I have been on MetaNx for several years. Originally started because of homocysteine levels. Express Scripts has posted this message:

Drug Discontinued
Unfortunately, METANX 3-35-2MG has been discontinued by the manufacturer. By law, the Express Scripts Pharmacy can no longer fill prescriptions for this medication.

Recommended Next Step
We encourage you to discuss this issue with your doctor. Your doctor should be able to explain why METANX 3-35-2MG was discontinued and can recommend an alternative medication for your needs.

So, not quite sure what to do, I stopped taking it. Not sure if it is related (but am suspicious it is), but blood pressure has become elevated (especially systolic), mouth ulcers have appeared, and tingling/burning in feet is noticeable.

Fortunately, I have a supply and started retaking it last night. Last two BPs are much better. If all things improve then that will strongly suggest I need MetaNx or equivalent.

One of the things that concern me is the high level of folate in MetaNx, especially with some studies that suggest increased risk of colon cancer with MetaNx.

Assuming that things do improve, then what? Is there an alternative? From my reading here, my hope of finding another Rx solution is slim.

Does this make sense:

Ignore the folate component.

Find a supplement for activated P-5-P (which one and how much)?

Find a supplement for Methylcobalamin (which one and how much)?

Would something like Neuropathy Support Formula from the Neuropathy Treatment Group be a reasonable option?

For my situation, should I focus on B6, B12 or both?

First post -- great information here!

I am not surprised. This was way overpriced to begin with, and some insurances refused to pay for it.

All 3 ingredients are OTC anyway.

If you are not low in B12, you can use the B-right by Jarrow.

http://www.iherb.com/Jarrow-Formulas...eggie-Caps/110

Or if you want higher levels:
P5P separately-- one a day
http://www.iherb.com/Now-Foods-P-5-P...60-Tablets/740

Metafolin 800mcg-- one a day
http://www.iherb.com/Solgar-Folate-A...-Tablets/13961

Methylcobalamin 1mg any brand on an empty stomach -- one a day.

There was quite a bit of methylfolate in Metanx... you may not need that much. It is the reason it was on RX. FDA only allows less than 1mg OTC.

Metanx was a good idea, but they didn't enteric coat it...to protect the P5P. They didn't specify empty stomach for best absorption of the B12.

There have been some recent studies showing no effect on homocysteine etc, and that may have contributed to doctors declining to order it. However, the ingredients remain important for PN and some other neurological uses.

mrsD,

Thank you for the information. Things are noticeably improving for me. I have an appt tomorrow with my PCP and need to figure out what I want to do. As an aside, Express Scripts is making me go through loops to get my Benicar Rx refilled which adds to my anxiety. Why go to doctors when you can use bureaucrats in big government run health systems!

I am coming to grips with the fact that my MetaNx Rx will no longer be filled by Express Scripts. If I want to continue with MetaNx ordered directly, it looks like it will cost ~$150 for 90 day supply.

I think your suggestion to buying them individually makes more sense. Especially since B12 can then be taken on an empty stomach.

I have been taking 35mg B6 and 2mg B12 daily. I think I would like to keep that level since I know it works.

3000 mcg is a lot. Your suggestions are appreciated.

BTW, do the folks on the forum have a preferred B12 brand?

Thanks

Mike

Mike, I use Puritan's Pride methyB12. They came out with it
2 yrs ago, and I decided to test it out. So I took 5mg a day and had testing about 3 months later. I tested out at 1999 (which was the lab's highest calibrated amount). My doctor was stunned, as she told me B12 doesn't work orally!

I've been using that which I get from their big sales once a year.
This buy one get 2 free is the best deal. But recently a member here pointed out the Kirkland (Costco) brand just available at Costco for 250 tablets 5mg MethyB12 for $19.99! So we were almost out of Puritans, since both my hubby and I use it twice a week, and therefore, we bought the Costco one instead. The Costco one works out to 6 cents a pill! Can't beat that price!

The Puritan's sale has just started so take a look at those. They have both the 1mg and 5mg methylcobalamin in 30 ct bottles.
Read carefully because they also offer the cyano on the same page and they look very much alike on the monitor!
They are small soft cherry discs which dissolve very quickly. I just chew them up and swallow with a little water. (no food).

In the past we all used Jarrow brand, because that is all there was basically. But over the last 10 yrs, other places have now started making it more common to find. Walgreen's also has it in their stores now! That means there is knowledge and demand for it and that makes me happy...that people are learning more about it. (and hopefully their doctors, too! )

Puritan's Pride says, Directions: For adults, take one (1) microlozenge daily, preferably with a meal. Place microlozenge under tongue for 30 seconds before swallowing.

I thought B12 should be taken on empty stomach?

Also, they cost $12.99 for 120 - 5mg or 0.22 per pill which is pretty good?

