Proton Pump Inhibitors & B12 Deficiency

Last Updated: Aug 16, 2013 | By Esther Sherry

Proton Pump Inhibitors & B12 Deficiency
Vitamin B12 deficiency can be caused by the chronic use of proton pump inhibitors. Photo Credit Jupiterimages/ Images

Vitamin B12, also known cobalamin, is a water-soluble B-complex vitamin that is necessary for the production of energy from consumed foods, maintenance of healthy nerve cells and manufacture of healthy red blood cells. Proton pump inhibitors, or PPIs, are drugs used to suppress acid production in the stomach. Chronic use of PPIs may cause a vitamin B12 deficiency.


Long-term use of PPIs causes decreased absorption of vitamin B12, leading to deficiency in the vitamin, according to the University of Maryland Medical Center. PPIs are usually prescribed to patients with chronic heartburn problems in order to heal ulcers and prevent damage to the esophagus. PPIs stop production of stomach acid. Vitamin B12 is usually absorbed in the stomach with the help of a protein known as intrinsic factor. Blocking stomach acid causes vitamin B12 to be absorbed improperly from foods or supplements. Examples of proton pump inhibitors include lansoprazole, pantoprazole, omeprazole, esomeprazole and raberprazole.


Patients with vitamin B12 deficiency experience pernicious anemia and neurological damage. Pernicious anemia occurs because the body lacks enough vitamin B12 to make new healthy red blood cells. Neurological damage occurs because vitamin B12 is needed for maintenance of healthy nerve cells. Symptoms of neurological damage include numbness and tingling, lack of coordination, headache, mood changes, confusion, irritability and weakness.

Vitamin B12 injections are preferred in patients with chronic vitamin B12 deficiency due to use of proton pump inhibitors. Injected B12 is administered as a deep intramuscular injection, which causes the vitamin to absorb immediately into the bloodstream. Patients with severe B12 deficiency require B12 injections daily. As symptoms of deficiency improve, patients may only require the injection once a month.

Side Effects

Vitamin B12 injections may cause common side effects such as redness and swelling at injection site, nausea, vomiting, heartburn and diarrhea. Adverse side effects of B12 include blood clots in extremities, heart failure, rashes and hives and problems breathing. Treatment with B12 injection can unmask symptoms of polythycemia vera, which is abnormal production of high numbers of red blood cells. Patients with Leber’s disease may also develop blindness after B12 injections.


Patients who take PPIs to treat chronic gastrointestinal disorders should have levels of B12 checked regularly. Low levels of B12 can lead to permanent neurological damage. Severe pernicious anemia cause by B12 deficiency can also damage the brain, heart and other vital body organs. Patients should make sure to regularly attend doctor’s appointments to receive B12 injections in order to avoid complications

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