cyanocobalamin (Rx, OTC)

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

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

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

and cyanocobalamin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (0)

                Monitor Closely (2)

                • dichlorphenamide

                  dichlorphenamide and cyanocobalamin both decrease serum potassium. Use Caution/Monitor.

                • omadacycline

                  cyanocobalamin will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

                Minor (67)

                • acetazolamide

                  acetazolamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • amikacin

                  amikacin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin

                  aspirin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin rectal

                  aspirin rectal decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • aspirin/citric acid/sodium bicarbonate

                  aspirin/citric acid/sodium bicarbonate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • balsalazide

                  balsalazide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • bazedoxifene/conjugated estrogens

                  bazedoxifene/conjugated estrogens decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • carbamazepine

                  carbamazepine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • chloramphenicol

                  chloramphenicol decreases effects of cyanocobalamin by pharmacodynamic antagonism. Minor/Significance Unknown.

                • choline magnesium trisalicylate

                  choline magnesium trisalicylate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • cimetidine

                  cimetidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • clonazepam

                  clonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • colchicine

                  colchicine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • colestipol

                  colestipol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • conjugated estrogens

                  conjugated estrogens decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • conjugated estrogens, vaginal

                  conjugated estrogens, vaginal decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • dexlansoprazole

                  dexlansoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • diflunisal

                  diflunisal decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • eslicarbazepine acetate

                  eslicarbazepine acetate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • esomeprazole

                  esomeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • estradiol

                  estradiol decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • estrogens conjugated synthetic

                  estrogens conjugated synthetic decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • estrogens esterified

                  estrogens esterified decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • estropipate

                  estropipate decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • ethanol

                  ethanol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • ethosuximide

                  ethosuximide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • famotidine

                  famotidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • felbamate

                  felbamate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • fosphenytoin

                  fosphenytoin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • gabapentin

                  gabapentin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • gabapentin enacarbil

                  gabapentin enacarbil decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • gentamicin

                  gentamicin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • ibuprofen/famotidine

                  ibuprofen/famotidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • lacosamide

                  lacosamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • lamotrigine

                  lamotrigine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • lansoprazole

                  lansoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • levetiracetam

                  levetiracetam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • lorazepam

                  lorazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • mesalamine

                  mesalamine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • mestranol

                  mestranol decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.

                • metformin

                  metformin decreases levels of cyanocobalamin by unspecified interaction mechanism. Minor/Significance Unknown. It may take several years of metformin therapy to develop vitamin B12 deficiency.

                • methsuximide

                  methsuximide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • neomycin PO

                  neomycin PO decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • nizatidine

                  nizatidine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • octreotide

                  octreotide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • octreotide (Antidote)

                  octreotide (Antidote) decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • omeprazole

                  omeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • oxcarbazepine

                  oxcarbazepine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • pantoprazole

                  pantoprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • paromomycin

                  paromomycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • phenobarbital

                  phenobarbital decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • phenytoin

                  phenytoin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • primidone

                  primidone decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • rabeprazole

                  rabeprazole decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • rose hips

                  rose hips decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • rufinamide

                  rufinamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • salicylates (non-asa)

                  salicylates (non-asa) decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • salsalate

                  salsalate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • streptomycin

                  streptomycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • sulfasalazine

                  sulfasalazine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • tiagabine

                  tiagabine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • tobramycin

                  tobramycin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • topiramate

                  topiramate decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • valproic acid

                  valproic acid decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • willow bark

                  willow bark decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

                • zidovudine

                  zidovudine decreases levels of cyanocobalamin by unspecified interaction mechanism. Minor/Significance Unknown.

                • zonisamide

                  zonisamide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

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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; monitor serum potassium and platelet counts more frequently in these patients

                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

                Vitamin B12 deficiency masks signs of polycythemia vera; vitamin B12 administration may unmask condition

                IM and SC route used to treat pernicious anemia; oral and intranasal not indicated until hematologic remission and no signs of nervous system involvement

                Use with caution in patients with Leber’s disease; B12 treatment may result in rapid optic atrophy

                Parenteral product may contain aluminum; toxic aluminum concentrations may occur with renal dysfunction, high doses, or prolonged use

                Efficacy of intranasal administration in patients with nasal pathology or concomitant therapy has not been determined; use with caution

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                Pregnancy & Lactation

                Pregnancy

                Administration of approved recommended dose is not expected to cause major birth defects, miscarriage or adverse maternal or fetal outcomes

                There are risks associated with vitamin B12 deficiency during pregnancy; severe maternal vitamin B12 deficiency during pregnancy may result in adverse pregnancy outcomes such as low birth weight, preterm birth and megaloblastic anemia

                Lactation

                Vitamin B12 is present in human milk; administration of approved recommended dose is not expected to cause harm to a breastfed child; there is no information on effects the breastfed child or on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed infant from underlying maternal condition

                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.

