Tanya

 

 

 

 

 

 

 

 

TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

24 July 2000 - 24 July 2020

Twenty years online!

(Not tax deductible since I am a private individual)

 

 

          

 

 

B VITAMINS, INCLUDING VITAMIN B12 (METHYLCOBALAMIN)

 

ON THIS PAGE:


The Different Types of B Vitamin


Why B Vitamins Are Important for CKD Cats


Which B Vitamins to Give


Vitamin B Complex


B Vitamins with Iron


B Vitamins with Potassium


Methylcobalamin (Vitamin B12)


 

 

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Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


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Home > Diet and Nutrition > B Vitamins

 


Overview


  • B vitamins are essential for good health. However, they are water-soluble, so are often lacking in CKD cats, who lose much of their vitamin B through the increased urination associated with the disease.

  • Cats who are not eating much will also probably not be taking in enough B vitamins.

  • A lack of vitamin B may in itself cause loss of appetite, or occasionally may cause twitching or itching. Vitamin B deficiencies are also known to cause non-regenerative anaemia.

  • B vitamin supplements are safe and can often help a CKD cat feel better.

  • Vitamin B12 in the form of methylcobalamin may be particularly helpful.


The Different Types of B Vitamin


 

Although vitamin B is commonly referred to as if it were a single vitamin, there are actually eight B vitamins. These are essential vitamins, which means that they cannot be manufactured in the cat's body, so must be obtained from external sources (i.e. from food or a supplement). They are all water soluble, so they cannot be stored by the body.

 

B Vitamin

Alternative Name

B1

Thiamine

B2

Riboflavin

B3

Niacin or niacinamide

B5

Pantothenic acid

B6

Pyridoxine or pyridoxamine

B7

Biotin, also known as vitamin H

B9

Folic acid or folate, also known as vitamin M

B12

Cyanocobalamin or methylcobalamin

 

PetCoach explains more about the different B vitamins.

 

Nutritional management of renal disease (2008) Sturgess K Presentation to the World Small Animal Veterinary Association World Congress has a table showing the recommended intake of the various B vitamins for CKD cats. Remember, this is total intake, i.e. it includes vitamin B in food.

 


The Importance of B Vitamins


 

The B vitamins play a role in many important bodily functions. This table shows the areas where each B vitamin plays a rôle and possible signs of a deficiency:

 

B Vitamin

Alternative Name

Important For

Symptoms of Deficiency

Total Daily Requirement

B1

Thiamine

Nerve function and appetite

Neurological problems, loss of appetite

0.01 mg/lb

B2

Riboflavin

Vision and heart function

Cataracts, fatty liver

0.05 mg/lb

B3

Niacin or niacinamide

Appetite and

red blood cell production

Loss of appetite and weight loss, bloody diarrhoea

0.12 mg/lb

B5

Pantothenic acid

Skin and coat

Itching, poor coat, diarrhoea

0.10 mg/lb

B6

Pyridoxine or pyridoxamine

Skin and coat and

red blood cell production

Anaemia, itching, poor coat, seizures, kidney lesions

.010 mg/lb.

B7

Biotin, also known as vitamin H

Skin and coat

Itching, poor coat, diarrhoea

0.001 mg/lb

B9

Folic acid or folate, also known as vitamin M

Red blood cell production

Anaemia, increased iron levels in blood

0.002 mg/lb

B12

Cyanocobalamin or methylcobalamin

Red blood cell production, nerve function and appetite

Anaemia, weight loss; vomiting; diarrhoea

.00025 mg/lb

 

Appetite


Your cat's nutritional needs (2006) National Research Council states "Thiamin and niacin deficiency may contribute to anorexia associated with renal failure."

 

Pharmacological appetite stimulation: rational choices in the inappetent cat (2014) Agnew W & Korman R Journal of Feline Medicine and Surgery 16(9) pp749-56 says "Cats have a higher requirement for some B  vitamins  when  compared  with  dogs. Experimental depletion of B vitamins results in  anorexia  in  other  species. Supplementation with B vitamins may prevent this occurring, although no evidence exists to confirm this. Still, provision of B vitamins is simple and should be considered in all inappetent cats."

 

Muscle and Nerve Function


Some B vitamins are important for muscle and nerve function. Deficiencies may cause twitching or itching, and sometimes diarrhoea.

 

Red Blood Cell Production


Four of the eight B vitamins play a rôle in red blood cell production. A deficiency may cause non-regenerative anaemia. Your cat's nutritional needs (2006) National Research Council states "Human patients with CKD apparently are especially prone to pyridoxine and folate deficiency (Gilmour et al, 1993)."

 

Anaemia of renal disease: what is it, what to do and what's new (2011) Chalhoub S, Langston C & Eatroff A Journal of Feline Medicine and Surgery 13(9) pp629-40 states "Several B vitamins are necessary for erythropoiesis, including cobalamin (B12), folic acid (B9), niacin (B3) and pyridoxine (B6). Deficiencies of these vitamins may exacerbate anemia and increase erythropoietin resistance."

 

Coat and Skin


Vitamin B deficiencies may cause itching and poor coat.

 

Heart


Nutritional aspects of heart disease (2012) Di Tollo BA Veterinary Focus 22(1) pp11-16 states "cats with heart disease need more B vitamins than healthy cats. Diets for cats with heart disease should therefore contain levels of water-soluble vitamins 2-3 times higher than that found in food for healthy cats."

 

Thiamine Deficiencies


A mild deficiency of vitamin B1 (thiamine) can cause loss of appetite and vomiting, while a severe deficiency can cause numerous health problems, including an inability to lift the head, blindness, seizures and even death.

 

Thiamine deficiency is not common, but can arise for a number of food-related reasons. Cats who eat fish regularly can develop thiamine deficiency (see Which Foods to Feed). There have also been food recalls in the past of commercial cat foods because they did not contain sufficient thiamine, including a recall in February 2017 of some Pets at Home dry cat foods in the UK, as reported by the Food Standards Agency.

