Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - B Vitamins, Including Vitamin B12 (Methylcobalamin)

B vitamins are water-soluble, so are often lacking in CKD cats, who lose much of their Vitamin B through urination.
Cats who are not eating much will also probably not be taking in enough B vitamins.
A lack of vitamin B may cause loss of appetite, or occasionally may cause twitching or itching. Vitamin B deficiencies are also known to cause non-regenerative anaemia.
B vitamin supplements are safe and can often help a CKD cat feel better.
Vitamin B12 in the form of methylcobalamin may be particularly helpful.

The Different Types of B Vitamin Back to Page Index

Although Vitamin B is commonly referred to as if it were a single vitamin, there are actually a number of B vitamins. These are essential vitamins, which means that they cannot be manufactured in the cat's body, so must be obtained from external sources (from food or a supplement).

These are the main B vitamins:

Vitamin B1 - thiamine
Vitamin B2 - riboflavin
Vitamin B3 - niacin or nicotinamide
Vitamin B5 - pantothenic acid
Vitamin B6 - pyridoxine or pyridoxamine
Vitamin B7 - biotin, also known as vitamin H
Vitamin B9 - folic acid, also known as vitamin M
Vitamin B12 - cyanocobalamin or methylcobalamin

Pet Education explains more about the different B vitamins.

The Importance of B Vitamins Back to Page Index

B vitamins are water-soluble, so are often lacking in CKD cats, who lose much of their Vitamin B through urination. Cats who are not eating much will also probably not be taking in enough B vitamins. A lack of vitamin B may cause loss of appetite, or occasionally may cause twitching or itching. Vitamin B deficiencies are also known to cause non-regenerative anaemia.

Your vet may therefore suggest a supplement in order to avoid these problems. I definitely recommend starting a Vitamin B supplement for any cat who is anaemic or in the low end of the lab range.

Because B vitamins are water-soluble, they are a safe supplement, because any excess will simply be peed out, but you should still be careful not to over-supplement B6 and B9 in particular.

Vitamin B Complex Back to Page Index

B vitamins need to be in a certain ratio to each other, so many people buy their supplements in the form of a Vitamin B complex. These products usually contain the correct balance of B vitamins, though for some strange reason they often do not contain Vitamin B9 (folic acid).

These products are sold for humans, so obviously need to be reduced to a cat-sized dose. The general rule of thumb is to give a 10 lb cat approximately 1/10th of a human dose each day. Divide this further into 2-3 doses each day. If you wish to be more specific, Nutritional management of renal disease (2008) Sturgess K Presentation to the World Small Animal Veterinary Association World Congress has a table showing the recommended intake of the various B vitamins for CKD cats. Remember, this is total intake, i.e. it includes vitamin B in food.

B Vitamins are sensitive to heat and light so are best kept in a cool dark place. Some vets add Vitamin B to the sub-Q fluids bag, but this is not a good idea because it can make the fluids sting; it can compromise the sterility of the bag; and giving vitamins in this way (i.e. added by the vet) tends to increase the cost of the fluid bags. In addition, since most people warm their fluids before using them, the B vitamins could well be rendered ineffective through the repeated warming. Injectible B complex (which is yellow) also stings when injected directly into the cat. However, injectible Vitamin B12 (pinky red) does not sting, so some people give this to their cats immediately after sub-Qs.

Avoid products containing alpha lipoic acid, which is toxic to cats.

B vitamins may make urine yellow or orange, so don't panic if you see this.

Vitamin B Complex US Sources

Jarrow's B-Right is a popular choice because it contains all the B vitamins including B9, and some B-12 in the favoured methylcobalamin form. It comes in capsule form, and most people give around 1/10th of the capsule in total each day, but divide this into two or three daily doses. You can decant the contents into a gelpcap, or you can open the capsule and sprinkle the contents on food.

Amazon sells 100 capsules for US$12.50 including shipping.

Vitacost sells 100 capsules for US$7.97. Shipping is a flat rate US$4.99 per order.

iHerb sells 100 capsules for US$8.97 plus shipping.

