B VITAMINS, INCLUDING VITAMIN B12 (METHYLCOBALAMIN)
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:
Pet Education explains more about the different B vitamins.
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.
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 the increased urination associated with CKD. 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. A lack of Vitamin B1 may cause an inability to lift the head.
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.
Many people use a vitamin B complex supplement for their CKD cats, as described below. Vitamin B12, in the form of methylcobalamin, can be particularly useful for CKD cats, but there is only a relatively small amount of vitamin B12 in most B complex supplements, so some people give a separate B12 supplement as well. There is more about vitamin B12 here.
Because B vitamins are water-soluble, they are generally considered to be a safe supplement because any excess will simply be urinated 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).
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.
B vitamins may make urine yellow or orange, so don't panic if you see this.
B vitamin supplements 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 can. Obviously it is much easier to do this if you use capsules, but if you do buy tablets, you can crush them and divide them after crushing. You can decant the amount you are giving into a gelpcap, or you can sprinkle it on food.
Avoid products containing alpha lipoic acid, which is toxic to cats.
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.
Renal Advanced is a product made by Candioli which is commonly offered to people in Italy and Canada. It contains vitamin B6, vitamin B12 and vitamin B9 (folic acid), plus probiotics. However, it also contains Lespedeza capita, which is a diuretic and therefore contra-indicated in CKD cats, and prebiotics in the form of fructooligosaccharides which may increase calcium levels in some cases. Personally I would just use B vitamins, and a probiotic separately if appropriate.
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 does contain sugar so may not be suitable for diabetic cats. See above for how to give.
Amazon sells 100 capsules for US$11.46 including shipping.
Vitacost sells 100 capsules for US$8.16. Shipping is a flat rate US$4.99 per order.
iHerb sells 100 capsules for US$10.77 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.
Amazon UK sells 100 Jarrows B-Right capsules (see above) for £11.98.
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, but you should never give iron to a cat with an infection. These are the two most popular combined products on Tanya's CKD Support Group.
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
NutriVed Sources UK
Pet-tinic, now also known as 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
Pet-tinic Sources UK
Vitamin B with Potassium (Kaminox or Renal K+) Back to Page Index
If you are in the UK, you may be offered a product called Kaminox. This is a combination of B vitamins, iron and potassium. Alfamedic provides a list of the ingredients.
I would not recommend using these products 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 benazepril (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.
You should also not use Kaminox if your cat has an infection because Kaminox contains iron, see Anaemia for more information.
Vitamin B with Potassium: USA
Vitamin B with Potassium: UK
Vitamin B12 - Methylcobalamin Back to Page Index
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. A lack of Vitamin B12 may also cause cognitive dysfunction. 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.
Cats with IBD or pancreatitis tend to have low levels of cobalamin so are often given methylcobalamin. It is also often recommended for cats with diabetic neuropathy. The prevalence of hypocobalaminaemia in cats with spontaneous hyperthyroidism (2011) Cook AK, Suchodolski JS, Steiner JM & Robertson JE Journal of Small Animal Practice 52(2) pp101–106 found that a sizeable percentage of cats with hyperthyroidism have low levels of cobalamin.
Plasma homocysteine, B vitamins, and amino acid concentrations in cats with cardiomyopathy and arterial thromboembolism (2000) McMichael MA, Freeman LM, Selhub J, Rozanski EA, Brown DJ, Nadeau MR, Rush JE Journal of Veterinary Internal Medicine 14(5) pp507-12 found that cats with heart disease who have thromboembolism (thrown a clot or saddle thrombus) have significantly lower levels of vitamin B6, vitamin B12 and arginine, an amino acid. The study concludes "We interpret the results of this study to suggest that vitamin B12 and arginine may play a role in CM and ATE of cats." If your cat has heart disease, therefore, you may wish to discuss using methylcobalamin with your vet.
Vitamin B12 may 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."
Methylcobalamin has been found by members of Tanya's CKD Support Group to be very helpful for various CKD-related problems, including anaemia, incontinence, appetite loss and constipation. If you are using famotidine (Pepcid AC), it may reduce the absorption of vitamin B12 from food, so it might be worth supplementing it.
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.
Net Doctor has some information about Vitamin B12 deficiency in humans.
Vitamin B12 is available in oral or injectible forms, but the injectible form is usually cyanocobalamin rather than the preferred methylcobalamin.
