Vitaminas B1, B6, B12 y Neuropatías Periféricas. Consenso de expertos.
Vitamins B1, B6, and B12 and Peripheral Neuropathies: International expert consensus
DOI:
https://doi.org/10.25176/RFMH.v24i1.6413Palabras clave:
Deficiencia vitamina B1, B6, B12, neuropatía periférica, consenso de expertosResumen
A partir de una revisión bibliográfica de la literatura se ha planeado y desarrollado un consenso de expertos internacionales sobre la utilización de las vitaminas B1, B6,B12 en sus déficits y en la neuropatía periférica que puede estar asociada a la misma, como tema que precia de esa aproximación aclaratoria para optimizar su manejo.
Se plantearon varias cuestiones de discusión que se consideraron importantes y dignas de ser abordadas y aclaradas, conservando nueve de ellas para su discusión ulterior buscando el consenso en tres rondas consecutivas.
Se han propuesto 41 recomendaciones sobre el manejo de estas condiciones, con unanimidad por parte de los participantes en el consenso. Con ellas se ha intentado aclarar puntos oscuros o controvertidos, facilitando la actitud del clínico ante ellos en la práctica médica actual.
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Stein J, Geisel J, Obeid R. Association between neuropathy and B-vitamins: A systematic review and meta-analysis. Eur J Neurol. 2021 Jun;28(6):2054-2064. doi: 10.1111/ene.14786.
Longa López JC, Dinamarca-Montecinos JL, Mejía-Rojas K, Bernaola Cuadros AC, Ampuero Bárcena JB, Palacio-Sánchez L, Fernandez-Fairen M. Vitaminas B1, B6, B12 y Neuropatías Periféricas. Revisión sistemática de la literatura. Rev Fac Med Hum. 2024; en prensa.
Ang CD, Alviar MJ, Dans AL, Bautista-Velez GG, Villaruz-Sulit MV, Tan JJ, Co HU, Bautista MR, Roxas AA. Vitamin B for treating peripheral neuropathy. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004573. doi: 10.1002/14651858.CD004573.pub3.
Chapman LE, Darling AL, Brown JE. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab. 2016 Nov;42(5):316-327. doi: 10.1016/j.diabet.2016.03.008.
Julian T, Syeed R, Glascow N, Angelopoulou E, Zis P. B12 as a Treatment for Peripheral Neuropathic Pain: A Systematic Review. Nutrients. 2020 Jul 25;12(8):2221. doi: 10.3390/nu12082221.
Liew J, Barlow A, Lim L-L, Suastika K, Yasahardja Y, Chan SP, Soh A, Li LS, Tan AT; 2244-PUB: Role of B Vitamins (B1, B6, B12) in Managing Diabetic Peripheral Neuropathy (DPN): A Systematic Review. Diabetes June 2019;68(Suppl.1):2244–PUB. https://doi.org/10.2337/db19-2244-PUB.
Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan. 2005 Jun;14(2):48-54. PMID: 16008162.
Calderón-Ospina CA, Palacios-Sánchez L, Nava-Mesa MO, Huertas-Quintero JA. Vitaminas B neurotrópicas y neuropatía periférica: estado del arte y acuerdo de expertos. Acta Neurol Colomb. 2023;39(4):1201. doi: 10.22379/anc.v39i4.1201.
Pinzon RT, Schellack N, Matawaran BJ, Tsang MW, Deerochanawong C, Hiew FL, Nafach J, Khadilkar S. Clinical Recommendations for the use of Neurotrophic B vitamins (B1, B6, B12) for the Management for Peripheral Neuropathy: Consensus from a Multidisciplinary Expert Panel. J Assoc Physicians India. 2023;71(7):93-98. doi: 10.59556/japi.71.0290.
Ziegler D, Tesfaye S, Spallone V, Gurieva I, Al Kaabi J, Mankovsky B, Martinka E, Radulian G, Nguyen KT, Stirban AO, Tankova T, Varkonyi T, Freeman R, Kempler P, Boulton AJ. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Res Clin Pract. 2022;186:109063. doi: 10.1016/j.diabres.2021.109063.
Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificación de la calidad de la evidencia y graduación de la fuerza de la recomendación. Cir Esp. 2014 Febrero;92(2):82-88. doi: 10.1016/j.ciresp.2013.08.002.
