Drug-Induced Vitamin B 12 Deficiency: A Focus on Proton Pump Inhibitors and Histamine-2 Antagonists

Abstract

Objective:

To review primary literature of gastric acid suppressive agents and vitamin B₁₂ deficiency.

Data Synthesis:

From the published articles, proton pump inhibitors (PPIs) are associated with a higher risk of inducing vitamin B₁₂ deficiency than histamine-2 receptor antagonists (H2RAs). Literature suggests that there is an increased risk of developing vitamin B₁₂ deficiency in patients who are exposed to extended durations of therapy with PPIs. There are, however, some conflicting data in elderly patients suggesting that the PPI use for more than 3 years does not increase the risk of vitamin B₁₂ deficiency. No evidence was found to support the extended use of H2RA monotherapy causing vitamin B₁₂ deficiency. The inconsistency of results reported could be due to the differing patient populations studied, such as Zollinger-Ellison syndrome (ZES) and elderly patients. Overall, the lack of consistent evidence shows the need for more research in this area.

Conclusion:

To investigate the clinical significance of vitamin B₁₂ deficiency caused by acid suppression with PPIs and H2RAs, longer prospective studies are needed. These studies should focus on patient-centered outcomes to accurately determine the extended usage of PPI and H2RA and the true effects on vitamin B₁₂ deficiency.