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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

                BRAND FORM. UNIT PRICE PILL IMAGE
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                2,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg/15 mL liquid
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                5,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                2,500 mcg chewable tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg capsule
                cyanocobalamin (vitamin B-12) oral
                -
                2,500 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                500 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                500 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                100 mcg tablet
                cyanocobalamin (vitamin B-12) oral
                -
                250 mcg tablet
                Vitamin B-12 oral
                -
                100 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                100 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg lozenge
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                1,000 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                2,000 mcg tablet
                Vitamin B-12 oral
                -
                500 mcg tablet
                Vitamin B-12 oral
                -
                100 mcg tablet
                Vitamin B-12 oral
                -
                250 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                5,000 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                500 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                2,500 mcg tablet
                B-12 DOTS oral
                -
                500 mcg tablet
                Nascobal nasal
                -
                500 mcg/spray liquid
                Vitamin B-12 sublingual
                -
                2,500 mcg tablet
                Vitamin B-12 sublingual
                -
                2,500 mcg tablet
                Vitamin B-12 sublingual
                -
                5,000 mcg tablet
                Vitamin B-12 sublingual
                -
                2,500 mcg tablet
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial
                cyanocobalamin (vit B-12) injection
                -
                1,000 mcg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                cyanocobalamin (vitamin B-12) oral

                CYANOCOBALAMIN - ORAL

                (SYE-an-oh-koe-BAL-a-min)

                COMMON BRAND NAME(S): Vitamin B-12

                USES: See also Precautions section.Cyanocobalamin is a man-made form of vitamin B12 used to prevent and treat low blood levels of this vitamin. Most people get enough vitamin B12 from their diet. Vitamin B12 is important to maintain the health of your metabolism, blood cells, and nerves. Serious vitamin B12 deficiency may result in a low number of red blood cells (anemia), stomach/intestine problems, and permanent nerve damage.Vitamin B12 deficiency may occur in certain health conditions (such as intestinal/stomach problems, poor nutrition, cancer, HIV infection, pregnancy, old age, alcoholism). It may also occur in people who follow a strict vegetarian (vegan) diet.

                HOW TO USE: If you are taking the over-the-counter product to self-treat, follow all directions on the product package before taking this medication. If you have any questions, consult your pharmacist. If your doctor has directed you to take this medication, take as directed by your doctor.Take this medication by mouth, usually once daily with or without food or as directed by your doctor or the product package. Use this product regularly to get the most benefit from it. To help you remember, take it at the same time each day.The dosage is based on your medical condition, response to treatment, and laboratory tests. Consult your doctor or pharmacist for more details.There are many brands and forms of cyanocobalamin (vitamin B12) available. Read the dosing instructions carefully for each product because the amount of cyanocobalamin (vitamin B12) may be different between products.If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. Some liquid brands may require you to shake the bottle well before each dose.If you are taking the extended-release tablets, do not crush or chew them. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.If you are taking the chewable tablet, chew the medication thoroughly before swallowing.If you are taking the rapidly-dissolving tablets, dissolve in the mouth with or without water as directed by your doctor or the product package.Vitamin C (ascorbic acid) can decrease the amount of vitamin B12 you absorb. Avoid taking large doses of vitamin C within one hour before or after taking this product.If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

                SIDE EFFECTS: This product usually has no side effects. If you have any unusual effects, contact your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.If you have severe anemia, this medication may rarely cause low potassium levels in the blood (hypokalemia) as your body makes new red blood cells. Tell your doctor right away if any of these unlikely but serious side effects occur: muscle cramps, weakness, irregular heartbeat.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before taking cyanocobalamin, tell your doctor or pharmacist if you are allergic to it; or to any form of vitamin B12; or to cobalt; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this medication: a certain eye disease (Leber's optic neuropathy), a certain blood disorder (polycythemia vera), gout, iron or folic acid deficiency anemia, low potassium blood levels (hypokalemia).Cyanocobalamin taken by mouth should only be used if your body can properly absorb it. You may need a form of vitamin B12 that is injected or inhaled in the nose if you have any of the following health problems: pernicious anemia, food absorption problems, stomach/intestinal surgery (such as gastric bypass or bowel resection), stomach/intestinal disease (such as Crohn's disease, colitis, diverticulitis, pancreatic insufficiency), irradiation of the small bowel.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Cyanocobalamin is safe to use during pregnancy when taken in recommended doses. Higher doses should be used only when clearly needed. Discuss the risks and benefits with your doctor.Cyanocobalamin passes into breast milk and is unlikely to harm a nursing infant when used in recommended doses. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.Some products that may interact with this drug include: drugs that affect the bone marrow (such as chloramphenicol), vitamins/supplements that contain intrinsic factor.Certain medications can decrease the absorption of vitamin B12, including: colchicine, metformin, extended-release potassium products, antibiotics (such as gentamicin, neomycin, tobramycin), anti-seizure medications (such as phenobarbital, phenytoin, primidone), medications to treat heartburn (such as H2 blockers including cimetidine/famotidine, proton pump inhibitors such as omeprazole/lansoprazole).Vitamin B12 is an ingredient found in many combination vitamin and nutritional products. Tell your doctor or pharmacist if you are taking other products that contain cyanocobalamin, vitamin B12, or hydroxocobalamin.Cyanocobalamin may interfere with certain laboratory tests (including intrinsic factor, blood tests for other types of anemia), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.Certain drugs may interfere with laboratory tests for vitamin B12 levels, possibly causing false results. Tell laboratory personnel and all your doctors if you take any of the following: antibiotics (such as amoxicillin, erythromycin), methotrexate, pyrimethamine.This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: Keep all regular medical and laboratory appointments.Laboratory and/or medical tests (such as vitamin B12 levels, complete blood count, blood potassium levels) may be performed to monitor your progress or check for side effects. Consult your doctor for more details.Remember that it is best to get your vitamins and minerals from food whenever possible. Eat a well-balanced diet, and follow any dietary guidelines as directed by your doctor. Foods rich in vitamin B12 include meat, poultry, shellfish, eggs, milk, and other dairy products.

                MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

                STORAGE: This product is usually stored at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Different brands of this medication may have different storage needs. Check the product package for specific instructions on how to store your brand, or ask your pharmacist. Keep all medications and herbal products away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised July 2021. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • Compare formulary status to other drugs in the same class.
                • Access your plan list on any device – mobile or desktop.

                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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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.