 

There may be concerns even if foods are not recalled. Analysis of thiamine concentrations in commercial canned foods formulated for cats (2014) Markovich JE, Freeman LM & Heinze CR Journal of the American Veterinary Medical Association 244(2) pp175-179 examined ninety US canned cat foods and found 13.3% of the foods contained lower thiamine levels than recommended by AAFCO. Pâté-style foods and foods from smaller manufacturers were more likely to be affected, though dry foods have also been implicated in the past. The study recommends that vets should consider thiamine deficiency as a possible cause when presented with a cat with ventroflexion (an inability to lift the head). Another common cause of ventroflexion is low potassium levels.

 

Thiamine deficiency (2006) Schaer M NAVC Clinician's Brief August 2006 has a short article about thiamine deficiency, including photos of an affected cat.

 

Thiamine deficiency made my cat crazy! (2017) Steele MS VCA Animal Specialty Group discusses the case of a cat who developed neurological problems linked to a thiamine deficiency caused by a fish-based diet.

 


The Importance of B Vitamins for CKD Cats


 

B vitamins are particularly important for CKD cats because these vitamins are water-soluble, so are often lacking in CKD cats who lose much of their vitamin B through the increased urination associated with CKD. Cats who are not eating much will also probably not be taking in enough B vitamins. In addition, CKD cats are prone to many of the problems caused by vitamin B deficiencies anyway, such as appetite loss or anaemia. Your cat's nutritional needs (2006) National Research Council says "these patients are at risk for B-vitamin deficiency because of decreased appetite, vomiting, diarrhea and polyuria."

 

Managing anemia in patients with chronic kidney disease (2011) Chalhoub S, Langston CE Veterinary Medicine May 2011 says "B vitamins, such as vitamin B12, folic acid, niacin, and vitamin B6, are important for erythrogenesis. Supplementation is recommended in polyuric patients; however, the contribution of vitamin supplementation to the overall correction of anemia is minimal." I am not sure I agree that vitamin B supplementation has a minimal effect on anaemia. In my experience, for some CKD cats with mild to moderate anaemia (PCV or HCT of 20-30%), this may be the only treatment they need.

 

Folate (Vitamin B9)


Folate (vitamin B9) is important for red blood cell production (see above), but it may be of additional use to CKD patients. Efficacy of folic acid therapy on the progression of chronic kidney disease. The renal substudy of the China Stroke Primary Prevention Trial (2016) Xu X, Qin X, Li Y, Sun D, Wang J, Liang M, Wang B, Huo Y, Hou F Journal of the American Medical Association Internal Medicine 176(10) pp1443-1450 found that giving folic acid together with an ACE inhibitor (enalapril) to human CKD patients with hypertension in China "can significantly delay the progression of CKD among patients with mild-to-moderate CKD."

 

Niacin (Vitamin B3)


Niacin ameliorates oxidative stress, inflammation, proteinuria, and hypertension in rats with chronic renal failure (2009) Cho K, Kim H, Rodriguez-Iturbe B & Vaziri ND American Journal of Physiology - Renal Physiology 297 ppF106–F113 looked at the use of niacin in rats with artificially induced kidney disease (5/6ths of their kidneys were surgically removed). The study found that rats given 50mg/kg of niacin in their drinking water for twelve weeks appeared to do better than rats not given niacin. The study concludes "niacin supplementation helps to attenuate histological injury and mitigate upregulation of oxidative and inflammatory systems in the remnant kidney."

 

A slightly later study by the same authors, Niacin improves renal lipid metabolism and slows progression in chronic kidney disease (2010) Cho KH, Kim HJ, Kamanna VS & Vaziri ND Biochimica et Biophysica Acta 1800(1) pp6-15 concludes "Niacin administration improves renal tissue lipid metabolism and renal function and structure in experimental CRF."

 

One human study, A randomized double-blind placebo-controlled trial of niacinamide for reduction of phosphorus in hemodialysis patients (2008) Cheng SC, Young DO, Huang Y, Delmez JA & Coyne DW Clinical Journal of the American Society for Nephrology 3(4) pp1131–1138, found that vitamin B3 (niacin) helped reduce phosphorus levels. The patients in the study did continue to receive standard phosphorus binders during the trial as well, but later trials used vitamin B3 alone to control phosphorus levels. See Phosphorus Binders for more information on this.

 


Which B Vitamins to Give


 

Your vet will often routinely offer vitamin B supplementation for your cat. If not, I would raise the subject yourself. This is particularly important if your cat is anaemic or at the low end of the laboratory range for PCV or HCT (measures of anaemia), but even non-anaemic cats often seem to feel and act better when given additional B vitamins, exhibiting improved appetite and increased energy levels.

 

Many people with CKD cats give their cat two main forms of vitamin B supplement:

  • vitamin B complex; plus a

  • separate vitamin B12 supplement

Vitamin B Complex


Although you can buy the eight B vitamins individually, it can be fiddly and more expensive to work out the correct dose for a cat. You need to be careful not to over-supplement B6 and B9 in particular. Therefore most people use vitamin B complex for their CKD cats, as described below.

 

Vitamin B12


Vitamin B12 can be particularly useful for CKD cats, but there is only a relatively small amount of vitamin B12 in most B complex supplements, so some people give a separate B12 supplement as well. This is especially important for anaemic cats. There is more about vitamin B12 below.

 


Vitamin B Complex


 

B vitamins need to be in a certain ratio to each other, so many people buy their supplements in the form of a vitamin B complex. These are usually human products and they are supposed to contain the correct balance of B vitamins, though obviously if you are using a human product, you will need to reduce the dose so it is suitable for a cat..

 

B vitamins are sensitive to heat and light so are best kept in a cool dark place.

 

B vitamins may make urine yellow or orange, so don't panic if you see this.