It used to be thought that only the injectible form was effective, but Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency (2005) Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, McDowell I & Papaioannou A Cochrane Database of Systematic Reviews 20(3) found that oral vitamin B12 was as effective as intramuscular vitamin B12 for human patients with vitamin B12 deficiency.
The US National Library of Medicine mentions that many injectible forms of Vitamin B12 in the form of cyanocobalamin "contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired."
If you are only using the injectible form occasionally, it is probably safe but discuss this further with your vet. To be on the safe side, I would consider using oral Vitamin B12 instead, which also has the advantage of being available in the preferred methylcobalamin form. The oral form does seem to work well for cats, though it may possibly be less effective in cats with IBD (inflammatory bowel disease). It is common to give a relatively high dose though, to make sure the cat receives enough (any excess should be peed out).
Oral 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 and capsules are also available, though less easy to find. Injectible Vitamin B12 is only available via prescription in the USA, but is an over the counter product in the UK. See below for stockists, including a US supplier of injectible methylobalamin.
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 if you are giving methylcobalamin orally would be 500mcg (0.5mg) a day, though some people give twice as much. Although this sounds high, only a small percentage of oral B12 is absorbed. Most people using capsules simply open a 500mcg capsule and mix the contents with their cat's food.
I would not give Vitamin B12 to a cat with cancer because cancer cells rely on Vitamin B12 for growth.
Cats with diabetes tend to be given higher dosages. However, Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial (2010) House AA, Eliasziw M, Cattran DC, Churchill DN, Oliver MJ, Fine A, Dresser GK & Spence JD Journal of the American Medical Association 303(16) pp1603-1609 found that humans with diabetes and kidney disease caused by the diabetes who were given three B vitamins, 25mg/d of vitamin B6 (pyridoxine), 2.5mg/d of vitamin B9 (folic acid) and 1mg/d of vitamin B12 had a lower GFR (a measure of kidney function) and an increased incidence of strokes. The study states "Because these vitamins are water-soluble and renally excreted, vitamin toxicity may be more of a concern in patients with impaired renal function."
Cats with diabetes are usually only given methylcobalamin for up to three months, until the diabetes is regulated, but the humans in this study were taking cobalamin for 36 months. It is also not known which form they were taking, but most probably it was cyanocobalamin. These patients had severe diabetes as well as advanced CKD and were receiving multiple treatments apart from B vitamins.
I would not give more than 1 mg a day to your CKD cat, and personally, I would feel more comfortable giving 500mcg (0.5mg) only. Be guided by your vet as to the most appropriate dose for your cat.
Some national chains such as Vitamin Shoppe sell methylcobalamin, but it is often in lozenge form rather than capsules. Check for other ingredients too. Vitamin Shoppe sells 60 Superior Source 1000mcg methylcobalamin lozenges for US$9.99 online, and you can often find this product in store too.
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. If you are a new Vitacost customer, but know somebody who already uses them, you should be able to use this coupon to get a US$10 discount off your first order.
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$34.10. 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.
Diamondback Drugs sell injectible methylcobalamin, which can be very hard to find otherwise. It is not mentioned on their site but members of my support group have obtained it from them with no problems. It costs US$30 for a 5ml vial of 1mg/ml strength, with a three month expiration date.
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. If you are a new Vitacost customer but know somebody who already uses them, you should be able to use this coupon to get a US$10 discount off your first order.
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 UK sells 60 Superior Source Methylcobalamin tablets in 1000mcg strength for£12.99.
Vitamin UK sells a number of different types of methylcobalamin, click on Search, then type in methylcobalamin.
Pet Meds in the UK sells injectible Vitamin B12 in the form of cyanocobalamin (I do not know of any UK suppliers of injectible methylcobalamin). A possible dose is 0.5ml once or twice a week into port on fluids but check with your vet. You should buy a new one every month.
Natural Vitamin Direct in Canada sells 90 1000mcg methylcobalamin tablets for CAN$7.50.
Complementary Compounding Services in Australia sells 50 3mg capsules for AUS$65. These are stronger than usually used for CKD cats, but the capsules can be opened and divided into smaller doses.
Complementary Compounding Services in Australia also sell injectible methylcobalamin.
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, so the sizes and doses may be too high for a CKD cat; ask your vet.
This page last updated: 14 October 2012
Links on this page last checked: 29 April 2012
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.
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