B12 Injection Protocol
HAUS OF ÄSTHETIK
B12 INJECTION PROTOCOL
DATE OF IMPLEMENTATION 1ST APRIL 2025
REVIEW DATE 1ST APRIL 2026
VERSION NUMBER 1.1
INTRODUCTION
This protocol outlines the safe, effective, and regulated administration of Vitamin B12 (Hydroxocobalamin or Cyanocobalamin) injections at HAUS OF ÄSTHETIK. The protocol ensures full compliance with CQC, Save Face, NICE, GMC, NMC, MHRA, and HAUS OF ÄSTHETIK’s internal policies, including Medicines Management, Infection Control, Record Keeping, Consent, and Patient Safety Policies.
Only Doctors, Dentists, Registered Nurses, and Independent Prescribers who have completed accredited Vitamin B12 injection training or relevant NHS experience may administer this treatment. Before proceeding with treatment, a face-to-face consultation and medical history review must be completed.
INDICATIONS FOR B12 INJECTION
Vitamin B12 injections may be used to treat or support:
• Vitamin B12 deficiency due to pernicious anaemia or dietary insufficiency
• Malabsorption syndromes (e.g., Crohn’s disease, Coeliac disease, post-gastric surgery)
• Neurological symptoms linked to B12 deficiency (e.g., numbness, tingling, memory loss, fatigue, cognitive decline)
• General fatigue and wellness support in non-deficient individuals
• Patients following a strict vegetarian or vegan diet
Hydroxocobalamin (preferred by NHS & NICE) is the first-line treatment for B12 deficiency, while Cyanocobalamin is an alternative option, particularly for maintenance therapy.
Dietary Causes of Vitamin B12 Deficiency
Vitamin B12 is an essential water-soluble vitamin primarily found in animal-based foods. Individuals following a vegetarian or vegan diet are at a higher risk of deficiency, as plant-based foods do not naturally contain sufficient B12. Unlike other vitamins, B12 is not synthesised by plants, making supplementation or fortified foods essential for those avoiding animal products.
Sources of B12 in Animal-Based Diets
• Meat (beef, pork, lamb)
• Poultry (chicken, turkey)
• Fish & Shellfish (salmon, tuna, clams)
• Dairy Products (milk, cheese, yogurt)
• Eggs
Why Are Vegetarians & Vegans at Risk?
Since Vitamin B12 is predominantly found in animal products, individuals who avoid these foods are at risk of developing B12 deficiency over time. Even vegetarians who consume dairy and eggs may not get adequate amounts, depending on their dietary intake. Vegans, in particular, have no natural dietary sources of B12, making supplementation essential.
Plant-Based Sources & Fortified Foods
While no plant naturally contains bioavailable B12, some foods are fortified with synthetic B12, making them suitable alternatives for vegans and vegetarians. Examples include:
• Fortified plant-based milk (soy, almond, oat)
• Fortified breakfast cereals
• Nutritional yeast with added B12
• Fortified tofu and meat substitutes
B12 Absorption Challenges
Even when consumed fortified foods, B12 absorption can be limited due to digestive factors such as low stomach acid, age-related absorption issues, or gut conditions like Crohn’s disease and coeliac disease.
Supplementation for Vegetarians & Vegans
To prevent deficiency, individuals following a plant-based diet should:
• Take a daily B12 supplement (cyanocobalamin or methylcobalamin)
• Consume fortified foods regularly
• Consider B12 injections for optimal absorption, especially if dietary intake is inadequate
Routine blood tests can help identify early signs of deficiency, allowing for preventative treatment before symptoms develop.
PRODUCT STORAGE INFORMATION
• Hydroxocobalamin (1mg/1mL) or Cyanocobalamin (1mg/1mL) ampoules must be stored between 2°C and 25°C
• Keep in a locked medication cupboard to prevent unauthorised access
• Expiry dates must be checked before administration
• Batch numbers must be recorded in the patient’s medical notes
STAFF REQUIREMENTS
• Only Doctors, Dentists, Registered Nurses, and Independent Prescribers may administer Vitamin B12 injections
• Practitioners must hold valid indemnity insurance and documented competency in B12 administration
• Non-prescribers must have a prescription or Patient-Specific Directive (PSD) from a registered prescriber before administering treatment
INCLUSION CRITERIA
Patients must be:
• Over the age of 18 (unless referred by a GP for a medical deficiency)
• Medically fit, with no contraindications to B12 injection therapy
• Able to provide informed consent
• Not allergic to Vitamin B12 or its excipients
EXCLUSION CRITERIA
Vitamin B12 injections are contraindicated in:
• Patients under 18 unless medically supervised
• Pregnant or breastfeeding individuals without GP referral
• History of allergic reaction to Vitamin B12 injections
• Leber’s hereditary optic neuropathy (B12 can worsen optic atrophy)
• Patients with Polycythaemia Vera (risk of blood thickening and clot formation)
• Uncontrolled cardiovascular disease or history of stroke (requires GP consultation)
• Active infections or inflammation at the intended injection site
Caution should be exercised in patients with renal or hepatic impairment, those on anticoagulants, and those with undiagnosed neurological symptoms.
