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Ulcer Medications
Proton Pump Inhibitors (Gastric Acid Secretion Inhibitors)

Depletions
Vitamin B12 (Cobalamin)

Symptoms of vitamin B12 deficiency are rare because it takes years to develop complications associated with long-term depletion of this nutrient. Irritability, weakness, numbness, anemia, loss of appetite, headache, personality changes, and confusion are some of the signs and symptoms associated with vitamin B12 depletion. Low levels of this vitamin may also be associated with an increased risk of colon cancer, heart disease, brain disorders, and birth defects.

Editorial Note

Supporting Research

Ames BN. Micronutrient deficiencies: A major cause of DNA damage. Ann NY Acad Sci. 2000;889:87-106.

Bellou A, Aimone-Gastin I, De Korwin JD, et al. Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy. J Intern Med. 1996;240(3):161-164.

Berger W. Incidence of severe side effects during therapy with sulfonylureas and biguanides. Horm Metab Res Suppl. 1985;15:111-115.

Carpentier JL, Bury J, Luyckx A, Lefebvre P. Vitamin B12 and folic acid serum levels in diabetics under various therapeutic regimens. Diabetes Metab. 1976;2(4):187-190.

Covington T, ed. Nonprescription Drug Therapy Guiding Patient Self-Care. St Louis, MO: Facts and Comparisons; 1999:467-545.

Marcuard SP, Albernaz L, Khazanie PG. Omeprazole therapy causes malabsorption of cyanocobalamin. Ann Intern Med. 1994;120(3):211-215.

Saltzman JR, Kemp JA, Golner BB, et al. Effect of hypochlorhydria due to omeprazole treatment or atrophic gastritis on protein-bound vitamin B12 absorption. J Am Coll Nutr. 1994;13(6):584-591.

Termanini B, Gibril F, Sutliff VE, et al. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med. 1998;104(5):422-430.

Review Date: October 2000
Reviewed By: All depletions monographs have been reviewed by a team of experts including Derrick M. DeSilva, Jr., MD, Raritan Bay Medical Center, Perth Amboy, NJ; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor, A.D.A.M., Inc., Boston, MA; John Hinze, PharmD, NMD, Woodbine, IA; Ruth Marlin, MD, Medical Director and Director of Medical Education, Preventive Medicine Research Institute, Sausalito, CA; Brian T Sanderoff, PD, BS in Pharmacy, Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira Zunin, MD, MPH, MBA, President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.