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.

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💧

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

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💧

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

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

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💧

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

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

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💧

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