Vitamin B Complex Requirements


There are a number of recommendations for total daily vitamin B intake for cats, and they can vary quite a lot. Here are the recommendations from the National Research Council for B vitamins for a healthy cat compared with the recommendations for a CKD cat from Dr K Sturgess:

 

 

Healthy Cat

CKD Cat

B Vitamin

The National Research Council

Nutritional management of renal disease

9 lb (4 kg) cat

eating 250 calories per day

9 lb (4 kg) cat

B1

thiamine

0.33 mg

0.32 - 1.0 mg

B2

riboflavin

0.27 mg

0.36 - 1.28 mg

B3

niacin or nicotinamide

2.5 mg

3.6 - 7.2 mg

B5

pantothenic acid

0.4 mg

0.3 - 0.72 mg

B6

pyridoxine or

pyridoxamine

0.16 mg

0.28 - 0.8 mg

B7

biotin

Also known as vitamin H

na

6.0 - 12.0 μg

B9

folic acid or folate

Also known as vitamin M

47 µg

64 -160 μg

B12

cobalamin

1.4 µg

1.2 - 4.0 μg

 

You will note some of the measurements are in mg and some are in μg, be careful not to get these confused because they are very different.

  • mg = milligram

  • μg  = microgram

  • A microgram is 1000 of a milligram i.e. 1000 μg = 1 mg

Vitamin B Complex Formulations


There are three main ways to give vitamin B complex:

  • orally

  • injected into the cat

  • injected into the subcutaneous fluid bag

There are a wide range of vitamin B complex products available throughout the world. The vast majority are made for humans but these are commonly used for cats in reduced, cat-sized doses. Here are some products which are widely used on Tanya's CKD Support Group, but check with your vet before using.


Oral Vitamin B Complex


Here are the most popular brands on Tanya's CKD Support Group. Be sure to check with your vet before you use any of these products, because your vet may wish you to give less of certain B vitamins. If so, you should of course comply.

 


Oral Vitamin B Complex: Human Products


 

B vitamin supplements are widely available for human use, and therefore need to be divided into cat-sized doses. The general rule of thumb is to give a 10 lb cat approximately 1/10th of a human dose each day. Thus, if you buy a product where the dose for a human is one capsule a day, one capsule would be enough  to last a cat for ten days.

 

Ideally, you then want to divide this daily dose further into 2-3 doses each day if you can, but in practice that is not easy, since you are talking tiny amounts.

 

If you buy tablets, you can crush them and divide them (usually into ten) after crushing. If you use capsules, you can open the capsule and divide its contents. Either way, it can be fiddly obtaining cat-sized doses, but there are tips below.

 

Jarrow's B-Right


Jarrow Formulas B-Right is a popular choice because it contains all the B vitamins including B9 (folic acid), and some B12 in the favoured methylcobalamin form. It is also widely available.

 

The formulation changes at intervals, but the current formulation (August 2020) appears to be acceptable and is used by many people on Tanya's CKD Support Group with no problems.

 

 

Jarrow's B-Right: Sources


Jarrow's B-Right is widely available.

 

USA

Vitacost sells 100 capsules of Jarrows B-Right  for US$13.74. Shipping is a flat rate US$4.99 per order.

 

iHerb sells 100 capsules of Jarrows B-Right for US$15.02 plus shipping (US$4 to NYC).

 

Amazon sells 100 capsules but they are currently (August 2020) not available.

 

UK

Amazon UK sells 100 Jarrows B-Right capsules for Ł16.95.

 

Australia

Megavitamins sells Jarrows B-Right in Australia for AUD$36.50 plus shipping.

 

Swanson Ultra Activated B-Complex High Bioavailability


Swanson Ultra Activated B-Complex High Bioavailability has become more popular on Tanya's CKD Support Group in recent times.

 

This product contains all eight B vitamins, but it also contains inisotol (previously known as vitamin B8) and PABA (previously known as vitamin B10). WonderLabs explains how they are no longer referred to as B vitamins because they no longer fit the definition of a vitamin.

 

USA

Swanson sells 60 capsules for US$8.84.

 

UK

Swanson sells the product in the UK. It is available from a UK distributor, though this is currently out of stock; however, you can have it shipped from the USA.

 

Dividing Human-Sized Vitamin B Complex Capsules Into Cat-sized Doses


I have been asked so often about how to divide the small amount in these capsules into ten. There are a number of ways people on Tanya's CKD Support Group do this:

  • Empty the contents of the capsule onto foil and divide it roughly into ten with a knife or razor.

  • Pour the capsule contents into a shallow bowl or plate and divide it into ten.

  • Use measuring spoons. These are discussed here. These spoons can vary a bit in size depending upon the manufacturer but apparently the drop spoon holds about a tenth of a Jarrows B-Right capsule and the smidgen spoon holds about an eighth of a Jarrows B-Right capsule. The easiest way to determine which size spoon to use is to divide the capsule contents into ten, then tip a tenth into the spoon you think might work; however, once you've decided which size spoon to use, you can just scoop up enough of the powder to fill the spoon.

Ideally, you then want to divide the daily dose further into 2-3 doses each day if you can, but in practice that is not easy, since you are talking tiny amounts. Therefore once the original capsule contents have been divided into ten cat-sized doses, most people find the simplest thing is to decant the portions into ten empty gelatin capsules and give a capsule once daily. People dividing their dosage on pieces of foil may carefully tear the foil and fold it into a funnel shape, which they then use to pour the powder into an empty gelcap. Other people prefer to buy a little funnel specially for this task. Members have used this Torpac one, or have found them in the USA at Bed, Bath and Beyond for about US$2.

 

One person actually found that if she emptied out the contents of a Jarrows B-Right capsule, the correct cat-sized dosage (one tenth of the original capsule) filled one half of a size 5 gelcap to the top, so she simply used the empty size 5 gelcap to scoop up the powder. She could then pop other medications in the capsule as well if necessary, by squashing down the powder with the additional medications.

