Because vitamin B-12 helps produce red blood cells, a B-12 deficiency can cause anemia if not treated. Vegetarians are more likely to develop B-12 deficiency because meat is the best source of B-12. People who have malabsorption problems after stomach surgery can also develop B-12 deficiency. Doctors often prescribe B-12 injections to treat B-12 deficiency, but it's also possible to take B-12 sublingually, or under the tongue. Sublingual forms of B-12 are made from synthetic B-12.
Method
To take medication sublingually, place it underneath your tongue rather than swallowing it and let it dissolve. Sublingual medications absorb through the mucous membranes directly into the bloodstream rather than passing through the stomach. When medications can't be absorbed in the stomach due to malabsorption issues or because they break down in the stomach, they can be given either sublingually or via injection. B-12 can be given via injection or sublingually if the stomach can't absorb it, which happens when the stomach doesn't produce enough intrinsic factor. Intrinsic factor breaks down the proteins in B-12 for absorption in the small intestine. Because intrinsic factor is produced in the stomach, removal of part of the stomach, surgery or other stomach damage interferes with production. Pernicious anemia, an autoimmune disorder, also causes low intrinsic factor levels. Patient preference is another reason for sublingual B-12.
Dose
Sublingual doses come in 250-, 500-, 750- or 1,000-microgram dissolvable tablet doses. Typical intake ranges between 1,000 and 2,000 mcg per day to treat deficiency, 125 to 500 mcg per day for maintenance in people with malabsorption and 1,000 mcg per day in people with pernicious anemia.
Advantages
The advantages of sublingual absorption of B-12 over injection administration include less pain for the patient and no need to visit the doctor's office for an injection. Sublingual products, unlike oral products that are swallowed, are marketed not as dietary supplements, but as prescription drugs. Prescription drugs are subject to more stringent manufacturing standards and controls.
Disadvantages
Disadvantages of sublingual administration include the need for daily dosing and the chance that the person will not take her dose regularly. Some people might not be able to hold the B-12 tablet under the tongue reliably. If a medical provider wants to ensure that his patient gets her dose of B-12, a once-a-month injection is the best method. Sublingual forms might also cost more.
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