Dosing & Uses
Dosage Forms & Strengths
lyophilized powder for reconstitution
- 5g/vial
injection solution
- 1000mcg/mL (30mL)
Cyanide Poisoning
Drug of choice in continental Europe/Australia
70 mg/kg (usually 5 g) IV infusion over 15 minutes; additional 5 g IV may be given depending on severity of poisoning and clinical response
Not to exceed a cumulative dose of 10 g
Vitamin B12 Deficiency
Initial: 30 mcg IM qDay for 5-10 days
Maintenance: 100-200 mcg IM qmonth; may administer higher dose if critically ill or hyperthyroidism or neurologic or infectious disease present
Dosage Forms & Strengths
lyophilized powder for reconstitution
- 5g/vial
injection solution
- 1000mcg/mL (30mL)
Cyanide Poisoning (Off-label)
70 mg/kg (usually 5 g) IV infusion over 15 minutes; additional dose of 35 mg/kg IV may be given depending on severity of poisoning and clinical response
Vitamin B12 Deficiency
Initial: 100 mcg IM qDay for > 2 weeks (1-5 mg total dose)
Maintenance: 30-50 mcg IM qmonth
Adverse Effects
>10 %
IV infusion
- Increased blood pressure (18-28%)
- Headache (6-33%)
- Chromaturia (100%)
- Erythema (94-100%)
- Nausea (6-11%)
- Decrease in lymphocytes (8-17%)
- Local infusion site reactions (6-39%)
Frequency Not Defined
IM injection
- Exanthema (transient)
- Itching
- Diarrhea (mild transient)
- Feeling of sweating of entire body
- Anaphylaxis
IV infusion
- Hot flashes
- Peripheral edema
- Chest discomfort
- Memory impairment
- Dizziness
- Restlessness
- Urticaria
- Pruritus
- Hematochezia
- Vomiting
- Abdominal discomfort
- Dry throat
- Throat tightness
- Angioneurotic edema
Postmarketing Reports
Renal injury, including renal failure with acute tubular necrosis, renal impairment, and urine calcium oxalate crystals
Warnings
Contraindications
None listed by the manufacturer
Cautions
Consider alternative therapies, if available, in patients with known anaphylactic reactions to hydroxocobalamin or cyanocobalamin
Acute renal failure with acute tubular necrosis, renal impairment and urine calcium oxalate crystals have been reported following therapy; monitor renal function for 7 days following therapy
Substantial increases in blood pressure may occur following therapy; monitor blood pressure during treatment
Pregnancy & Lactation
Pregnancy
Available data from cases reported in published literature and postmarketing surveillance in pregnant women are insufficient to identify a drug-associated risk for major birth defects, miscarriage, or adverse maternal and fetal outcomes
There are risks to pregnant woman and fetus associated with untreated cyanide poisoning
Cyanide readily crosses the placenta; cyanide poisoning is a medical emergency in pregnancy which can be fatal for pregnant woman and fetus if left untreated; life-sustaining therapy should not be withheld due to pregnancy
Animal data
- In animal studies, hydroxocobalamin administered to pregnant rats and rabbits during the period of organogenesis caused skeletal and soft tissue abnormalities, including alterations in central nervous system, at exposures similar to human exposures at therapeutic dose
Lactation
Breastfeeding not recommended during treatment; there are no data to determine whenbreastfeeding may be safely restarted following administration of drug; hydroxocobalamin and Vitamin B12 (which is formed when hydroxocobalamin combines with cyanide) are present in human milk; there are no data on effects of hydroxocobalamin on breastfed infant or effects on milk production
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.Pharmacology
Mechanism of Action
Vitamin B12 with hydroxyl group complexed to cobalt which can be displaced by cyanide resulting in cyanocobalamin that is renally excreted
Pharmacokinetics
Protein binding: Forms cobalamin (III) complexes
Half-life: 26-31 hr
Excretion: Urine (50-60%)
Administration
IV Preparation
Reconstitute lyophilized powder with 200 mL 0.9% NaCl; resulting concentration is 25 mg/mL
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| hydroxocobalamin intramuscular - | 1,000 mcg/mL vial |  | |
| Cyanokit intravenous - | 5 gram vial |  |
Copyright © 2010 First DataBank, Inc.
Formulary
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