Vitamin B12 in Pakistan

• You have symptoms the NHS lists for a B12 deficiency, such as extreme tiredness, a lack of energy, pins and needles, a sore and red tongue, mouth ulcers, muscle weakness or problems with your vision.
• Warning: You have numbness, problems with balance and coordination, or incontinence: the NHS says a B12 deficiency can affect your brain and nervous system, and that some problems can be irreversible if left untreated.
• You take metformin or a proton pump inhibitor (PPI): the NHS says these medicines can reduce the amount of vitamin B12 in your body. Do not stop them without talking to your doctor.
• You eat a vegan diet and don’t take B12 supplements or eat foods fortified with B12, which the NHS says puts you at risk.
• Warning: You have had part of your stomach removed, have Crohn’s disease, or have pernicious anaemia, which the NHS says is the most common cause of B12 deficiency in the UK. The NIH says people with pernicious anaemia have trouble absorbing B12 from foods and supplements.

From the NHS pages on the symptoms and causes of vitamin B12 or folate deficiency anaemia, and the NIH vitamin B12 fact sheet. Martin Dow’s Pakistani leaflet for Neurobion injection says it should not be given to patients with suspected vitamin B12 deficiency without first confirming the diagnosis.

• The NIH says B12 in supplements is usually cyanocobalamin, that other common forms include methylcobalamin, and that research has not shown that any form of supplemental vitamin B12 is better than the others.
• Sublingual tablets dissolve under your tongue. The NIH says evidence suggests no difference in efficacy between oral and sublingual forms.
• On our shelf, B-Sub and Nutraxin are sublingual methylcobalamin and Methyl is a methylcobalamin tablet, according to their packs. Sukooon’s Mecofeb is cyanocobalamin, to swallow, according to its maker, despite the “Meco” in its name.

• Neurobion tablets combine vitamins B1, B6 and B12 (cyanocobalamin), and are a registered drug in Pakistan.
• Neuromet tablets contain mecobalamin, which is methylcobalamin, and are a registered drug in Pakistan.
• Supravit-M is a multivitamin and mineral tablet, registered with DRAP (registration 018685), with 9 micrograms of vitamin B12 per tablet among its ingredients. The NIH says multivitamin and mineral supplements typically contain 5 to 25 mcg of B12.

Neurobion and Neuromet have their own pages, with their prices, ingredients and cautions.

• Methycobal Injection, made by Hilton Pharma, contains mecobalamin 500 micrograms in each 1 ml ampoule and is registered with DRAP (registration 010313).
• Neurobion Injection, made by Martin Dow Marker, contains vitamins B1 and B6 with 1,000 micrograms of vitamin B12 (cyanocobalamin) in each 3 ml ampoule, according to its leaflet, and is registered with DRAP (registration 001485).
• The NHS says that in the UK, B12 deficiency anaemia is usually treated with injections of hydroxocobalamin, given by a GP or nurse, and that hydroxocobalamin is preferred to cyanocobalamin because it stays in the body for longer.

• The NIH says no upper limit has been set for vitamin B12, because of its low potential for toxicity.
• Warning: Combination tablets carry the limits of their other ingredients. Neurobion tablets contain 200 mg of vitamin B6 each, and Martin Dow’s leaflet for Neurobion injection says nerve damage has been seen with more than 50 mg of vitamin B6 a day taken for more than 6 to 12 months.
• Warning: Folic acid can hide a B12 deficiency: the NHS says that before you start taking folic acid, your GP will check your B12 levels, because folic acid treatment can sometimes improve your symptoms so much that it masks an underlying B12 deficiency.
• The NHS says a blood test is often carried out around 7 to 10 days after starting treatment to check that it is working.

From the NIH vitamin B12 fact sheet for health professionals, the NHS treatment page and Martin Dow’s Neurobion injection leaflet.

When we searched DRAP’s drug registry on 5 November 2026, B-Sub, Nutraxin, Methyl and Mecofeb were not listed as registered drugs; Supravit-M, Neurobion, Neuromet and Methycobal were. DRAP’s Health & OTC product index was unavailable when we tried to check. Under S.R.O. 1688(I)/2026 of 6 October 2026, DRAP notified food supplements in pharmaceutical dosage forms as therapeutic goods under the DRAP Act, 2012.