Jarrow Has Xylitol as the first other ingredient in it of which I am not a big fan.

Wow - Kirkland Signature™ Sublingual B-12 5000 mcg., 300 Tablets $19.99. We do not have a CostCo -- gotta see what it costs to order online.

BTW, I have been taking MetaNx daily. I was going to do the same with B12, but double the dose. However, you say you take it twice a week. Will I be over doing it?

Thanks.

The studies done with B12 orally showing various absorption rates, were done on an EMPTY stomach.

One thing you will see as you investigate various supplements, is that the makers of them are imperfect. And Big Pharma who makes drugs, are also imperfect.

Do what you think is best. If you want the BEST results take your B12 on an empty stomach.

Metanx was NOT enteric coated either... and P5P is best protected from stomach acid with an enteric coating. The better manufacturers of it provide it this way.

Taking vitamins with food is a generalization. It reflects the need for acid in the stomach for many of them. But taking microgram doses of B12 (and this pertains to some RX drugs also), with food, loses the drug in the fiber of the food, and it won't get to the lining of the intestines adequately. So in the case of B12 you need an empty stomach with nothing in the small intestine, to absorb the tiny micrograms of the cobalamin.

You are not going to absorb 1000mcg of methylB12...per dose. If you are lucky and do it correctly, you may absorb 13 micrograms of that huge dose. (this was found in the study I provide on the B12 thread. 13mcg a day is about 3 times the RDA and over time is adequate to improve B12 status in most people).

So I suggest you do it the way that has been opened for you and disregard the makers of Metanx, who are in error on this factoid.

Thanks.

I ordered the Kirkland 5mg from CostCo. They had a $3.00 non-member surcharge, but since they do not have one where I live it was not worth $55 to join.

I was just surprised to see Puritan Pride say to take it with food. Empty stomach it will be .

I am thinking 5mg/day. Your 5mg/day maxed out your lab. What level should I be trying to obtain for PN and homocysteine control? Typically, what is the dosage used by most folks?

Your comments have been very helpful. Thank you very much!

Next is to look at P5P.

My Metanx prescription was also declined by Express Scripts for reason that my insurance does not cover it. But it's isn't so clear to me because when I bought it through my local pharmacy, they got approval from my insurance. I am not just sure if they will allow a refill. I started taking it last April 3 so i don't know yet if there will be an effect on my pain. I hope so..does it have a good effect on your neuropathy?

You mentioned about some studies that suggest increased risk of colon cancer with Metanx, did it mention which ingredient/s of Metanx that make it high risk?

I called an online pharmacy that sells Metanx (I forgot the name)- I asked if they have generic, the pharmacist said they do but these are not considered as AB generic.

If I could not get a refill next week, I might just try buying a separate folate to be combined with Vit B12 and Vit B6.

The tablet form of MetaNx was changed to a capsule. That is the reason it was listed as discontinued. I would need a new Rx for the capsule form. However, MetaNx is listed as a "medical food" which is not covered under any circumstances by my coverage. I have been taking MetaNx since ~1996 (originally prescribed because of high homocysteine). I did not realize I had PN until I stopped taking MetaNx -- shock! Yes it did help me.

It was folate; however, later studies concluded that no risk exists.

My local pharmacy told me that a generic was Foltanx manufactured by Breckenridge. My doctor has submitted a Rx to Express Scripts using the generic component formula - I expect to see it rejected too.

Based on the comments by mrsD that is my strategy. I ordered the CostCo Kirkland B12 5000 mcg, but have canceled the order (gotta find another source since Kirkland does not have 1000 mcg). I was getting 2mg with MetaNx and think I should start with 1mg tabs two a day. I have ordered Solgar - Folate (Metafolin) 800 Mcg and am thinking about the Solgar P5P.

I hate having to fix something that was really not broken.

You can still use the 5mg and just take it twice a WEEK, to get the dose you want.

I have to wonder about the studies also for homocysteine effects. Recently there have been studies (they quote them on the Mayo site) that vitamins don't work. I have to wonder if ANYONE in research learns from other studies on microgram dosing... EMPTY STOMACH!!! Also P5P should be enteric coated and saved from stomach acids. AND all 3 vitamins should be given in their activated states... so that best results can be had for the MTHFR patients. Sometimes it is like the left hand not knowing what the right hand is doing! ...sigh!
Putting P5P in there with two other ingredients that don't need enteric coating, doesn't make sense. An all in one pill was rather doomed IMO.

When reading "studies" on nutrients, which tend to have results all over the place, we never see what variables are controlled and which are not. I think this is the main reason for all the data which seems to be very hard to corroborate.

Upon reading the NEW ingredients for Metanx...one has to wonder???

Only thing missing is the kitchen sink?
from
http://www.metanx.com/helpful-resources/package-insert/