Omeprazole and Vitamin B-12 Deficiency

If you take omeprazole to control acid reflux, you should be aware that the drug interferes with your body's ability to absorb vitamin B-12. The higher the dose of omeprazole, the less vitamin B-12 you are able to absorb. Although your body may still absorb enough vitamin B-12 to meet your needs, certain groups are at risk for vitamin B-12 deficiency.

Omeprazole and B-12 Absorption

Omeprazole belongs to a class of drugs known as proton pump inhibitors. It decreases symptoms of acid reflux by making the envirmonment in your stomach less acidic. However, an acidic environment is needed for optimal absorption of vitamin B-12, because your stomach acid activates intrinsic factor, an enzyme that aids in the absorption of vitamin B-12.

Certain Populations Are at Risk

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In young, healthy adults there is no evidence that long-term omeprazole use leads to vitamin B-12 deficiency. Certain people, however, are at greater risk. If high doses of omeprazole are given for long periods of time, for example to people with Zollinger-Ellis disease, there is a risk for developing vitamin B-12 deficiency. The elderly -- even healthy elderly people -- also tend to be at risk, because stomach acid and vitamin B-12 absorption both normally decrease with age.

Deficiency Occurs Slowly

Vitamin B-12 is the only water-soluble vitamin stored in the body. Because it is stored, the body makes up for decreased levels by tapping into its own reserves. That means deficiency may take a while to develop, and therefore symptoms may take a long time to appear.

One difficulty in diagnosing B-12 deficiency is that symptoms are often vague and could be caused by many other conditions -- you may experience fatigue, weakness, rapid heartbeat, pale skin, easy bruising and GI upset. More severe cases of deficiency are the result of nerve damage, and these can include numbness and tingling, changes in mood, or even memory problems. If you have any concerns, let your doctor know.


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Your doctor might recommend taking over-the-counter vitamin B-12 supplements to prevent deficiency or replenish B-12 stores. In severe cases of deficiency, intramuscular injections may be prescribed by your doctor.