{"id":27,"date":"2026-04-03T23:25:19","date_gmt":"2026-04-03T21:25:19","guid":{"rendered":"https:\/\/me-cfs.se\/info\/?page_id=27"},"modified":"2026-04-03T23:28:13","modified_gmt":"2026-04-03T21:28:13","slug":"vitamin-b12-vid-me","status":"publish","type":"page","link":"https:\/\/me-cfs.se\/info\/myalgisk-encefalomyelit\/vitamin-b12-vid-me\/","title":{"rendered":"Vitamin B12 vid ME"},"content":{"rendered":"

Inneh\u00e5ll:<\/strong><\/p>\n

Vitamin B12 (kobalamin) f\u00f6r ME drabbade<\/a><\/p>\n

Hj\u00e4lpmedel<\/a><\/p>\n

Exempel p\u00e5 vitamin B12 preparat<\/a><\/p>\n

\u00d6kat folatbehov hos personer med viss gentyp<\/a><\/p>\n

<\/a>Vitamin B12 (kobalamin) f\u00f6r ME drabbade<\/h1>\n

En del patienter k\u00e4nner sig b\u00e4ttre av t.ex. magnesium, antioxidanter, B-vitaminkombination, L-karnitin, coenzym Q10 (ubiquinon), NADH (nicotinamide adenine dinucleotide), fiskolja med omega-3 eller B12-injektioner (metylkobalamin).<\/p>\n

Det som har tydligast effekt och som m\u00e5nga patienter rapporterar fungera \u00e4r metylkobalamin (Mekobalamin\u00ae ATL-K 10 mg, 5 mg\/ml, 2 ml) som injiceras djupt subkutant. Intervallet \u00e4r patientberoende och brukar vara 2, 3 eller 4 dagar. M\u00e5nga f\u00e5r effekt efter 1-2 veckor. Ifall ingen effekt observeras efter 3 m\u00e5nader, kan man avbryta behandlingen. Vid positiv effekt \u00e4r behandlingen fortvarig. Ibland kan man \u00f6ka injektionsintervallet efter l\u00e5ng tids behandling (\u00e5r). M\u00e5nga rapporterar att hydroxokobalamin ej ger samma effekt som metylkobalamin.<\/p>\n

Notera att B12-behandling av ME-patienter inte avser behandling av en megaloblastisk anemi eller pernici\u00f6s anemi. Det \u00e4r ej fullst\u00e4ndigt utrett varf\u00f6r ME-patienter svarar positivt p\u00e5 B12. Det finns studier som tyder p\u00e5 att de lider av en funktionell brist i likvor cerebrospinalis med f\u00f6rh\u00f6jda homocysteinehalter som f\u00f6ljd (enkolsmetabolismen, folsyrecykeln). Det kan ocks\u00e5 vara s\u00e5 att patienterna har sv\u00e5righeter att bilda metylgrupper (metyleringscykeln). ME-drabbade har ofta f\u00f6rh\u00f6jda halter kv\u00e4veoxid (NO) och f\u00f6rh\u00f6jd oxidativ stress. B12 \u00e4r en antioxidant som tar bort kv\u00e4veoxid. L.O. Simpson har funnit att cirka 50% av ME-patienterna f\u00e5r minskad andel deformerade erytrocyter av vitamin B12 (kobalamin) och att det \u00e4r dessa patienter som k\u00e4nner att de m\u00e5r b\u00e4ttre av B12.<\/p>\n

Patienten kan genotypas f\u00f6r funktionellt \u00f6kad folatbehov. Mutationerna hos enzymet Enzymet 5,10-metylentetrahydrofolatreduktas (MTHFR, MTHFR 677 C->T och MTHFR 1298 A->C i homocygot form kan g\u00f6ra att patienten kr\u00e4ver \u00f6kat folat intag. Allm\u00e4nt kan s\u00e4gas att patienter med eller utan mutationerna kr\u00e4ver ett folsyraintag som balanseras i f\u00f6rh\u00e5llande till kobalaminintaget. Optimal dos f\u00f6r folsyratillskott f\u00f6r en patient utan mutationer kan vara noll, men kan vara t.ex. 2×500 \u00b5g\/dag vid anv\u00e4ndninga av B12-injektioner. Marginalen kan vara liten och en h\u00f6gre dos kan g\u00f6ra patienten s\u00e4mre. Folsyra g\u00e5r \u00e4ven under ben\u00e4mningen vitamin B9.<\/p>\n

Evidensbaserad behandling<\/h3>\n

Behandling med vitamin B12 vid ME har troligtvis evidensniv\u00e5 III, men \u00e5tminstone IV. H\u00f6gsta evidensniv\u00e5 \u00e4r I (ett) och l\u00e4gsta V (fem).\u00a0<\/p>\n

