Snelle antwoord
Walcobal Injection (methylcobalamin 2500 mcg ampoule IM) is methylcobalamin (the bioactive coenzyme form of vitamin B12) given by intramuscular injection for B12 deficiency, diabetic peripheral neuropathy, and post-bariatric replacement.
- Methylcobalamin 2500 mcg per ampoule — bioactive coenzyme form
- Intramuscular use — bypasses intrinsic-factor dependence
- Standard schedule: alternate-day × 5 doses (loading), then weekly to monthly
- WHO-GMP gecertificeerde fabrikant
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What is Walcobal Injection?
Walcobal is methylcobalamin 2500 mcg in an aqueous IM ampoule. Methylcobalamin is one of two coenzyme forms of vitamin B12 (the other is adenosylcobalamin) and is preferred over older cyanocobalamin for neurological indications because it is the form active in cytosolic methylation reactions. After IM injection it bypasses intrinsic-factor dependence and gut absorption entirely — useful in pernicious anaemia, post-gastrectomy, post-bariatric surgery, severe malabsorption, or any setting requiring rapid replenishment.
Indicaties
- Vitamin B12 deficiency — macrocytic anaemia, glossitis, peripheral neuropathy, fatigue
- Pernicious anaemia (autoimmune intrinsic-factor deficiency) — lifelong replacement
- Post-gastrectomy / post-bariatric malabsorption
- Subacute combined degeneration of the spinal cord — emergency replacement, specialist supervision
- Diabetic peripheral neuropathy — adjunctive use, evidence is modest but supplementation in deficient patients is beneficial
- Alcoholic neuropathy alongside thiamine
- Long-term metformin or PPI use with documented deficiency
- Trigeminal neuralgia, Bell’s palsy — off-label adjunct
| Indicatie | Laaddosis | Onderhoudsdosis |
|---|---|---|
| B12 deficiency anaemia (no neuro) | 1 mg IM alternate days × 5 doses | 1 mg IM monthly |
| Pernicious anaemia | 1 mg IM alternate days × 6–7 doses | 1 mg IM every 1–3 months lifelong |
| Subacute combined degeneration | 1 mg IM alternate days until improvement (often 3 weeks) | 1 mg IM monthly lifelong |
| Diabetic / alcoholic neuropathy | 500–2500 mcg daily × 1–2 weeks | 500–2500 mcg weekly to monthly × 8–12 weeks |
| Post-bariatric surveillance | — | 1 mg IM every 1–3 months (or oral 1500 mcg/day) |
High-dose oral cyanocobalamin 1500 mcg/day is non-inferior to monthly IM in pernicious anaemia (passive diffusion delivers ~1% — sufficient at 1500 mcg). Choose IM (Walcobal) when adherence is uncertain, when the deficiency is severe with neurological signs, when oral malabsorption is profound (e.g. very-low-residue post-bariatric anatomy), or when patients prefer monthly clinic visits to daily tablets. Both routes work.
Bijwerkingen
- Injection site discomfort — pain, transient lump
- Hypokaliëmie (rare, after rapid correction of severe megaloblastic anaemia — rapid red-cell production consumes potassium)
- Acneiform rash at high doses
- Allergische reactie — rare; cyanocobalamin formulations occasionally implicated more than methylcobalamin
Geneesmiddelinteracties
- Metformine — lowers B12 levels with prolonged use; routine annual screening recommended
- PPIs and H2 blockers — reduce dietary B12 absorption (relevant for oral but not IM)
- Chloramphenicol — can blunt haematopoietic response to B12 (rare)
- Folate-only treatment in B12 deficiency — corrects anaemia but allows neurological deterioration; B12 status must be checked before starting folate-only therapy
Contra-indicaties
- Hypersensitivity to cobalamin
- Leber’s hereditary optic neuropathy (theoretical concern with cyanocobalamin; methylcobalamin is preferred)
Opslag
Store below 25°C, protect from light. Use ampoule once opened.
Veelgestelde vragen
Methylcobalamin or cyanocobalamin?
For neurological indications methylcobalamin (Walcobal) is preferred — it is the bioactive form active in cytosolic methylation. For routine deficiency replacement either works. Cyanocobalamin is converted to methylcobalamin and adenosylcobalamin in the body but the conversion is mildly inefficient in some patients (smokers, certain genetic variants).
How quickly will my symptoms improve?
Anaemia: reticulocyte response by day 3–5, normalisation of haemoglobin in 6–8 weeks. Glossitis and macrocytosis: weeks. Peripheral neuropathy: months — nerve recovery is slow and incomplete if damage was prolonged. Subacute combined degeneration: weeks-to-months, partial recovery only if treated early.
Should I have a folate level checked too?
Yes — B12 and folate deficiencies often coexist (especially in alcohol use disorder, malnutrition, malabsorption). Treating folate alone in B12 deficiency masks the anaemia but allows neurological damage to progress. Check both first.
Is het veilig tijdens de zwangerschap?
Yes. B12 requirements rise in pregnancy and deficiency in the mother causes neural tube defects and infant macrocytic anaemia. Methylcobalamin is the preferred form in pregnancy.
Why am I deficient if I eat meat and dairy?
Common causes despite adequate intake: pernicious anaemia (autoimmune intrinsic factor antibodies), atrophic gastritis (very common over age 60), long-term PPI use, long-term metformin, post-gastric surgery, terminal ileal disease (Crohn’s). Dietary deficiency is mainly a vegan/vegetarian issue, not the most common adult cause.
Should diabetics on metformin take B12?
Patients on metformin for >2–4 years should have annual B12 screening. About 10–30% develop deficiency; replacing it (oral 1500 mcg/day or monthly IM) prevents neuropathy that can be confused with diabetic neuropathy.
Can I overdose on B12?
Practically no. B12 is water-soluble with no established upper safe limit. Doses up to 5,000–10,000 mcg daily are used in some clinical settings without toxicity. Excess is excreted in urine (which often turns bright yellow temporarily).
Is Walcobal the same as Methycobal Injection?
Same molecule (methylcobalamin), same indication, same dosing. Brand differences are manufacturer (Walcobal: Wallace Pharma; Methycobal: Eisai/Janssen) and excipients. Clinically interchangeable.
Can I inject it myself?
Methylcobalamin IM is given by deep IM injection (deltoid or upper outer gluteal). Some patients on long-term replacement learn to self-inject — this requires training from a healthcare professional and proper sharps disposal. Most prefer clinic administration monthly.
How does Walcobal compare to oral B12?
Equivalent for most patients at the right dose. High-dose oral 1500 mcg/day is non-inferior to monthly IM in pernicious anaemia. Choose IM when severity is high, adherence is doubtful, or for patient preference.
Andere Vitamines & Mineralen
- Vitamine B12 1500 mcg — high-dose oral cyanocobalamin
- Walcobal Injectie — methylcobalamin IM
- Polybion Ampoule — B-complex parenteral
- Beplex Forte — B-complex oral
- Becozinc — B-complex with zinc
- Thiamine HCL 100 — thiamine 100 mg for alcohol-related neuropathy
































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