Cats-Baril W, Gehrke T, Huff K, Kendoff D, Maltenfort M, Parvizi J. International consensus on periprosthetic joint infection: description of the consensus process. Clin Orthop Relat Res. 2013 Dec;471(12):4065-75. doi: 10.1007/s11999-013-3329-4.
Devalia V, Hamilton MS, Molloy AM; British Committee for Standards in Haematology. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol. 2014 Aug;166(4):496-513. doi: 10.1111/bjh.12959.
Carmel R. Cobalamin (vitamin B12). In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2014:369-389.
Leishear K, Boudreau RM, Studenski SA, Ferrucci L, Rosano C, de Rekeneire N, Houston DK, Kritchevsky SB, Schwartz AV, Vinik AI, Hogervorst E, Yaffe K, Harris TB, Newman AB, Strotmeyer ES; Health, Aging and Body Composition Study. Relationship between vitamin B12 and sensory and motor peripheral nerve function in older adults. J Am Geriatr Soc. 2012 Jun;60(6):1057-63. doi: 10.1111/j.1532-5415.2012.03998.x.
Vargas-Uricoechea H, Nogueira JP, Pinzón-Fernández MV, Agredo-Delgado V, Vargas-Sierra HD. Population Status of Vitamin B12 Values in the General Population and in Individuals with Type 2 Diabetes, in Southwestern Colombia. Nutrients. 2023; 15(10):2357. https://doi.org/10.3390/nu15102357.
Dinamarca-Montecinos JL, Vásquez-Leiva A. Are older adults with hip fractures a specific risk group for vitamin B12 deficiency? JCSM Clinical Reports 2022;7:44-52. doi: 0.1002/crt2.48.
Langan RC, Goodbred AJ. Vitamin B12 Deficiency: Recognition and Management. Am Fam Physician. 2017 Sep 15;96(6):384-389. PMID: 28925645.
Hannibal L, Lysne V, Bjørke-Monsen AL, Behringer S, Grünert SC, Spiekerkoetter U, Jacobsen DW, Blom HJ. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci. 2016 Jun 27;3:27. doi: 10.3389/fmolb.2016.00027. Erratum in: Front Mol Biosci. 2017 Aug 08;4:53. PMID: 27446930; PMCID: PMC4921487.
Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev. 2018 Mar 15;3(3):CD004655. doi: 10.1002/14651858.CD004655.pub3. PMID: 29543316; PMCID: PMC6494183.
Vinik A. Diabetic sensory and motor neuropathy. N Enlg J Med. 2016; 374:1455-1464. doi; 10.1056/NEJMcp1503948.
Vollbracht C, Gündling PW, Kraft K, Friesecke I. Blood concentrations of vitamins B1, B6, B12, C and D and folate in palliative care patients: Results of a cross-sectional study. J Int Med Res. 2019 Dec;47(12):6192-6205. doi: 10.1177/0300060519875370.
Solomon LR. Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress. Eur J Clin Nutr. 2015 Jun;69(6):687-92. doi: 10.1038/ejcn.2014.272.
Qureshi SA, Ainsworth A, Winocour PH. Metformin therapy and assessment for vitamin B12 deficiency: is it necessary? Practical Diabetes 2011;28(7): 302-304. doi: 10.1002/pdi.1619.
de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial. BMJ. 2010 May 20;340:c2181. doi: 10.1136/bmj.c2181.
Shivaprasad C, Gautham K, Ramdas B, Gopaldatta KS, Nishchitha K. Metformin Usage Index and assessment of vitamin B12 deficiency among metformin and non-metformin users with type 2 diabetes mellitus. Acta Diabetol. 2020 Sep;57(9):1073-1080. doi: 10.1007/s00592-020-01526-4.
Mumtaz H, Ghafoor B, Saghir H, Tariq M, Dahar K, Ali SH, Waheed ST, Syed AA. Association of Vitamin B12 deficiency with long-term PPIs use: A cohort study. Ann Med Surg (Lond). 2022 Sep 26;82:104762. doi: 10.1016/j.amsu.2022.104762.
McCaddon A. Vitamin B12 in neurology and ageing; clinical and genetic aspects. Biochimie 2013; 95: 1066-1076. doi: 10.1016/j.biochi.2012.11.017.
Vinik AI, Strotmeyer ES. Diabetic Neuropathy. In Pathy’s Principles and Practice of Geriatric Medicine. Sinclair AJ, Morley JE, Vellas B, eds.; JohnWiley & Sons, Ltd.: Chichester, UK, 2012; pp. 751–767. ISBN 978-1-119-95293-0.
