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Frontiers | Efficacy of sublingual and oral vitamin B12 versus intramuscular administration: insights from a systematic review and meta-analysis
- when there is risk of torsades de pointes, for example in patients with prolonged QT, concomitant administration of other medications that produce torsades de pointes (amiodarone, quinidine, bepridil, IV erythromycin, halofrantine, pentamidine, sparfloxacin, sultopride, vincamine, betrilio, disopyramide, sotalol, etc)
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Oral B12 supplementation may be appropriate in specific circumstances: Dietary deficiency in individuals with normal absorption capacity (typically 50-150 micrograms daily) Patient preference (after discussion of relative efficacy) Maintenance therapy in selected cases Higher oral doses (1000–2000 micrograms daily) may be used in some cases, as only a small percentage is absorbed through passive diffusion when intrinsic factor-mediated absorption is impaired