin B12 or folate deficiency anaemia will depend on what is causing the condition.

Different treatments are outlined below.

Vitamin B12 deficiency anaemia

Vitamin B12 deficiency anaemia is usually treated with injections of vitamin B12. The vitamin is in the form of a substance known as hydroxocobalamin.

At first you will have injections every other day for two weeks, or until your symptoms have stopped improving. Your GP or nurse will give you the injections.

After the initial treatment, your dosage will depend on whether the cause of your vitamin B12 deficiency is related to your diet or not. The most common cause of vitamin B12 deficiency is pernicious anaemia.

Read more about the causes of vitamin B12 or folate deficiency.

Diet related

If your vitamin B12 deficiency is caused by a lack of the vitamin in your diet, you may be prescribed vitamin B12 tablets to take every day between meals. Alternatively, you may need to have an injection of hydroxocobalamin twice a year.

People who find it difficult to get enough vitamin B12 in their diets, such as vegans (people whose diet only contains food from plants), may need vitamin B12 tablets for life. People with vitamin B12 deficiency caused by a poor diet over a long period of time may have their tablets stopped by their GP once their vitamin B12 levels have returned to normal and their diet has improved. However, it is rarer for a non-vegan to experience vitamin B12 deficiency.

Good sources of vitamin B12 include:

  • meat
  • salmon
  • milk
  • eggs

If you are a vegetarian or vegan, or are looking for alternatives to meat and dairy products, there are other foods that contain vitamin B12, such as:

  • some fortified breakfast cereals
  • some soy products

You can check the nutritional labels of these foods to see how much vitamin B12 they contain.

Read more information about good sources of B vitamins and folates.

Not diet related

If your vitamin B12 deficiency is not caused by a lack of vitamin B12 in your diet, you will usually need to have an injection of hydroxocobalamin every three months for the rest of your life.

If you have had neurological symptoms (symptoms that affect your nervous system, such as an altered sense of touch) because of vitamin B12 deficiency, you will be referred to a haematologist (a doctor who specialises in blood conditions). You may need to have injections every two months. Your haematologist will advise on how long you need to keep taking the injections.

If you need replacement injections of vitamin B12, hydroxocobalamin is preferred to cyanocobalamin in the UK. This is because hydroxocobalamin stays in the body longer.

If you need regular injections of vitamin B12, cyanocobalamin will need to be given once a month, while hydroxocobalamin can be given every three months.

As a result of this, cyanocobalamin injections are not recommended and not routinely available on the NHS. However, if you need replacement tablets of vitamin B12, these will be cyanocobalamin.

Read more about hydroxocobalamin and cyanocobalamin.

Folate deficiency anaemia

To treat folate deficiency anaemia, your GP will usually prescribe daily folic acid tablets to build up your folate levels. They may also give you dietary advice so you can increase your folate intake.

Most people will need to take folic acid tablets for about four months. However, if the underlying cause of your folate deficiency anaemia is persistent, you may have to take folic acid tablets for longer, and maybe for life.

Before you start taking folic acid, your GP will check your vitamin B12 levels to make sure they are normal. This is because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying vitamin B12 deficiency. If a vitamin B12 deficiency is not detected and treated, it could affect your nervous system (brain, nerves and spinal cord).

Monitoring your condition

To ensure your treatment is working, your vitamin B12 or folate levels will need to be closely monitored.

Around 10 days after starting treatment, you will need a blood test to check your vitamin B12 or folate levels are starting to rise. You will need  another blood test after approximately eight weeks to confirm your treatment has been successful.

If you have been taking folic acid tablets, you may be tested again once the treatment has finished (usually after four months).

Most people who have had a vitamin B12 or folate deficiency will not need further monitoring unless their symptoms return, or their treatment is ineffective. If your GP feels it is necessary, you may have to return for an annual blood test to see whether your condition has returned.

Page last reviewed: 31/05/2012

Next review due: 31/05/2014

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