Patient/caregiver was educated on how to take Vitamin B12 as follows:

1. Take this medication as ordered by your physician. Do not change the dose and frequency on this medication without consulting your doctor. Take the medication dose for the duration prescribed without fail.
2. Take the medication dose at the same time, every day, to avoid forgetting the intake of medication.
3. Taking the medication at regularly spaced intervals help maintain appropriate blood levels of Vitamin B12 needed to derive the beneficial effects.
4. If Vitamin B12 use on empty stomach results in nausea and vomiting, it may be taken with a small snack, to help avoid the unpleasant gastrointestinal symptoms.
5. Take the Vitamin B12 regular tablet as a whole, using a glass of water. If you encounter difficulty swallowing the whole tablet, you may cut the tablet and swallow it in pieces with a glass of water. You can also crush the regular tablet and sprinkle the powder on a spoon of apple sauce or jello or pudding, to facilitate an easy swallow.
6. If you are prescribed Vitamin B12 extended-release softgel capsule, try to swallow the capsule as a whole, with a glass of water. Do not cut, crush, or chew the extended-release tablet, as it can damage the extended-release coating on the soft gel capsule, which can result in rapid release and absorption of the supplement into the blood stream, thus resulting in toxicity and compromising the therapeutic benefit of the supplement.
7. In individuals with difficulty swallowing, Vitamin B12 supplement could also be administered as an orally chewable tablet or a lozenge that are sucked on and allowed to dissolve in the mouth completely and swallowed, as it dissolves.
8. Vitamin B12 is absorbed in the intestines and individuals with history of intestinal malabsorption and intestinal resections can have poor absorption of the supplement, when administered orally. Vitamin B12 can be administered by intramuscular or intravenous injection or nasal inhalation in such individuals, to cover for the deficiency.
9. Increasing the intake of food naturally rich in Vitamin B12, such as, meat, poultry, eggs, milk, and dairy products can significantly help offset the symptoms of Vitamin B12 deficiency.
10. Vitamin B12 is mainly needed by your body for cell growth and multiplication, production of red blood cells, and synthesis of myelin, which is needed for proper functioning of nerves. Deficiency of this vitamin can therefore result in reduced cell growth and multiplication compromising production of active new cells in the body, reduced energy, listlessness, malaise, anemia, peripheral neuropathy.
11. Vitamin B12 can take some time to fairly adjust to your body and reach a therapeutic level in your blood, before controlling symptoms of anemia and neuropathy. Do not discontinue taking the medication without your physician’s consult, as you failed to see the desired result immediately after taking the medication.
12. If you are prescribed Vitamin B12 for relief of symptoms of anemia, report to your physician regarding any continuing or worsening signs and symptoms of anemia, such as, shortness of breath, poor endurance and exercise tolerance, pale skin, fatigue, weakness, and general malaise.
13. If you are prescribed Vitamin B12 for relief of neuropathy, report to your physician regarding any worsening signs and symptoms of neuropathy in the extremities, such as, altered sensation, tingling and numbness, reduced sensitivity to touch or pain, and/or burning sensation. The symptoms of neuropathy due to deficiency of Vitamin B12 could not be completely reversed with the supplement.
14. Your physician could change the dose of Vitamin B12, based on the relief obtained or any side-effects developed. So, maintain compliance with follow-up physician appointments, to update on the relief from symptoms. Be accommodative to the plan of dose changes, if need be, until you show an optimum response.
15. Periodical labs could be drawn for blood cell counts, to evaluate improvement with anemia. Labs could also be drawn for therapeutic blood levels of Vitamin B12. Observe compliance with any lab draws ordered.
16. Continue taking Vitamin B12 as ordered, even if you experience relief from the symptoms. Abrupt discontinuation can result in deficiency of Vitamin B12 levels, thus resulting in recurrence of symptoms of anemia and neuropathy. Discontinuing the medication should only be on your physician’s recommendation.
17. If you miss a dose, try taking it at the earliest notice of noncompliance. If it is time for the next dose, skip the missed dose and take the dose scheduled. Do not take an extra dose to try making up for the missed dose. Notify your doctor and other health care personnel regarding your dose noncompliance.