 


Oral Vitamin B Complex: Veterinary Products


 

Thorne B-ComplexVet


ThorneVet B-ComplexVet is a veterinary product which contains B vitamins including methylcobalamin. It is available as a soft chew, though I don't know if cats would be happy to eat it as is or not.

 

It also contains some rather odd ingredients, including rosemary extract, coconut oil and white vinegar. Personally, I think I'd stick to the human products discussed above.

 

Oral Vitamin B Complex Dosages for Commonly Used Products


Here are tables showing the composition of the above mentioned products and how much of each B vitamin you would be giving if you gave the usual cat-sized dosages:

 

 

Recommended Total Daily Intake Including From Food for a

9 lb (4 kg)

CKD Cat

Human Products

Veterinary Products

Jarrows

B-Right

Swanson Ultra Activated High Bioavailability

Thorne B ComplexVet

B Vitamin

 

One capsule contains:

One capsule contains:

One capsule contains:

B1 Thiamine

0.32 - 1.0 mg

25 mg

36 mg

110 mg

B2 Riboflavin

0.36 - 1.28 mg

25 mg

25 mg

 18.2 mg

B3 Niacin

3.6 - 7.2 mg

25mg

50 mg

140 mg

B5 Pantothenic Acid

0.3 - 0.72 mg

125 mg

25 mg

120 mg

B6 Pyridoxine

0.28 - 0.8 mg

35 mg

25 mg

15.8 mg

B7 Biotin

6.0 - 12.0 μg

300 mcg

25 mcg

400 mcg

B9 Folic Acid

64 -160 μg

400 mcg

400 mcg

400 mcg

B12 Cobalamin

1.2 - 4.0 μg

100 mcg

250 mcg

400 mcg

Commonly used dosage for cats:

One tenth of a capsule

per day

One tenth of a capsule

per day

One quarter of a

soft chew per day

 

If you give the usual cat-sized doses of these products, you would be giving:

 

 

Recommended Total Daily Intake Including From Food for a

9 lb (4 kg)

CKD Cat

Human Products

Veterinary Products

B Vitamin

Jarrows

B-Right

Swanson Ultra Activated High Bioavailability

Thorne B ComplexVet

Commonly used dosage for cats:

 

One tenth of a capsule

per day

One tenth of a capsule

per day

One quarter of a capsule

per day

B1 Thiamine

0.32 - 1.0 mg

2.5 mg

3.6 mg

27.5 mg

B2 Riboflavin

0.36 - 1.28 mg

2.5 mg

2.5 mg

4.55 mg

B3 Niacin

3.6 - 7.2 mg

2.5 mg

5.0 mg

35 mg

B5 Pantothenic Acid

0.3 - 0.72 mg

12.5 mg

2.5 mg

30 mg

B6 Pyridoxine

0.28 - 0.8 mg

3.5 mg

2.5 mg

3.95 mg

B7 Biotin

6.0 - 12.0 μg

30 mcg

2.55 mcg

100 mcg

B9 Folic Acid

64 -160 μg

40 mcg

40 mcg

100 mcg

B12 Cobalamin

1.2 - 4.0 μg

10 mcg

25 mcg

100 mcg

 

As you can see, there are quite a few differences between the various formulations. Be guided by your vet as to the best approach for your cat.

 


Injectable Vitamin B Complex


I think every vet on the planet has this available. My vet often gives my cats a one-off shot if they are off colour, but for CKD cats who are not visiting the vet every week or so, it can be easier to give the shots at home.

 

Injectable B complex (which is yellow) does sting when injected though, so oral dosing may be better; but it might be worth using the injectable form in vomiting cats.

 

Some vets add vitamin B complex to the sub-Q fluids bag, but this is not a good idea because it can make the fluids sting; it can compromise the sterility of the bag; and giving vitamins in this way (i.e. added by the vet) tends to increase the cost of the fluid bags. In addition, since most people warm their fluids before using them, the B vitamins could well be rendered ineffective through the repeated warming.

 

Vedco 1000mcg strength is used by some members of Tanya's CKD Support Group in the USA. It requires a prescription.

 

Injectable Vitamin B Complex Dosages


For humans, the recommended dosage of the Vedco product is 1-5ml per 100 lbs of bodyweight given once or twice a week.

 

For a 10 lb (4.5kg) cat, the equivalent dose would be 0.1 - 1.0 ml once or twice a week, but the Vedco link says "Dogs and Cats 0.25 to 0.5 mL May be repeated once or twice a week, as indicated by the condition and response of the animal." Be guided by your vet.

 

The Vedco product contains a relatively high amount of vitamin B1 (thiamine) and Vedco does mention "Parenteral administration of thiamine has resulted in anaphylactic shock. Administer slowly and with caution doses over 1/3 mL (50 mg thiamine)."

 

Injectable Vitamin B Complex Sources


 

USA

Thriving Pets sell a 100ml bottle of injectable vitamin B complex for $9.95. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$100. Shipping is free for orders over US$49 after the discount.

 

UK and Other Countries

I do not know of any stockists but your vet probably can assist.

 

Vitamin B Complex Cautions


The US Food and Drug Administration (2017) warns that in humans, taking large doses of biotin supplements may adversely affect test results for T4, T3 and parathyroid hormone (PTH).

 

Avoid products containing alpha lipoic acid, because it is toxic to cats. Increased vocalisation in elderly cats (2015) Gunn-Moore DA European Journal of Companion Animal Practice 25(3) pp20-29 states "Unfortunately, alpha-lipoic acid is toxic in cats so products containing it should not be given."

 

NutriVed is something I used to recommend but I discovered it now apparently contains propylene glycol, which is safe for dogs but not allowed in cat foods because it can cause red blood cell abnormalities, not exactly what you want in an anaemic cat. Propylene glycol: educate yourself and your veterinary clients (2015) Scheidegger S DVM360 Magazine explains more about propylene glycol.