F\u00f6rklaring: Utg\u00e5 ifr\u00e5n denna skala<\/a> f\u00f6r evidensniv\u00e5 (level of evidence). Niv\u00e5 IV kr\u00e4ver att en expertkommitt\u00e9 rekommenderar vitamin B12 behandling vid ME. Det \u00e4r 26 specialister som i l\u00e4karhandledningen tillh\u00f6randes de internationella kriterierna (ICC 2011<\/a>) och 11 specialister som i l\u00e4karhandledningen tillh\u00f6randes Kanadas koncensusdokument (CCC 2003<\/a>), som rekommenderar vitamin B12. Likas\u00e5 rekommenderas vitamin B12 av International Association for ME\/CFS\u00a0i sin handledning (IACFSME\u00a02012). Studien av Gottfries Clinic fr\u00e5n 2015<\/a> r\u00e4knas troligtvis som en observationsstudie (kohortsstudie), vilket i s\u00e5 fall g\u00f6r att evidensniv\u00e5 III skulle g\u00e4lla f\u00f6r kobalaminbehandling vid ME.<\/p>\n

Apotekets information<\/h2>\n

\u2022 Information av Apoteket om Mekobalamin fr\u00e5n \u00e5r 2005, produktresum\u00e9, f\u00f6rvaring vid resa: \u00f6ppna<\/a><\/p>\n

\u2022 Apotekets produktresum\u00e9 av Mekobalamin APL Injektionsv\u00e4tska, l\u00f6sning 5 mg\/ml: \u00f6ppna<\/a><\/p>\n

Handledningar<\/h2>\n

Kanadas koncensusrapport<\/h4>\n

I Kanadas koncensusrapport (”Myalgic Encephalomyelitis\/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols”, Carruthers et al, ISBN 0-7890-2207-9, \u00e5r 2003, l\u00e4nk<\/a>) st\u00e5r f\u00f6ljande om vitamin B12 (kobalamin) injektioner.<\/p>\n

Sidan 56, utdrag:<\/p>\n\n\n\n
\n

Cyanocobalamin<\/p>\n<\/td>\n

\n

Start with 1,000 mcg once per week parenterally, IM or deep SC. Build up to a maximum of 3,000 mcg every 2-3 days<\/p>\n<\/td>\n

\n

Measure B12 and folate levels before commencing this treatment. Patients can be taught to self-administer injections using the same1cc insulin syringes used by diabetics. Cyanocobalamin should be stored in a cool, dark place to prevent it from being degraded by light. It is recommended that those who do not respond well take 1 mg of folic acid daily in tablet form. To prevent deficiencies of other B complex vitamins, it is recommended that patients supplement their daily diet with multi-vitamins containing B complex and folic acid which are best taken in the morning due to their occasional excitatory effect. See additional comments below. Note: oral and subliminal B12 are usually ineffective.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Sidan 57, utdrag:<\/p>\n

Citat: \u201cB12\/Cyanocobalamin: Based on anecdotal reports of CFS patients improving with B12 injections and research studies demonstrating that persons with normal blood counts who had CFS-like neurological symptoms may benefit from injections of cyanocobalamin (120,121,122), Cheney and Lapp began treating CFS patients with cyanocobalamin parenterally. Fifty to eighty percent of their patients reported some improvement. Most patients had normal serum B12 and folate levels prior to treatment. Measurements of homocysteine and methylmalonate levels taken at the Cheney Clinic showed elevation in approximately one\/third of CFS patients suggesting a B12 deficiency may be a contributing factor in the symptomology of this subset of patients. Lapp suggested that this may be due to a reduced ability of B12 to be transported into the cell, as major doses of B12 gives marked improvement of energy level, cognitive ability, and mood, and reduced irritability, numbness and weakness in this subgroup. Improvement is usually seen in six weeks (123). Lapp reports treating thousands of patients with high dose B12 over a ten-year period with no evidence of cyanide toxicity even at 15,000 mcg per week, and no serious adverse effects other than some bruising at injection site. Rarely the urine may have a slight pinkish tint following injection but that appears to be benign. The occasional patient may develop an acnelike rash but it responds quickly to a reduced dosage. B12 injections are contra-indicated for patients with kidney failure. Another theory is that hydroxocobalamin is a nitric oxide scavenger and may address suspected elevated nitric oxide\/peroxynitrite (124).\u201d<\/p>\n

Vetenskapliga artiklar<\/h2>\n

Bj\u00f6rn Regland<\/h4>\n

\u2022 Increased concentrations of homocysteine in the cerbrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome, Regland et al, Scand J Rheumatol 1997;26:301-7.<\/p>\n

\u2022 Response to Vitamin B12 and Folic Acid in Myalgic Encephalomyelitis and Fibromyalgia. Bj\u00f6rn Regland mfl. 2015. PLoS ONE<\/a><\/p>\n

Olof Zachrissons doktorsavhandling<\/h4>\n

\u2022 Fibromyalgia\/Chronic Fatigue Syndrome – Aspects on biology, treatment, and symtom evaluation, Olof Zachrisson, 2002, ISBN 91-628-5386-4<\/p>\n

Dana Myatt och Mark Ziemann<\/h4>\n

\u2022 B-12 Deficiency in ME\/CFS and FM May Provide Clues & Relief, 2008-04-11: B-12 Deficiency in ME\/CFS and FM May Provide Clues & Relief<\/a><\/p>\n

Simpson<\/h4>\n

L.O. Simpson har funnit att cirka 50% av ME-patienterna f\u00e5r minskad andel deformerade erytrocyter av vitamin B12 (kobalamin) och att det \u00e4r dessa patienter som k\u00e4nner att de m\u00e5r b\u00e4ttre av B12.<\/p>\n