PRE-TREATMENT ASSESSMENT
Each patient must undergo a comprehensive consultation, including:
• Full medical history and medication review
• Evaluation of symptoms and history of deficiency (e.g., fatigue, cognitive issues, weakness, anaemia, neuropathy)
• Assessment of recent blood test results (if applicable)
• Pre-treatment discussion on benefits, risks, and potential side effects
• Informed consent signed and documented
DOSAGE AND ADMINISTRATION
The dose and frequency depend on whether the patient has a diagnosed deficiency or receives the injection for general wellness.
Treatment of B12 Deficiency (As per NICE Guidelines)
• Loading Dose: 1mg Hydroxocobalamin IM every other day for 2 weeks
• Maintenance Dose: 1mg Hydroxocobalamin IM every 2-3 months
Wellness Injections (Non-Medical Use)
• Cyanocobalamin 1mg IM every 4-6 weeks
• Hydroxocobalamin 1mg IM every 8-12 weeks
Injection Route & Preferred Site:
• Intramuscular (IM) injection into the deltoid or gluteus Maximus
• For patients on anticoagulants, use a deep subcutaneous (SC) injection
• Rotate injection sites to prevent local irritation or fibrosis
TREATMENT ADMINISTRATION
1. Wash hands thoroughly and wear sterile gloves
2. Cleanse the injection site with 70% isopropyl alcohol
3. Draw up 1mL of Hydroxocobalamin or Cyanocobalamin using a 2mL syringe with a 21G or 23G needle
4. Expel air bubbles and ensure correct dose
5. Insert the needle at a 90-degree angle into the deltoid or gluteal muscle
6. Aspirate to check for intravascular placement (if necessary)
7. Inject slowly and steadily
8. Withdraw the needle and apply pressure with sterile gauze
9. Dispose of sharps safely in a designated sharps bin
10. Record treatment details in the patient’s medical notes
POST-TREATMENT CARE
• Advise the patient to monitor for any localised reactions (e.g., redness, soreness, mild swelling)
• Advise against strenuous exercise for 24 hours post-injection
• Instruct the patient to report any unusual side effects (e.g., itching, dizziness, breathlessness)
• Reinforce the importance of follow-up injections based on their individual plan
• Provide written aftercare instructions
Patients should be reviewed every 3-6 months to reassess symptoms and determine if ongoing injections are required.
MEDICAL RECORD KEEPING
Practitioners must document:
• Patient identity and full medical history
• Injection site, dose, batch number, and expiry date
• Pre- and post-treatment assessments
• Any adverse reactions or unexpected outcomes
All records must comply with GDPR and HAUS OF ÄSTHETIK’s Medical Records Policy.
ADVERSE EVENTS MANAGEMENT
Most patients tolerate B12 injections well. However, potential side effects include:
• Mild soreness, redness, or swelling at the injection site
• Temporary itching, dizziness, or nausea
• Very rarely, severe allergic reaction or anaphylaxis
If anaphylaxis is suspected, immediately administer intramuscular adrenaline (0.5mg in adults) and call 999 for emergency assistance.
All severe adverse reactions must be reported to the MHRA via the Yellow Card Scheme and recorded in the clinic’s incident log.
QUALITY ASSURANCE AND TRAINING
Practitioners must complete annual CPD training in IM injection techniques, complications management, and Vitamin B12 deficiency assessment. The clinic will conduct regular audits and peer reviews to ensure compliance with best practice standards.
This protocol will be reviewed annually or sooner if new clinical evidence, regulatory updates, or internal risk assessments necessitate revisions.
CONCLUSION
The Vitamin B12 Injection Protocol at HAUS OF ÄSTHETIK ensures the safe, effective, and ethical administration of B12 injections. By following these guidelines, practitioners will maintain the highest standards of patient care, safety, and regulatory compliance.