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AMBULATORY CARE

Increased Vitamin B₁₂ Requirement Associated with Chronic Acid Suppression Therapy

Director of Special Studies, Idaho Drug Utilization Review Program (IDURP); Associate Professor of Family Medicine and Pharmacy Practice, Department of Family Medicine, Idaho State University, Pocatello, ID

Angela D Meeker, PharmD

at time of writing, PharmD Student, College of Pharmacy, Idaho State University; now, Pharmacist, McKenzie-Willamette Hospital, Springfield, OR

Paul S Cady, PhD

Database Manager, IDURP; Associate Professor and Associate Dean, College of Pharmacy, Idaho State University

Vaughn L Culbertson, PharmD

Project Director, IDURP; Professor and Chair, Department of Pharmacy Practice, Idaho State University

Wendy S Force, BSPharm

Clinical Specialist, IDURP

Craig M Kelley, BS

Computer Systems Manager, IDURP

Reprints: Rex W Force PharmD BCPS, Department of Family Medicine, Idaho State University, Campus Box 8357, Pocatello, ID 83209-8357, FAX 208/236-4818, E-mail force{at}otc.isu.edu

BACKGROUND: Assimilation of vitamin B₁₂ from dietary sources requires gastric acid. By decreasing acid production, the proton pump inhibitors (PPIs) and histamine₂ (H₂)-blockers may reduce vitamin B₁₂ absorption.

OBJECTIVE: To determine whether chronic acid suppression therapy is associated with the initiation of vitamin B₁₂ supplementation, we conducted a retrospective case–control study using a state-wide Medicaid population.

METHODS: Case patients were identified as those who initiated vitamin B₁₂ supplementation during the study period. Four control patients were age- and gender-matched to each case. Patients (n = 109 844) with a paid claim between September 27, 1995, and September 27, 1997, were eligible for inclusion. Chronic acid suppression therapy was defined as treatment with H₂-blockers or PPIs for 10 of the 12 months prior to the first vitamin B₁₂ injection. Comparisons were made between the case and control groups regarding exposure to chronic acid suppression therapy.

RESULTS: One hundred twenty-five cases were matched to 500 controls. Twenty-three patients (18.4%) had been exposed to chronic acid suppression therapy compared with 55 (11.0%) of the control group (p = 0.025; OR 1.82; 95% CI 1.08 to 3.09).

CONCLUSIONS: Initiation of vitamin B₁₂ supplementation was associated with chronic gastric acid suppression therapy.

Key Words: gastric acid suppression, vitamin B₁₂

Published Online, February 20, 2003. www.theannals.com, DOI 10.1345/aph.1C037

This article has been cited by other articles:

				E. Andres, E. Noel, and M. B. Abdelghani Vitamin B12 deficiency associated with chronic acid suppression therapy Ann. Pharmacother., November 1, 2003; 37(11): 1730 - 1730. [Full Text] [PDF]