Kibirige D, Mwebaze R. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? J Diabetes Metab Disord. 2013 May 7;12(1):17. doi: 10.1186/2251-6581-12-17.
Al Mansoori A, Shakoor H, Ali HI, Feehan J, Al Dhaheri AS, Cheikh Ismail L, Bosevski M, Apostolopoulos V, Stojanovska L. The Effects of Bariatric Surgery on Vitamin B Status and Mental Health. Nutrients. 2021 Apr 20;13(4):1383. doi: 10.3390/nu13041383.
Riccò M, Rapacchi C, Romboli A, Vezzosi L, Rubichi F, Petracca GL, Ferrari S, Valente M, Tartamella F, Marchesi F. Peripheral neuropathies after bariatric surgery. Preliminary results from a single-centre prospective study in Northern Italy. Acta Biomed. 2019 Sep 6;90(3):259-265. doi: 10.23750/abm.v90i3.7601.
Russell JW, Zilliox LA. Diabetic neuropathies. Continuum (Minneap Minn). 2014 Oct;20(5 Peripheral Nervous System Disorders):1226-1140. doi: 10.1212/01.CON.0000455884.29545.d2.
Shipton MJ, Thachil J. Vitamin B12 deficiency - A 21st century perspective. Clin Med (Lond). 2015 Apr;15(2):145-50. doi: 10.7861/clinmedicine.15-2-145.
Ankar A, Kumar A. Vitamin B12 Deficiency. [Updated 2022 Oct 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441923/.
Castelli MC, Friedman K, Sherry J, Brazzillo K, Genoble L, Bhargava P, Riley MG. Comparing the efficacy and tolerability of a new daily oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low cobalamin levels: a randomized, open-label, parallel-group study. Clin Ther. 2011 Mar;33(3):358-371.e2. doi: 10.1016/j.clinthera.2011.03.003.
Didangelos T, Karlafti E, Kotzakioulafi E, Margariti E, Giannoulaki P, Batanis G, Tesfaye S, Kantartzis K. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-controlled Trial. Nutrients. 2021 Jan 27;13(2):395. doi: 10.3390/nu13020395.
Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A, Mcdowell I, Goringe A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Fam Pract. 2006 Jun;23(3):279-85. doi: 10.1093/fampra/cml008.
Andrès E, Kurtz JE, Perrin AE, Maloisel F, Demangeat C, Goichot B, Schlienger JL. Oral cobalamin therapy for the treatment of patients with food-cobalamin malabsorption. Am J Med. 2001 Aug;111(2):126-9. doi: 10.1016/s0002-9343(01)00792-6.
Hin H, Clarke R, Sherliker P, Atoyebi W, Emmens K, Birks J, Schneede J, Ueland PM, Nexo E, Scott J, Molloy A, Donaghy M, Frost C, Evans JG. Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study. Age Ageing. 2006 Jul;35(4):416-22. doi: 10.1093/ageing/afl033.
NICE. Guideline Vitamin B12 deficiency in over 16s: diagnosis and management. July 2023. https://www.nice.org.uk/guidance/GID-NG10176/documents/draft-guideline.
Sathienluckana T, Palapinyo S, Yotsombut K, Wanothayaroj E, Sithinamsuwan P, Suksomboon N. Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins. J Pharm Policy Pract. 2024 Feb 7;17(1):2306866. doi: 10.1080/20523211.2024.2306866.
Gu Y, Dennis SM. Are falls prevention programs effective at reducing the risk factors for falls in people with type-2 diabetes mellitus and peripheral neuropathy: A systematic review with narrative synthesis. J Diabetes Complications. 2017 Feb;31(2):504-516. doi: 10.1016/j.jdiacomp.2016.10.004.
Orlando G, Balducci S, Boulton AJM, Degens H, Reeves ND. Neuromuscular dysfunction and exercise training in people with diabetic peripheral neuropathy: A narrative review. Diabetes Res Clin Pract. 2022 Jan;183:109183. doi: 10.1016/j.diabres.2021.109183.
Dixit S, Maiya AG, Shastry BA. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. J Diabetes Complications. 2014 May-Jun;28(3):332-9. doi: 10.1016/j.jdiacomp.2013.12.006.
Seyedizadeh SH, Cheragh-Birjandi S, Hamedi Nia MR. The Effects of Combined Exercise Training (Resistance-Aerobic) on Serum Kinesin and Physical Function in Type 2 Diabetes Patients with Diabetic Peripheral Neuropathy (Randomized Controlled Trials). J Diabetes Res. 2020 Mar 6;2020:6978128. doi: 10.1155/2020/6978128.
