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cyanocobalamin (Rx, OTC)Brand and Other Names:vitamin B12, Nascobal, more...Athlete, Calomist, cobalamin, Cobex, Crystamine, Prime, Rubramin PC, Vibisone, Eligen B12

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 100mcg
  • 250mcg
  • 500mcg
  • 1000mcg

tablet, extended release

  • 1000mcg

tablet, sublingual

  • 2500mcg

injectable solution

  • 1000mcg/mL

nasal spray

  • 500mcg/spray
more...

Nutritional Supplementation

Recommended daily allowance (RDA)

>19 years: 2.4 mcg

Pregnant women: 2.6 mcg

Breastfeeding women: 2.8 mcg

Dietary supplement: 50-6,000 mcg/day

Pernicious Anemia

Manufacturer recommendation: 100 mcg IM/SC once daily for 6-7 days, then every other day for 7 doses, then every 3-4 days for 2-3 weeks, then monthly

Alternative parenteral dosing: 1000 mcg IM/SC once daily for 7 days, then weekly for 1 month, then monthly

Nasal spray: 500 mcg (1 spray in 1 nostril) weekly; if patient is taking hot meals, spray should be administered 1 hour before or after meal

B12 Deficiency

Initial: 30 mcg IM once daily for 5-10 days

Maintenance: 100-200 mcg IM monthly

Nasal dose: 500 mcg once weekly

Dosing considerations

  • PO absorption requires intrinsic factor
  • Cyanide poisoning: See Hydroxycobalamin AD

Dosage Forms & Strengths

tablet

  • 100mcg
  • 250mcg
  • 500mcg
  • 1000mcg

tablet, extended release

  • 1000mcg

tablet, sublingual

  • 2500mcg

injectable solution

  • 1000mcg/mL

nasal spray

  • 500mcg/spray
more...

Nutritional Supplementation

RDA

0-6 months: 0.4 mcg

7-12 months: 0.5 mcg

1-3 years: 0.9 mcg

4-8 years: 1.2 mcg

9-13 years: 1.8 mcg

>14 years: 2.4 mcg

Pernicious Anemia

30-50 mcg IM/SC once daily for &ge2 weeks for total dose of 1,000 mcg to 5,000 mcg administer concomitantly with 1 mg/day of folic acid for 1 month

Maintenance: 100 mcg IM/SC monthly

B12 Deficiency

0.2 mcg/kg for 2 days; follow by 1,000 mcg/day for 2-7 days; follow by 100 mcg/day for 2-7 days; then 100 mcg/week for 1 month

Maintenance: 100 mcg IM/SC monthly

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Interactions

Interaction Checker

cyanocobalamin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
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            Adverse Effects

            >10%

            Arthralgia (12%)

            Dizziness (12%)

            Headache (12%)

            Nasopharyngitis (12%)

            Frequency Not Defined

            Anaphylaxis

            Angioedema

            Congestive heart failure

            Peripheral vascular disease

            Pulmonary edema

            Diarrhea

            Dyspepsia

            Polycythemia vera

            Sore throat

            Nervousness

            Rhinitis

            Glossitis

            Hypoesthesia

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            Warnings

            Contraindications

            Hypersensitivity to product; sensitivity to cobalt

            Cautions

            Intensive treatment of B12-deficient megaloblastic anemia may cause hypokalemia and sudden death

            Nasal disease; defer use until symptoms resolve

            Use with caution in patients with Leber optic nerve atrophy

            Injection is incompatible with some common drugs (eg, warfarin and several phenothiazines) but is compatible with vitamins B and C

            Vitamin B12 deficiency for >3 months results in irreversible degenerative CNS lesions

            Thrombocytosis may occur with treatment of severe vitamin B12 megaloblastic anemia

            Oral and intranasal route are not indicated for the treatment of pernicious anemia until symptoms resolve

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            Pregnancy & Lactation

            Pregnancy category: A; C (for doses exceeding RDA and for intranasal products)

            Lactation: Drug distributed in milk; safe to use

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Coenzyme; metabolic functions include protein synthesis and carbohydrate metabolism

            Plays role in cell replication and hematopoiesis

            Absorption

            Bioavailability: 6.1% (intranasal solution relative to IM)

            Distribution

            Distributed to liver, bone marrow, and other tissues

            Protein bound: Binding to transcobalamins

            Elimination

            Excretion: Urine (excess amount), bile (mostly reabsorbed)

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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