 

Hi-Vites and Felovite II are US multivitamin products. There is nothing wrong with these products as such, but unfortunately they tend to be too high in vitamin A and D for a CKD cat, and Felovite II also contains phosphorus. Several cats on the support group have not done well on Hi-Vites in particular.

 

Aventi KP Kidney Support (formerly Renal Advanced) is a product made by Candioli which is commonly offered to people in Italy and Canada. Drugs has some information about it. It contains vitamin B6, vitamin B12 and vitamin B9 (folic acid), plus probiotics. However, it also contains prebiotics in the form of fructooligosaccharides (FOS) which may increase calcium levels in some cases. Personally I would just use B vitamins, and give a probiotic separately if appropriate.

 

Renal Essentials is another product which contains a few B vitamins together with other ingredients including additional potassium. Not all CKD cats need added potassium, but if yours does, there is probably not enough potassium in this product to make a difference. Again, I would just use B vitamins, and give potassium separately if appropriate.

 


B Vitamins with Iron: Pet-tinic (Pet-Tabs Iron-Plus)


 

Some cats (typically anaemic ones) may need iron as well as B vitamins. In these cases it is usually easier to use a combined product, but you should never give iron to a cat with an infection. Most people on Tanya's CKD Support Group use Pet-tinic. The dosage recommended by the manufacturer for a 10lb (4.5kg) cat is 1 ml twice a day.

 

Vitamin B

One teaspoon (5ml) contains

Recommended Dose Twice a Day

Total Daily Dose

B1 thiamine

2.0 mg

0.4 mg

0.8 mg

B2 riboflavin

1.0 mg

0.2 mg

0.4 mg

B3 niacin

10.0 mg

2.0 mg

4.0 mg

B6 pyridoxine

1.0 mg

0.2 mg

0.4 mg

B12 cyanocobalamin

2.1 mcg

0.21 mcg

0.42 mcg

Iron

12.5 mg

2.5mg

5.0 mg

 

You can read more about it, including where to purchase it, here.

 


Vitamin B with Potassium (Kaminox or Renal K+)


 

Products with Potassium: Renal K+, Amino B & K and Kaminox


These products contain both B vitamins and potassium gluconate, though whether the amounts of vitamin B are enough to be of any real benefit is debatable, and not every CKD cat needs additional potassium. Some of them also contain iron, which may be necessary for anaemic cats, but which should never be given to a cat with an infection.

 

Personally I would use separate potassium and B vitamins products as appropriate, which should also work out cheaper.

 

See Potassium for more information on these products.

 


Vitamin B12 - Cobalamin (Methylcobalamin and Cyanocobalamin)



What is Vitamin B12?


 

Vitamin B12, or cobalamin, is important for nerve cells, energy production and red blood cell production. A lack of vitamin B12 may contribute to a variety of problems, including cognitive dysfunction.

 

Although vitamin B12 is often included in vitamin B complex formulations, there is usually too little vitamin B12 for it to be of much use. Therefore many people with CKD cats give both a vitamin B complex and a separate vitamin B12 product.

 

Oregon State University has some information about vitamin B12.

 

Prescribers' Drug Reference Health has some information about methylcobalamin in humans.

 


Vitamin B12 Deficiencies


 

A vitamin B12 deficiency can be found in patients with a variety of different conditions.

  • Cats with IBD or pancreatitis tend to have low levels of cobalamin.


Vitamin B12 and CKD


 

Vitamin B12 may be particularly useful for CKD cats. According to Renal and Urology News, B12 supplements help reduce inflammation in CKD.

 

Chronic renal failure promotes severe variant of Vitamin B12 deficiency (2006) Duning T, Nabavi DG, Dziewas R, Kugel H & Schäbitz W-R European Neurology 56 pp62–65 reports on the case of a human CKD patient with vitamin B12 deficiency and concludes that CKD patients "may require earlier and much larger therapeutic cobalamin doses than previously considered."

 

Many CKD cats have anaemia. Vitamin B12 is essential for red blood cell production, so too low a level of vitamin B12 in your cat's body may cause or contribute to anaemia, therefore vitamin B12 supplements may help treat anaemia. Treatment of confirmed B12 deficiency in hemodialysis patients improves Epogen requirements (2013) Saifan C, Samarneh M, Shtaynberg N, Nasr R, El-Charabaty E & El-Sayegh S International Journal of Nephrology and Renovascular Disease 6 pp9–93 found that giving vitamin B12 supplements to human CKD patients with low levels of vitamin B12 led to a reduced need for ESAs to treat CKD-related anaemia.

 

Medicines used to control gastric hyperacidity such as famotidine (Pepcid AC), ranitidine (Zantac 75) or omeprazole (Prilosec) may reduce the absorption of vitamin B12 from food. Proton pump inhibitor and histamine H2 receptor antagonist use and vitamin B12 deficiency (2013) Lam JR, Schneider JL, Zhao W & Corley DA Journal of the American Medical Association 310(22) pp2435-2442 found that in humans "gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency." Oregon State University states "Proton-pump inhibitors (e.g., omeprazole and lansoprazole)...markedly decrease stomach acid secretion required for the release of vitamin B12 from food but not from supplements." Therefore if you are using acid blockers, your cat might benefit from a vitamin B12 supplement.

 

Vitamin B12 has been found by members of Tanya's CKD Support Group to be very helpful for various CKD-related problems, including anaemia, incontinence, appetite loss and constipation. It is safe and easy to obtain and to give, so speak to your vet about supplementing it.

 


Vitamin B12: Methylcobalamin versus Cyanocobalamin


 

There are two forms of cobalamin (vitamin B12), cyanocobalamin and methylcobalamin, but cyanocobalamin tends to be routinely offered rather than methylcobalamin.