Calderon-Ospina CA, Nava-Mesa MO. B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. CNS Neurosci Ther. 2020;26:5-13. doi: 10.1111/cns.13207.
Jaya MK, Dwicandra NM. Effectivity analysis of neuroprotector (vitamin B complex and mecobalamin) as neuropathic pain supportive therapy in elderly with type 2 diabetes mellitus. Asian J Pharm Clin Res. 2017;10:320-323. doi: 10.22159/ajpcr.2017.v10i12.21845.
Karedath J, Batool S, Arshad A, Khalique S, Raja S, Lal B, Anirudh Chunchu V, Hirani S. The Impact of Vitamin B12 Supplementation on Clinical Outcomes in Patients With Diabetic Neuropathy: A Meta-Analysis of Randomized Controlled Trials. Cureus. 2022 Nov 22;14(11):e31783. doi: 10.7759/cureus.31783.
Fonseca VA, Lavery LA, Thethi TK, Daoud Y, DeSouza C, Ovalle F, Denham DS, Bottiglieri T, Sheehan P, Rosenstock J. Metanx in type 2 diabetes with peripheral neuropathy: a randomized trial. Am J Med. 2013 Feb;126(2):141-9. doi: 10.1016/j.amjmed.2012.06.022.
Liew J, Barlow A, Lim L-L, Suastika K, Yasahardja Y, Chan SP, Soh A, Li LS, Tan AT; 2244-PUB: Role of B Vitamins (B1, B6, B12) in Managing Diabetic Peripheral Neuropathy (DPN): A Systematic Review. Diabetes 1 June 2019; 68 (Supplement_1): 2244–PUB. https://doi.org/10.2337/db19-2244-PUB.
Hakim M, Kurniani N, Pinzon RT, Tugasworo D, Basuki M, Haddani H, et al. Management of peripheral neuropathy symptoms with a fixed dose combination of high-dose vitamin B1, B6 and B12: A 12-week prospective noninterventional study in Indonesia. Asian J Med Sci. 2018; 9:32-40. doi: 10.3126/ajms.v9i1.18510.
Thornalley PJ, Babaei-Jadidi R, Al Ali H, Rabbani N, Antonysunil A, Larkin J, Ahmed A, Rayman G, Bodmer CW. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia. 2007 Oct;50(10):2164-70. doi: 10.1007/s00125-007-0771-4.
Alvarez M, Sierra OR, Saavedra G, Moreno S. Vitamin B12 deficiency and diabetic neuropathy in patients taking metformin: a cross-sectional study. Endocr Connect. 2019 Oct 1;8(10):1324-1329. doi: 10.1530/EC-19-0382.
American Diabetes Association. 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020;43:S7-S13. doi: 10.2337/dc20-S001.
Serra MC, Kancherla V, Khakharia A, Allen LL, Phillips LS, Rhee MK, Wilson PWF, Vaughan CP. Long-term metformin treatment and risk of peripheral neuropathy in older Veterans. Diabetes Res Clin Pract. 2020 Dec;170:108486. doi: 10.1016/j.diabres.2020.108486.
Kakarlapudi Y, Kondabolu SK, Tehseen Z, Khemani V, J SK, Nousherwani MD, Saleem F, Abdelhameed AN. Effect of Metformin on Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus and Factors Associated With It: A Meta-Analysis. Cureus. 2022 Dec 7;14(12):e32277. doi: 10.7759/cureus.32277.
Niafar M, Hai F, Porhomayon J, Nader ND. The role of metformin on vitamin B12 deficiency: a meta-analysis review. Intern Emerg Med. 2015 Feb;10(1):93-102. doi: 10.1007/s11739-014-1157-5.
Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP Jr. Association of biochemical B₁₂ deficiency with metformin therapy and vitamin B₁₂ supplements: the National Health and Nutrition Examination Survey, 1999-2006. Diabetes Care. 2012 Feb;35(2):327-333. doi: 10.2337/dc11-1582.
Rodríguez-Gutiérrez R, Montes-Villarreal J, Rodríguez-Velver KV, González-Velázquez C, Salcido-Montenegro A, Elizondo-Plazas A, González-González JG. Metformin Use and Vitamin B12 Deficiency: Untangling the Association. Am J Med Sci. 2017 Aug;354(2):165-171. doi: 10.1016/j.amjms.2017.04.010.
