Hi doctor,
I am 21 year old. I am taking tablet Cymbalta 60 mg and tablet Citalopram 10 mg daily for depression and anxiety. Recently, I got a blood test for vitamin B12 and the results turned out to be pretty high at 1344 pg/mL. I am aware that the normal range of vitamin B12 is 200-900 pg/mL. My vitamin B12 is significantly above 900. What does it mean? Should I be worried about the same? Please help.
Hello,
Welcome to icliniq.com.
Based on your query my opinion is as follows.
- Increased vitamin B12 is worrisome. It is a water-soluble vitamin. It never increase unless there is some amount of hepatic damage or certain cancers.
- I strongly urge you to get a liver function test. Both Cymbalta (Duloxetine) and Citalopram are excreted partially or fully through liver and whether they have caused any liver injury needs to be looked into.
- Alcohol or other hepatotoxic drugs, needs to be thought of. ALT (alanine transaminase), AST (aspartate transaminase) enzyme levels can confirm, if there is any liver injury.
- Because of your age, I am suspecting liver injury. Otherwise numerous cancers can cause it like chronic myeloid leukemia, promyelocytic leukemia, polycythemia vera and hypereosinophilic syndrome. Certain solid tumors of liver, pancreas are also known to be associated.
- Hope there is no family history of cancer. Get a complete hemogram and a peripheral smear done. It will help in identifying blood cancer.
- Even in autoimmune disorder it can be increased. There are too many of them. I do not have your complete history, so I cannot comment much on that. At present, I am only worried about liver damage or cancers.
- Get the ALT, AST enzyme levels with complete hemogram with peripheral smear. If normal, then keep checking for once in three to four months for at least a year to make sure you do not have it.
- A single test alone would not mean much. Discuss your doctor regarding the tests.
Revert back after one week with the results to a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist
Thank you doctor,
I was told by my physician not to fast before the blood test. So, I did not fast. Previously, I used to take children's multivitamin. Since one month I have changed to adult vitamins of 100 mcg. But, I know the recommended value of vitamin B12 is 2.4 mcg/day. According to you, vitamin B12 values are generally increased only in case of hepatic damage or few cancers. I would like to know, how do I decrease vitamin B12 level? Has the change of multivitamin resulted in high vitamin B12?
Hi,
Welcome back to icliniq.com.
- You had excess vitamin B12. Studies have shown that even taking 1000 mcg/day delivers only 5-40 mcg of vitamin B12 when taken orally. Anything excess is always excreted through urine.
- Injectable vitamins can cause excess level as it is direct. But, orally it is very rare.
- Possibilities of malignancies are low at this age. Alcohol or drug induced hepatitis may be the cause.
- I would recommend you to repeat the vitamin B12 assay after stopping vitamin B12 supplements for 10 to 15 days.
- The gut bacteria and diet contains vitamin B12. So, you need not worry about it. Presently stopping vitamin B12 is a good option.
- If vitamin B12 level does not reduce, then you will have to get the tests of liver and complete hemogram with peripheral smear.
- Keep monitoring your vitamin B12 levels for a year in interval of every two to three months.
Revert back for further information to a hematologist online --> https://www.icliniq.com/ask-a-doctor-online/hematologist
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