 

Methylcobalamin is the neurologically active form of vitamin B12, and is used by the body to correct or prevent neurological problems. Cyanocobalamin is an artificial form of vitamin B12, which has to be converted into methylcobalamin before the body can use it. In the process, a tiny amount of cyanide is produced. This amount of cyanide is so small that it is considered to be harmless, but a human study, B vitamin therapy for homocysteine: renal function and vitamin B12 determine cardiovascular outcomes (2013) Spence JD Clinical Chemistry and Laboratory Medicine 51(3) pp633-7, found that "high-dose cyanocobalamin leads to accumulation of cyanide in patients with renal failure. B vitamin therapy is beneficial in patients with good renal function, but harmful in patients with significantly impaired renal function (a glomerular filtration rate <50). It seems likely that in patients with renal impairment, methylcobalamin should be used instead cyanocobalamin."

 

Since methylcobalamin is more bioavailable, and therefore more effective because it is absorbed more readily by the body, I would recommend giving it to your cat in the first place if possible. However, some members of Tanya's CKD Support Group do use the injectable form of cyanocobalamin, which is much more widely available than injectable methylcobalamin.

 


Vitamin B12 Formulations: Oral or Injectable


 

Vitamin B12 is available in oral or injectable forms, but the injectable form is almost always cyanocobalamin rather than methylcobalamin (I do know of one US compounding pharmacy which provides injectable methylcobalamin, see below).

 

It used to be thought that only the injectable form of vitamin B12 was effective, and indeed this may well be the case for cats with gastrointestinal disease, who may have problems absorbing oral medications. The Gastrointestinal Laboratory at Texas A&M University says "Until similar studies evaluating the efficacy of oral cobalamin supplementation in dogs and cats have been published, the parenteral route continues to be the route of choice." However, in a later article, Treatment of cobalamin deficiency in dogs and cats (2016) Clinician's Brief, Dr J Steiner, head of the Gastrointestinal Laboratory, says "Supplementation has traditionally been administered parenterally because cobalamin deficiency has been shown to lead to malabsorption of cobalamin in the ileum; however, recent data have shown that oral supplementation may be just as efficacious."

 

For patients without gastrointestinal disease, the oral route is definitely an option. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency (2005) Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, McDowell I & Papaioannou A Cochrane Database of Systematic Reviews 20(3) found that oral vitamin B12 was as effective as intramuscular vitamin B12 for human patients with vitamin B12 deficiency. Efficacy of oral cobalamin (vitamin B12) therapy (2010) Andrčs E, Fothergill H & Mecili M Expert Opinion on Pharmacotherapy 11(2) pp249-56 examined a number of studies and says these "provide evidence that oral cobalamin treatment may adequately treat cobalamin deficiency. The efficacy was particularly highlighted when looking at the marked improvement in serum vitamin B12 levels and hematological parameters, for example hemoglobin level, mean erythrocyte cell volume and reticulocyte count. The effect of oral cobalamin treatment in patients presenting with severe neurological manifestations has not yet been adequately documented." The study concludes "Our experience and the present analysis support the use of oral cobalamin therapy in clinical practice."

 

Many members of Tanya's CKD Support Group have successfully used orally administered methylcobalamin for their CKD cats. Some people whose cats have severe anaemia hedge their bets by using the injectable form as discussed below and giving the oral form on the other days; however, severe anaemia may well require other treatments in addition to methylcobalamin. Discuss the best approach for your cat with your vet.

 


Vitamin B12 Oral


 

The oral form of methylcobalamin does seem to work well for CKD cats, though it may be less effective in cats with IBD (inflammatory bowel disease) or pancreatitis. It is common to give a relatively high dose though, to make sure the cat receives enough (any excess should be passed out in the urine).

 

Oral methylcobalamin is often sold in the form of fruit-flavoured lozenges which some people do use to pill their cats successfully, though plain methylcobalamin tablets and capsules are also available and what I would choose. See below for stockists.

 

Some methylcobalamin products contain a sweetener called xylitol. Although this is toxic to dogs, there is currently no evidence that it is toxic to cats, according to. Effects of p.o. administered xylitol in cats (2018) Jerzsele A, Karancsi Z, Pászti‐Gere E, Sterczer A, Bersényi A, Fodor K, Szabó D & Vajdovich P Journal of Veterinary Pharmacology and Therapeutics 41(3) pp409-414. However, some people prefer to avoid products containing it.

 

Vitamin B12 Oral Dosages


A possible starting dose for oral methylcobalamin would be 500mcg (0.5mg) a day, though some people give twice as much. Although this sounds high, only a small percentage of oral B12 is absorbed. The Gastrointestinal Laboratory at Texas A&M University says "Since cobalamin is a water-soluble vitamin, excess cobalamin is excreted through the kidneys and clinical disease due to over-supplementation has not been described."

 

Most people using capsules simply open a 500mcg capsule and mix the contents with their cat's food. Ideally, I would divide this daily dose between two meals a day, i.e. give 250mcg with breakfast and 250mcg with dinner.

 

Vitamin B12 Oral Sources


Vitamin B12 Oral Sources - USA


You may be offered Cobalequin, which is made by the manufacturer of Cosequin (used for arthritis). Cobalequin is marketed for dogs and is supplied in packs of 45 chewable tablets which are chicken flavoured. They contain 250mcg of cobalamin and a form of folic acid known as 5-MTHF, however, the cobalamin is in the form of cyanocobalamin, so there are probably better choices available.  

 

Some national chains sell methylcobalamin, but it is often in lozenge form rather than capsules. Check for other ingredients too.

 

Vitacost

Sells 300 plain methylcobalamin 500mcg (0.5mg) capsules for US$10.68 plus flat rate shipping of US$4.99 per order. I ordered these myself on a Sunday evening, and received them on the following Tuesday. If you are a new Vitacost customer, you can use this coupon to get a US$10 discount off your first order.

 

Superior Source

Makes 1000mcg methylcobalamin lozenges. They are available from Vitamin Shoppe for US$13.69 or Amazon (currently unavailable), and you can often find this product in stores too. This product contains lactose, so may not be suitable if your cat is lactose intolerant.