Sánchez H, Masferrer D, Lera L, Arancibia E, Angel B, Albala C. Vitamin B12 deficiency associated with high doses of metformin in older people diabetic. Nutr Hosp. 2014;29:1394‑1400.
Ts R, Ranganathan RS, Solai Raja M, Srivastav PSS. Prevalence of Vitamin B12 Deficiency in Type 2 Diabetes Mellitus Patients on Metformin Therapy. Cureus. 2023 Apr 12;15(4):e37466. doi: 10.7759/cureus.37466. PMID: 37187650; PMCID: PMC10176038.
Shivaprasad C, Gautham K, Ramdas B, Gopaldatta KS, Nishchitha K. Metformin Usage Index and assessment of vitamin B12 deficiency among metformin and non-metformin users with type 2 diabetes mellitus. Acta Diabetol. 2020 Sep;57(9):1073-1080. doi: 10.1007/s00592-020-01526-4.
Calderón-Ospina CA, Franco-González H, Leal-Martínez F, Orozco-Vázquez H, Plascencia-Pérez S, Sánchez-Mijangos J. Uso clínico de las vitaminas B neurotrópicas en enfermedades del sistema nervioso periférico en México y América Central. Med Int Mex. 2022;38:887-902. doi: 10.24245/mim.v38i4.5133.
Botas Velasco M, Cervell Rodríguez D, Rodríguez Montalbán AI, Vicente Jiménez S, Fernández de Valderrama Martínez I. Actualización en el diagnóstico, tratamiento y prevención de la neuropatía diabética periférica. Angiología. 2017;69(3):174-181.
Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, Malik RA, Maser RE, Sosenko JM, Ziegler D; American Diabetes Association. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005 Apr;28(4):956-62. doi: 10.2337/diacare.28.4.956.
Calderón-Ospina CA, Palacios-Sánchez L, Nava-Mesa MO, Huertas-Quintero JA. Vitaminas B neurotrópicas y neuropatía periférica: estado del arte y acuerdo de expertos. Acta Neurol Colomb. 2023;39(4):1201. doi: 10.22379/anc.v39i4.1201.
Elangovan R, Baruteau J. Inherited and acquired vitamin B12 deficiencies: Which administration route to choose for supplementation? Front Pharmacol. 2022 Sep 29;13:972468. doi: 10.3389/fphar.2022.972468.
Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H, Raiten DJ. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J Nutr. 2018 Dec 1;148(suppl_4):1995S-2027S. doi: 10.1093/jn/nxy201.
Chawla J, Kvarnberg D. Hydrosoluble vitamins. Handb Clin Neurol. 2014;120:891-914. doi: 10.1016/B978-0-7020-4087-0.00059-0.
Sanz-Cuesta T, González-Escobar P, Riesgo-Fuertes R, Garrido-Elustondo S, del Cura-González I, Martín-Fernán dez J, Escortell-Mayor E, Rodríguez-Salvanés F, García-Solano M, González-González R, Martín-de la Sierra-San Agustín MÁ, Olmedo-Lucerón C, Sevillano Palmero ML, Mateo-Ruiz C, Medina-Bustillo B, Valdivia-Pérez A, García-de Blas-González F, Mariño-Suárez JE, Rodríguez-Barrientos R, Ariza-Cardiel G, Cabello-Ballesteros LM, Polentinos-Castro E, Rico-Blázquez M, Rodríguez-Monje MT, Soto-Díaz S, Martín-Iglesias S, Rodríguez-González R, Bretón-Lesmes I, Vicente-Herrero M, Sánchez-Díaz J, Gómez-Gascón T, Drake-Canela M, Asúnsolo-del Barco Á; OB12 Group. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12). BMC Public Health. 2012 May 31;12:394. doi: 10.1186/1471-2458-12-394.
Schijns W, Homan J, van der Meer L, Janssen IM, van Laarhoven CJ, Berends FJ, Aarts EO. Efficacy of oral compared with intramuscular vitamin B-12 supplementation after Roux-en-Y gastric bypass: a randomized controlled trial. Am J Clin Nutr. 2018 Jul 1;108(1):6-12. doi: 10.1093/ajcn/nqy072.
Ahmad I, Hussain W. Stability of cyanocobalamin in parenteral preparations. Pak J Pharm Sci. 1993 Jan;6(1):53-9. PMID: 16414727.
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