Method for delivering Vitamin B12 orally appears to have similar availability as Injection: Cyanocobalamin/Salcaprozate Sodium
The data referenced below presents compelling data for oral cyanocobalamin absorption that may infer similar possibilities for absorption of oral methylcobalamin or hydroxocobalamin (activated forms). If you are a prescriber and would like to explore oral delivery of B12, please contact the pharmacy.
Vitamin B12 and Anemia
Vitamin B12 deficiency and anemia are more common in the United States than many realize — and for too long, options for addressing them have remained fairly limited.
Fortunately, advances in pharmaceutical compounding now offer patients and practitioners an alternative: Cyanocobalamin combined with Salcaprozate Sodium (SNAC), an oral formulation shown to be comparable to traditional intramuscular (IM) injections.
Salcaprozate sodium (SNAC) is a compound used to improve how the body absorbs medications that are typically difficult to take orally — especially large molecules like peptides and proteins. It functions as a permeation enhancer, allowing drugs with naturally low bioavailability to pass more effectively through the gastrointestinal tract. One proposed mechanism is that SNAC temporarily associates with drug molecules, increasing their lipophilicity and making it easier for them to cross biological membranes. The FDA classifies SNAC as Generally Recognized as Safe (GRAS) for use in humans.
This novel delivery method is a potential game-changer for patients who struggle with regular injections or have difficulty absorbing oral B12 from traditional tablets. Many healthcare providers currently rely on methylcobalamin (MeB12) injections for Vitamin B12 deficiency and anemia due to their neurologic support and perceived superior bioavailability. Findings suggest that SNAC technology enables oral absorption that is comparable to intramuscular injection.
By inference, methylcobalamin (activated B12) and SNAC may achieve the same benefits. This supports the potential of compounded cyanocobalamin/SNAC as a practical alternative for patients who are injection/needle-averse, non-compliant with injections, or seeking a more convenient therapy — even if their providers have traditionally used methylcobalamin in injectable form.
But before we get into how this new option works, let’s look at the scope of the issue.
The Prevalence of B12 Deficiency and Anemia in the U.S.
Vitamin B12 deficiency affects approximately 6% of people under 60 and up to 20% of those over 60 in the U.S., according to the National Institutes of Health (NIH). The most common causes include:
- Inadequate dietary intake (common in vegetarians/vegans)
- Malabsorption syndromes (e.g., celiac or Crohn’s disease)
- Atrophic gastritis
- Long-term use of acid-reducing medications
- Pernicious anemia (an autoimmune condition)
B12 deficiency is one of the leading reversible causes of anemia. Anemia itself is widespread, affecting over 3 million Americans each year, with iron, folate, and B12 deficiencies being among the top causes.
Because unaddressed B12 deficiency can lead to irreversible neurological damage, early detection and accessible intervention are essential.
What Is Cyanocobalamin/Salcaprozate Sodium?
Cyanocobalamin is a synthetic form of vitamin B12 used in supplements and injections. Salcaprozate Sodium (SNAC) is an absorption enhancer that helps improve the bioavailability of certain molecules in the gastrointestinal (GI) tract.
When combined, the SNAC allows oral cyanocobalamin to bypass the usual B12 absorption pathways, which are often impaired in people with B12 deficiency. This technology has been explored in other medications like semaglutide (Rybelsus®) to successfully enable oral bioavailability of molecules traditionally given by injection.
Clinical Evidence Comparing Oral Cyanocobalamin/Salcaprozate Sodium Versus Intramuscular
A pivotal Phase 3 clinical trial compared oral cyanocobalamin/SNAC with traditional IM cyanocobalamin in patients with B12 deficiency. The study found that serum cobalamin levels were restored equally well in both groups, demonstrating non-inferiority of the oral formulation.
- Study: Oral delivery of cyanocobalamin using SNAC was clinically equivalent to IM cyanocobalamin in increasing serum B12 levels and improving hematological parameters over 12 weeks.
National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin B12: Fact sheet for health professionals. Retrieved September 30, 2025.
This makes the formulation a viable — and potentially preferable — alternative for many patients
Who Might Be Prescribed B12 (Cyanocobalamin or Methylcobalamin)/Salcaprozate Sodium?
1. Patients with Malabsorption Disorders
Patients with GI conditions like Crohn’s, celiac disease, or atrophic gastritis may struggle to absorb dietary or standard oral B12. This formulation allows for absorption independent of intrinsic factors, making it ideal.