 

Natural Factors

Makes 1000mcg methylcobalamin chewable tablets. They are often available from Amazon (currently unavailable). One member of Tanya's Support Group cuts these into quarters, dissolves the quarter in water, then adds it to food. This product also contains lactose, so may not be suitable if your cat is lactose intolerant.

 

Vitamin B12 Oral Sources - UK


You may be offered Cobalaplex, which contains vitamin B12 and vitamin B9 (folic acid), but this contains cyanocobalamin rather than methylcobalamin. It also contains fructooligosaccharides (FOS), which may bind calcium in the small intestine and lead to an increase in calcium levels in the body (hypercalcaemia), which is not  good for cats who already have high calcium levels.

 

You may also be offered Cobalequin, which is made by the manufacturer of Cosequin (used for arthritis). Cobalequin is marketed for dogs and is supplied in packs of 45 chewable tablets which are chicken flavoured. They contain 250mcg of cobalamin and a form of folic acid known as 5-MTHF, however, the cobalamin is in the form of cyanocobalamin, so there are probably better choices available.  

 

Some health food shops sell the Solgar brand of methylcobalamin, but it is often not easy to find methylcobalamin in UK stores, so you will probably have to shop online.

 

Health Leads

Sells 90 of the Health Leads brand 500mcg capsules for Ł7.20. Also available from Amazon UK. Health Leads ships to some other countries.

 

Superior Source

Makes 1000mcg methylcobalamin lozenges. They are available from Health Monthly or Amazon UK. The Superior Source product contains lactose, so may not be suitable if your cat is lactose intolerant.

 

Vitacost

Sells 300 plain methylcobalamin 500mcg (0.5mg) capsules for US$10.68 plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast. If you are a new Vitacost customer but know somebody who already uses them, you should be able to use this coupon to get a US$10 discount off your first order.

 

Vitamin B12 Oral Sources - Canada


Natural Vitamin Direct

Sells 90 1000mcg methylcobalamin tablets by Natural Factors for CAN$8.66. These contain lactose, so may not be suitable if your cat is lactose intolerant.

 

Vitamin B12 Oral Sources - Other Countries


Vitacost

Sells 300 plain methylcobalamin 500mcg (0.5mg) capsules for US$10.68 plus international shipping, which is calculated by weight but which costs roughly USD6.99 for small, lightweight orders and takes 7-14 days. Vitacost have local phone numbers in UK, Australia and Hong Kong. I have not used Vitacost to ship to the UK, but I used them within the USA and they were very efficient and very fast. Unfortunately they will not ship to Canada.

 

Jasper's Page

Has details of suppliers in USA, UK, and New Zealand, some of whom will ship worldwide. Please note this site is recommending methylcobalamin for cats with diabetes, so the sizes and doses may be too high for a CKD cat; ask your vet.

 


Vitamin B12 Injectable


 

Injectable vitamin B12 is only available via prescription in the USA, but is an over the counter product in Canada. See below for stockists, including a US supplier of injectable methylcobalamin.

 

Unlike vitamin B complex, injectable vitamin B12 (which is a pinky red colour) does not sting, so some people give this to their cats during or immediately after sub-Qs.

 

The US National Library of Medicine mentions that many injectable forms of vitamin B12 in the form of cyanocobalamin "contain aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired." If you are only using the injectable form occasionally, it is probably safe but discuss this further with your vet. Injectable methylcobalamin apparently does not contain aluminium (the version I know of is preserved with methyl alcohol).

 

If you do use an injectable form of vitamin B12, the Centers for Disease Control and Prevention recommend discarding multi-dose vials within 28 days of starting them.

 

Vitamin B12 Injectable Dosages


Doses are lower than for oral administration because less is wasted when the injectable form is used.

 

A commonly used dose for injectable cyanocobalamin is 250-500mcg every week or every two weeks. Drugs recommends 0.25 to 0.5 ml of the 1000mcg/1ml concentration (so 250-500mcg), every 1-2 weeks as required

 

Although it is more bioavailable than cyanocobalamin, I understand from those who have used injectable methylcobalamin that the dosage is the same as for injectable cyanocobalamin, i.e. 0.25ml of the 1000mcg/ml strength (which is 250mcg); however, it is normally only given every 2-4 weeks (although some members of Tanya's Support Group give it more often). Be guided by your vet on the best protocol for your cat.

 

Vitamin B12 Injectable Sources


A prescription is required. These products are normally only usable for twenty eight days after opening.

Vitamin B12 Injectable Sources - USA


 

Methylcobalamin


Wedgewood Pharmacy

apparently sells injectable methylcobalamin. It is not mentioned on their site but members of my support group have obtained it from them with no problems. It used to cost US$39.95 for a 5ml vial of 1000 mcg/ml (1 mg/ml) strength plus US$10 shipping, with a three month expiration date. They also sell cyanocobalamin if required.

 

McGuff Compounding Pharmacy Services

sell 1000 mcg/ml (1 mg/ml) injectable methylcobalamin, apparently in a 30ml vial, which means some will probably be wasted. It costs around US$30 plus shipping of around US$12-15.

 

Cyanocobalamin


Allivet

Sells a 100ml bottle of injectable cyanocobalamin 1000mcg/ml strength for US$5.49 plus shipping of around US$7.

 

KV Vet Supply

Sells a 250ml bottle of injectable cyanocobalamin 1000mcg/ml strength for US$7.09 or 250ml for US$15.55.

 

You can usually obtain injectable cyanocobalamin from your local Costco pharmacy. You can also search Good RX for cyanocobalamin.

 

Vitamin B12 Injectable Sources: UK


Injectable cyanocobalamin used to be licensed for animals in the UK. One popular brand was Anivit. Unfortunately this seems to have been discontinued. The NHS seems to favour hydroxocobalamin for humans because it stays in the body for longer, and I have heard of people also using this in their cats.

