Vitamin b12
Place in Therapy
Vitamin B12, or cobalamin, plays a vital role in the extraction of energy from fats and DNA synthesis. The exact mechanism of Vitamin B12 in treating aphthous ulcers is unknown however its role in preserving DNA may contribute to its effectiveness (1).
The relationship between Vitamin B12 deficiency and recurrent aphthous ulcers (RAU) has been under speculation for a number of decades. Multiples studies have demonstrated the relationship between low serum cobalamin levels and canker sores lasting more than 6 months (2). One study revealed that as many as 51% of the subjects with RAU also had a cobalamin deficiency (1). A systematic review of case reports and control trials showed a complete resolution of RAU once cobalamin deficiencies were corrected with Vitamin B12 therapy (supplementation or IM injection) (2). Therapeutics for Minor Ailments recommends that patients with RAU be screened for hematological deficiencies and be treated accordingly (3).
Treatment of RAU with Vitamin B12 has also been studied in patients without a cobalamin deficiency. Two control trials showed an improvement in number, pain and frequency of ulcers when treated with Vitamin B12 despite normal cobalamin levels (1). There were weakness in the study designs of these trials but they suggest that Vitamin B12 may be an alternative in all RAU cases.
In summary, Vitamin B12 should be recommended to treat RAU secondary to a cobalamin deficiency. Considering its safety profile, it may be considered for prevention/treatment of RAU (where other treatment options have failed) but is not a first-line option.
References:
1. Gulcan E, Toker S, Hatipoglu H, Gulcan A, Toker A. Cyanocobalamin May be Beneficial in the Treatment of Recurrent Aphthous Ulcers Even When Vitamin B12 Levels are Normal. Am J Med Sci. 2008;336(5):379-382
2. Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS. Urban Legends: Recurrent Aphthous Stomatitis. Oral Dis. 2011;17:755-770.
3. Repchinsky C, ed. Therapeutic Choices for Minor Ailments. Ottawa, ON. Canadian Pharmacists Association; 2013.
4. Micromedex Healthcare Series. DRUGDEX System. Greenwood Village, CO: Truven Health Analytics, 2013. http://www.thomsonhc.com/. Accessed July 14, 2013.
5. Cyanocobalamin. Lexi-Drugs Online [Internet]. Hudson (OH) : Lexi-Comp, Inc. 1978-2013http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6669. Accessed July 15, 2013.
6. Jamieson Vitamins. Timed Release Vitamin B12 1,200mcg. 2010. http://www.jamiesonvitamins.com/files/2268-Vitamin%20B12%20Timed%20Release%201,200%20mcg%20monograph.pdf. Accessed July 15, 2013
The relationship between Vitamin B12 deficiency and recurrent aphthous ulcers (RAU) has been under speculation for a number of decades. Multiples studies have demonstrated the relationship between low serum cobalamin levels and canker sores lasting more than 6 months (2). One study revealed that as many as 51% of the subjects with RAU also had a cobalamin deficiency (1). A systematic review of case reports and control trials showed a complete resolution of RAU once cobalamin deficiencies were corrected with Vitamin B12 therapy (supplementation or IM injection) (2). Therapeutics for Minor Ailments recommends that patients with RAU be screened for hematological deficiencies and be treated accordingly (3).
Treatment of RAU with Vitamin B12 has also been studied in patients without a cobalamin deficiency. Two control trials showed an improvement in number, pain and frequency of ulcers when treated with Vitamin B12 despite normal cobalamin levels (1). There were weakness in the study designs of these trials but they suggest that Vitamin B12 may be an alternative in all RAU cases.
In summary, Vitamin B12 should be recommended to treat RAU secondary to a cobalamin deficiency. Considering its safety profile, it may be considered for prevention/treatment of RAU (where other treatment options have failed) but is not a first-line option.
References:
1. Gulcan E, Toker S, Hatipoglu H, Gulcan A, Toker A. Cyanocobalamin May be Beneficial in the Treatment of Recurrent Aphthous Ulcers Even When Vitamin B12 Levels are Normal. Am J Med Sci. 2008;336(5):379-382
2. Baccaglini L, Lalla RV, Bruce AJ, Sartori-Valinotti JC, Latortue MC, Carrozzo M, Rogers RS. Urban Legends: Recurrent Aphthous Stomatitis. Oral Dis. 2011;17:755-770.
3. Repchinsky C, ed. Therapeutic Choices for Minor Ailments. Ottawa, ON. Canadian Pharmacists Association; 2013.
4. Micromedex Healthcare Series. DRUGDEX System. Greenwood Village, CO: Truven Health Analytics, 2013. http://www.thomsonhc.com/. Accessed July 14, 2013.
5. Cyanocobalamin. Lexi-Drugs Online [Internet]. Hudson (OH) : Lexi-Comp, Inc. 1978-2013http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/6669. Accessed July 15, 2013.
6. Jamieson Vitamins. Timed Release Vitamin B12 1,200mcg. 2010. http://www.jamiesonvitamins.com/files/2268-Vitamin%20B12%20Timed%20Release%201,200%20mcg%20monograph.pdf. Accessed July 15, 2013