NutriStack
Methylcobalamin and Omeprazole, a synergy.
Methylcobalamin, the active coenzyme form of vitamin B12, does not require gastric acid or pepsin to be released from food protein, making it a more reliable B12 source for patients on omeprazole. Long-term PPI use raises B12 deficiency risk roughly 65% over two or more years, and oral methylcobalamin can fully prevent that deficit in most patients.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Methylcobalamin and Omeprazole
- Pair type
- Synergy
- Evidence (highest tier)
- Strong
- Source citations
- 2 sources
- Stack Score effect
- +2 to your Stack Score (per scored synergy row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Synergy · Strong evidence
Synergy
What is happening. Methylcobalamin, the active coenzyme form of vitamin B12, does not require gastric acid or pepsin to be released from food protein, making it a more reliable B12 source for patients on omeprazole. Long-term PPI use raises B12 deficiency risk roughly 65% over two or more years, and oral methylcobalamin can fully prevent that deficit in most patients.
Mechanism. Free B12 supplements (including methylcobalamin) bypass the acid-pepsin step needed to liberate B12 from dietary protein. Intrinsic factor binds the free vitamin directly for ileal absorption, which remains intact during PPI therapy.
Recommendation. If you take omeprazole long-term, 500-1000 mcg of oral methylcobalamin daily is a sensible insurance dose. Recheck serum B12 (and methylmalonic acid if borderline) yearly while on the PPI.
Sources (2)
- Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-42. PMID 24327038
- Miller JW. Proton Pump Inhibitors, H2-Receptor Antagonists, Metformin, and Vitamin B-12 Deficiency: Clinical Implications. Adv Nutr. 2018;9(4):511S-518S. PMID 30032223
Stack Score
How this pair moves the number.
Effect on the composite score
If both Methylcobalamin and Omeprazole are in the same stack, this pair applies +2 to your Stack Score (per scored synergy row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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