This article was published in No 3 of The Rondel (March 31, 2000)
Bo Norberg
The editorial and the evaluation of the Swedish edition of The Rondel 2000;3 are devoted to the introduction of a low-dose oral combination (TrioBe) of cobalamin 0.5 mg, folic acid 0.8 mg and pyridoxin 3 mg for prophylactic supplementation to elderly people in the earliest pre-clinical stage of deficiency development, suggested only by elevated homocysteine levels. The vitamin content of the new combination is chosen to provide the daily requirements, with a moderate upper margin of safety.
My personal view is that the future belongs to oral B vitamin supplementation with combination preparations; combined deficiency states are common in elderly persons (1) and in women in fertile age (2). Furthermore, the determination of body stores of pyridoxin is even more difficult than the determination of body stores of cobalamin and folate. Homocysteine appears at present to be a broad and sensitive but non-specific marker for isolated or combined deficiency of the three B vitamins discussed.
Concerning costs and convenience, the new combination should be compared with the leading brands on the national market, oral Behepan vith cobalamin 1 mg and oral Folacin with folic acid 5 mg. As to costs, one TrioBe equals one Behepan plus one Folacin, approximately 0.25 US dlr a day. Compared by biological activity, the cost of TrioBe is twice the cost of Behepan plus Folacin.
As to convenience, the new combination is a large hard-swallowed tablet with a chalky taste. The established preparations are small tablets with a neutral taste. Nevertheless, one tablet daily of the new combination is deemed tolerable for fertile women and healthy elderly people with a need for prophylactic supplementation. Compliance problems are expected in other contexts.
In my opinion, the future combination of oral B vitamins should contain cobalamin 1 mg, folic acid 2 mg, and pyridoxin 10 mg. The standard regimen should be one tablet daily at a cost of 0.30 US dlr. By experience, about 80% of all deficiency cases can be managed by such a regimen. Another 10% could be managed by dose doubling, the rest by parenteral supplementation. The prophylactic supplementation to fertile women and healthy elderly people could be managed by half a tablet daily.
The taste, calculations, and evaluations expressed above are mine. A broad debate is welcome.
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Updated september 11, 2000