 

Oxford Biosciences

sell a vial containing 20mg of methylcobalamin for Ł25 plus VAT and shipping. You add 10ml of sterile saline to the vial, giving you a strength of 2mg per 1 ml.  I am informed the reconstituted product will then last for around 18 months, which seems a long time to me. I do not know anybody who has used this as yet.

 

Vitamin B12 Injectable Sources: Canada


Most pharmacies in Canada carry injectable cyanocobalamin and no prescription is required. It only costs around CAN$7.

 

Pet Drugs Mart

sells 10 ml of the 1000 mcg/ml strength for CAN$4.50.

 

Vitamin B12 Injectable Sources: Australia


Complementary Compounding Services

Sell injectable methylcobalamin.

 

Vitamin B12 Injectable Sources: Other Countries


Jasper's Page

Has details of suppliers in USA, UK, and New Zealand, some of whom will ship worldwide. Please note this site is recommending methylcobalamin for cats with diabetes, so the sizes and doses may be too high for a CKD cat; ask your vet.

 


Vitamin B12 Cautions


 

Side Effects


Drugs mentions that side effects of vitamin B12 supplementation may include itching and diarrhoea. If you see these signs, speak to your vet about reducing the dose.

 

Vitamin B12 and Potassium


Vitamin B-12 associated neurological diseases workup (2016) Singh NN Medscape states that when patients with a vitamin B12 deficiency and severe anaemia are given vitamin B12, "Hypokalemia [low potassium levels] may develop because of increased potassium utilization in hematopoiesis."

 

Most CKD cats do not have a cobalamin deficiency as such, and How I treat cobalamin (vitamin B12) deficiency (2008) Carmel R Blood 112(6) pp2214-2221 says that such falls in potassium levels are usually transient and "its clinical relevance has never been proven." If your cat already has severe anaemia and low potassium levels, speak to your vet before starting methylcobalamin.

 

Vitamin B12 and Cancer


Hypercobalaminaemia is associated with hepatic and neoplastic disease in cats: a cross sectional study (2014) Trehy MR, German AJ, Silvestrini P, Serrano G & Batchelor DJ BMC Veterinary Research 10 pp175 looked at elevated cobalamin levels in cats who had not received vitamin B supplementation and states "The current study has suggested possible associations between hypercobalaminaemia and the presence of either solid neoplasia or liver disease in cats."

 

It may be wiser not to give vitamin B12 to a cat with cancer because cancer cells rely on vitamin B12 for growth, according to Immunohistochemical quantification of the cobalamin transport protein, cell surface receptor and Ki-67 in naturally occurring canine and feline malignant tumors and in adjacent normal tissues (2015) Sysel AM, Valli VE & Bauer JA Oncotarget 6 pp2331-2348, which states "Cancer cells have an obligate need for cobalamin (vitamin B12) to enable DNA synthesis necessary for cellular replication."

 

Purina Pro Club Update (2013) 12(1) Dr Sysel of the Bauer Research Foundation states "Vitamin B12 is important in DNA synthesis, as cells cannot divide without it. Rapidly growing tumors that are actively dividing have an especially high demand for vitamin B12. Tumor cells produce TCII [transcobalamin, a protein which moves vitamin B12 through the bloodstream] to obtain all the vitamin B12 they can."

 

However, researchers are also looking into whether they can use cancer cells' need for vitamin B12 to target cancer. Immunohistochemical quantification of the cobalamin transport protein, cell surface receptor and Ki-67 in naturally occurring canine and feline malignant tumors and in adjacent normal tissues (2015) Sysel AM, Valli VE & Bauer JA Oncotarget 6 pp2331-2348 adds "The potential to utilize these proteins as biomarkers to identify neoplastic tissues, streamline therapeutic options, evaluate response to anti-tumor therapy and monitor for recurrent disease has important implications in the advancement of cancer management for both human and companion animal patients."

 

A stability-indicating HPLC method for the determination of nitrosylcobalamin (NO-Cbl), a novel Vitamin B12 analog (2014) Dunphy MJ, Sysel AM, Lupica JA, Griffith K, Sherrod T & Bauer JA Chromatographia 77(7-8) pp 581-589 reports further on the use of nitrosylcobalamin "as a biologic ‘Trojan horse’, utilizing the vitamin B12 transcobalamin II transport protein and cell surface receptor to specifically target cancer cells."

 

University of Pennsylvania School of Veterinary Medicine has been researching whether cats with lymphoma might actually have a vitamin B12 deficiency (which is quite possible, because lymphoma may reduce vitamin B12 absorption in the intestines), and if they do, they plan to offer supplemental treatment to address the deficiency.

 

Vitamin B12 and Diabetes


Cats with diabetes tend to be given relatively high dosages of methylcobalamin. However, Effect of B-vitamin therapy on progression of diabetic nephropathy: a randomized controlled trial (2010) House AA, Eliasziw M, Cattran DC, Churchill DN, Oliver MJ, Fine A, Dresser GK & Spence JD Journal of the American Medical Association 303(16) pp1603-1609 found that humans with diabetes and kidney disease caused by the diabetes who were given three B vitamins (25mg/d of vitamin B6 (pyridoxine), 2.5mg/d of vitamin B9 (folic acid) and 1mg/d of vitamin B12) had a lower GFR (a measure of kidney function) and an increased incidence of strokes. The study states "Because these vitamins are water-soluble and renally excreted, vitamin toxicity may be more of a concern in patients with impaired renal function."

 

Cats with diabetes are usually only given methylcobalamin for up to three months, until the diabetes is regulated, but the humans in this study were taking cobalamin for 36 months. It is also not known which form they were taking, but most probably it was cyanocobalamin. These patients had severe diabetes as well as advanced CKD and were receiving multiple treatments apart from B vitamins.

 

I would not give more than 1 mg a day to your CKD cat, and personally, I would feel more comfortable giving 500mcg (0.5mg) only. Be guided by your vet as to the most appropriate dose for your cat.

 

 

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This page last updated: 13 September 2020

Links on this page last checked:10 August  2020

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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