Vitamin B Complex UK Sources

Provet in the UK sells a phosphorus-free feline Vitamin B supplement called Pro-VitB, which costs £8.32 for 30 tablets.

B Vitamins with Iron: Pet-tinic or NutriVed Back to Page Index

Some cats (typically anaemic ones) may need iron as well as B vitamins. In these cases it is usually easier to use a combined product. These are the two most popular combined products on my support group.

NutriVed

Pet-tinic

NutriVed B Complex Plus Iron

NutriVed B Complex Plus Iron contains B vitamins and iron. The usual dose is 0.1ml per lb of cat, twice a day (which equates to 5mg of iron twice a day) so a 10lb (4.5kg) cat would need 1 ml twice a day, but do check with your vet in case your cat needs a different dose. It does contain sugar, so may not be suitable for diabetic cats.

I used NutriVed for my anaemic cat, Ollie, with no problems. I simply mixed his twice daily dose into a small amount of baby food and he gobbled it up.

NutriVed Sources USA

California Veterinary Supply sells NutriVed for US$6.99 for 4 oz.

Thriving Pets sells NutriVed for US$9.95. Handling costs US$2, shipping charges are determined by weight. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55.

Healthy Pets sells NutriVed at a cost of US$9.99 for 4 oz.

Natural Pets also sell Nutrived for US$9.99

NutriVed Sources UK

Natural Pets sell NutriVed for US$9.99 and will ship to the UK. Shipping via USPS Express Mail for one or two bottles costs around US$29.

Thriving Pets sells NutriVed for US$9.95. Handling costs US$2, shipping charges are determined by weight. It will ship to selected clients in selected countries. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55.

Pet-tinic (Pet-Tabs Iron-Plus)

Pet-tinic, or Pet-Tabs Iron-Plus, is both an iron supplement and Vitamin B supplement, though for some strange reason it does not contain folic acid. The usual dose for a 10lb (4.5kg) cat is 1 ml twice a day (which equates to 5.4mg of iron a day), but do check with your vet in case your cat needs a different dose. It does contain corn syrup, so may not be suitable for diabetic cats.

Pet-tinic Sources USA

KV Vet Supply sells Pet-tinic at US$6.85 for 4 oz, with free shipping for orders over US$50.

Thriving Pets sells Pet-tinic for US$10.85 for 4 oz. Handling costs US$2, shipping charges are determined by weight. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55.

Pet-tinic Sources UK

KV Vet Supply will ship Pet-tinic to the UK or Canada. It costs US$6.85 for 4 oz, but shipping is relatively expensive, so it is usually more cost effective to order more than one bottle at a time.

Thriving Pets sells Pet-tinic for US$10.85 for 4 oz. Handling costs US$2, shipping charges are determined by weight. It will ship to selected clients in selected countries. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55.

Vitamin B with Potassium (Kaminox) Back to Page Index

If you are in the UK, you may be offered a newish product called Kaminox. This is a combination of B vitamins, iron and potassium. Alfamedic provides a list of the ingredients. There is a similar product in the USA called Amino B & K, available from Emerson Ecologics.

I would not recommend using Kaminox unless your cat has low potassium levels, which not all CKD cats do; giving potassium when it is not needed can be very dangerous. ACE inhibitors such as Fortekor may make potassium levels rise; so if your vet has prescribed Fortekor, as so many British vets do, it might be wiser to use a different type of B Vitamin without the potassium.

Vet UK sells Kaminox for £29.49 for 120ml, with free UK shipping.

Vetscriptions sells Kaminox for £30.99 for 120ml.

Vitamin B12 - Methylcobalamin Back to Page Index

Why Vitamin B12 is helpful
Sources - USA
Sources - UK and other countries

Why Vitamin B12 is Helpful

Vitamin B12 may be particularly helpful to CKD cats. Vitamin B12 in the form of methylcobalamin (rather than the more commonly available cyanocobalamin) is the neurologically active form of Vitamin B12, and is used by the body to correct or prevent neurological problems. It is also essential for red blood cell production, so too low a level of Vitamin B12 in your cat's body may cause or contribute to anaemia. It has been found by members of Tanya's CRF Support Group to be very helpful for various CKD-related problems, including anaemia, incontinence, appetite loss and constipation. It also appears to help cats with diabetic neuropathy.

