Oral Contraceptive Pill

Users of the OCP showed significantly lower concentrations of cobalamin than controls in a 2003 clinical study (Sutterlin et al 2003). However, it would appear that this may be due to an effect on B12 binding proteins in serum affecting test results, because total homocysteine and methylmalonic acid markers were unchanged and no symptoms of deficiency were present (Bor 2004) — observe for signs and symptoms of B12 deficiency and conduct testing if deficiency is suspected.

GASTRIC ACID INHIBITORS: PPI AND H2 RECEPTOR ANTAGONISTS

Gastric acid is required to liberate protein-bound cobalamin. Therefore, vitamin B12 concentration may be decreased when gastric acid is markedly suppressed for prolonged periods (Laine et al 2000, Schenk et al 1999, Termanini et al 1998). Studies have shown that omeprazole therapy acutely decreases cyanocobalamin absorption in a dose-dependent manner (Marcuard et al 1994, Saltzman et al 1994) and deficiency may occur with long-term use (Valuck and Ruscin 2004). It should be noted that vitamin B12 supplements do not suffer the same fate, as they are not bound to protein — observe for signs and symptoms of B12 deficiency; vitamin B12 supplements may be required with long-term therapy.

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