2. Older Patients
Age-related atrophic gastritis reduces acid production, impairing B12 absorption. Oral cyanocobalamin/SNAC may offer a less invasive option for seniors needing consistent therapy without injections.
3. Patients on Proton Pump Inhibitors or Metformin
Long-term use of PPIs or metformin has been shown to impair B12 absorption. These individuals may benefit from this enhanced oral option.
4. Needle-Averse or Patients noncompliant with injection
Patients who fear needles, travel frequently, or have difficulty making regular appointments for injections may prefer a self-administered oral option that maintains therapeutic efficacy.
Who Prescribes It?
This medication may be prescribed by:
- Primary Care Physicians addressing nutritional deficiencies
- Gastroenterologists managing malabsorption disorders
- Endocrinologists in patients with diabetes or thyroid dysfunction
- Hematologists for anemia management
- Geriatricians who prioritize convenience and compliance for older adults
At HDRx, we frequently receive orders for this therapy from functional medicine practitioners, concierge physicians, and clinicians specializing in chronic GI or autoimmune diseases.
When Might It Be the Right Fit? (Hypothetical Scenarios)
Case 1: The Senior on Multiple Medications
Mr. S, age 72, has been experiencing fatigue and memory lapses. Lab tests reveal low B12. He’s also on omeprazole and metformin. Instead of monthly B12 shots, his provider starts him on oral cyanocobalamin/SNAC. After 8 weeks, his serum B12 and symptoms improve — with no injections.
Case 2: The Vegan Professional
Ms. T, a 35-year-old vegan, avoids injections due to anxiety. Despite oral B12 supplementation, her levels remain low. Her doctor prescribes HDRx’s compounded cyanocobalamin/SNAC. Her lab values improve within 3 months without disrupting her lifestyle.
Case 3: The Busy Mom with Crohn’s
Mrs. R, 40, has Crohn’s disease and struggles with fatigue. Past oral B12 supplements didn’t help due to impaired absorption. After switching to oral B12 with SNAC, she sees improvement in fatigue and no longer requires monthly trips to the clinic for injections.
The Compounding Advantage: Why Choose HDRx?
At Healing Dose Compounding Pharmacy (HDRx), we offer a custom-compounded oral cyanocobalamin/SNAC solution designed for optimal absorption and convenience.
Our pharmacy:
- Is PCAB accredited, ensuring the highest compounding quality
- Ships prescription medications to MI, OH, IN, IL, WI, MN, and FL
- Offers consultations for prescribers looking to optimize B12 delivery
We compound this formula into patient-friendly forms such as:
- Sublingual troches
- Oral suspensions
- Rapid-dissolve tablets
Final Thoughts: Providing Options in Modern Care
Vitamin B12 deficiency and anemia don’t have to rely solely on injections anymore. Oral cyanocobalamin with Salcaprozate Sodium represents a modern solution that fits into the evolving landscape of personalized medicine.
If you’re a healthcare provider, HDRx is here to support your prescribing needs with innovative formulations, including oral cyanocobalamin/SNAC.
If you’re a patient struggling with B12 deficiency, ask your doctor if this novel oral option may be right for you.
References
- Andres, E., & Serraj, K. (2012). Optimal management of pernicious anemia. J Blood Med, 3, 97–103. Link
- Green, R. (2017). Vitamin B12 deficiency from the perspective of a practicing hematologist. Blood, 129(19), 2603–2611. Link
- National Heart, Lung, and Blood Institute. (n.d.). Anemia – What is anemia? National Institutes of Health. Retrieved September 30, 2025, from link
- National Institutes of Health, Office of Dietary Supplements. (n.d.). Vitamin B12: Fact sheet for health professionals. Retrieved September 30, 2025, from link
- Sanz-Cuesta, T., Escortell-Mayor, E., Cura-González, I., Martín-Fernández, J., Riesgo-Fuertes, R., Garrido-Elustondo, S., … OB12 Study Group. (2019). Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care: A pragmatic, randomized, multicenter, non-inferiority clinical trial. BMJ Open, 10(8), e033687. Link
- Shipton, M. J., & Thachil, J. (2015). Vitamin B12 deficiency – A 21st century perspective . Clinical medicine (London, England), 15(2), 145–150. Link