Vitamin B12 can be a particular concern for older cats. Vitamin B12 deficiency (2003) OH RC & Brown DL American Family Physician 67(5) pp979-86 mentions that one study found that 15% of people over the age of 65 had a Vitamin B12 deficiency. Addressing age-related changes in feline digestion (2010) Patil AR & Cupp CJ Nestlé Purina Companion Animal Nutrition Summit 2010 Focus on Gerontology states "if Vitamins E & B12 are at low levels, then processing of fat and protein are likely compromised in older cats."

Vitamin B12 is available in oral or injectible forms. It used to be thought that only the injectible form (which is usually cyanocobalamin rather than the preferred methylcobalamin) was effective, but in fact the oral form seems to work well for cats. It is common to give a relatively high dose though, to make sure the cat receives enough (any excess should be peed out).

Some methylcobalamin products contain a sweetener called xylitol. Although this is toxic to dogs, there is currently no evidence that it is toxic to cats. However, some people prefer to avoid products containing it.

A possible starting dose would be 500mcg (0.5mg) a day, though some people give twice as much. Although these dosages sound high, only a small percentage of oral B12 is absorbed. Be guided by your vet. Methylcobalamin is often sold in the form of fruit-flavoured lozenges which some people do use to pill their cats successfully, though plain methylcobalamin tablets are also available, though less easy to find. Injectible Vitamin B12 is only available via prescription in the USA.

Oregon State University has some information about Vitamin B12.

Chronic renal failure promotes severe variant of Vitamin B12 deficiency (2006) Duning T, Nabavi DG, Dziewas R, Kugel H & Schäbitz W-R European Neurology 56 pp62–65 reports on the case of a human CKD patient with Vitamin B12 deficiency and concludes that CKD patients "may require earlier and much larger therapeutic cobalamin doses than previously considered."

PDR Health has some information about methylcobalamin in humans.

Methylcobalamin Sources - USA

Vitacost sells 200 plain methylcobalamin 500mcg (0.5mg) capsules for US$6.28 plus flat rate shipping of US$4.99 per order. I ordered these myself on a Sunday evening, and received them on the following Tuesday.

Vitacost also sells 300 of the NSI brand in 500mcg strength for US$8.49 plus flat rate shipping of US$4.99 per order.

Bayho sells 180 1000mcg (1mg) plain methylcobalamin tablets for US$26.81. Although the site states that it only sells to health professionals, they will normally sell to individuals if you tell them it is for veterinary use.

Methylcobalamin Sources - UK and Other Countries

Vitamin UK sells a number of different types of methylcobalamin, click on Search, then type in methylcobalamin.

Vitacost sells 200 plain methylcobalamin 500mcg (0.5mg) capsules for US$6.28 plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast.

Vitacost also sells 300 of the NSI brand in 500mcg strength for US$8.49 plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast.

Amazon sells 60 Superior Source Methylcobalamin tablets in 1000mcg strength for £12.99.

Methylcobalamin Resources has details of suppliers in USA, UK, and New Zealand, some of whom will ship worldwide. Please note this site is recommending methylcobalamin for cats with diabetes, and the doses given may be too high for a CKD cat; ask your vet.

B Vitamin Cautions Back to Page Index

I would avoid using multi-vitamin products, particularly two products called Hi-Vites and Felovite II, as a source of B vitamins. There is nothing wrong with these products as such, but unfortunately they tend to be too high in Vitamins A and D for a CKD cat, and Felovite II also contains phosphorus. Several cats on the support group have not done well on Hi-Vites in particular.

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This page last updated: 31 December 2011

Links on this page last checked: 16 November 2011