Cyanocobalamin injections for patients without documented deficiency. Reasons for administration and patient responses to proposed discontinuation.

We reviewed the records of 1222 patients who attended a newly acquired rural satellite clinic and found that 120 (10%) had been receiving regular cyanocobalamin injections, but that only 4 (3%) met accepted criteria for its administration. Open-ended interviews with 48 of these patients revealed that they had been receiving cyanocobalamin injections for a mean of 9.9 years for 3.3 symptoms each and with a mean effectiveness rating of 2.9 (scale, 0 to 4). After receiving education regarding the appropriate indications for cyanocobalamin injections, 25 (52%) of the patients were willing to stop receiving them at least temporarily. However, 18 patients (38%) who were younger and who reported greater symptom relief would actively seek a physician who would continue to administer cyanocobalamin. Our findings suggest that some patients who have been receiving cyanocobalamin injections but who do not have a documented deficiency will stop receiving the injections when presented with reasonable alternatives.