Dosing & Uses
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
Limitations of use
- Nasal spray should not be used for the vitamin B12 absorption test (Schilling test).
- In patients with correctible or temporary causes of vitamin B12 deficiency, the benefit of continued longterm use of nasal spray following adequate correction of vitamin B12 deficiency and underlying disease has not been established
- The effectiveness of nasal spray in patients with active symptoms of nasal congestion, allergic rhinitis or upper respiratory infection has not been determined; treatment with nasal spray should be deferred until symptoms subsided
Dosing modifications
- If serum levels of B12 decline after one month of treatment, consider increasing dose; assess serum B12 level one month after each dose adjustment; if serum B12 levels are persistently low, consider alternative therapy (eg, intramuscular or subcutaneous vitamin B12 therapy)
- In patients whose underlying cause of vitamin B12 deficiency has been corrected and are deemed no longer at risk for vitamin B12 deficiency, discontinue nasal spray administration; safety and effectiveness of continued long-term use in these individuals not established; in patients with pernicious anemia, continue appropriate vitamin B12 treatment indefinitely
Dosing considerations
- PO absorption requires intrinsic factor
- Cyanide poisoning: See Hydroxycobalamin AD
- In patients with concurrent folate and vitamin B12 deficiency, administer folic acid in addition to the nasal spray
- Administer iron in addition to the nasal spray in patients with concurrent iron and vitamin B12 deficiency
- Consider measures to treat underlying condition associated with vitamin B12 deficiency in addition to treatment with nasal spray
- In patients with suspected cobalamin hypersensitivity, consider administering an intradermal test dose of parenteral vitamin B12 prior to use of nasal spray
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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.
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
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
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; patients exhibiting clinical or hematologic response consistent with polycythemia vera should be referred for further evaluation
IM and SC route used to treat pernicious anemia; oral and intranasal not indicated until hematologic remission and no signs of nervous system involvement
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
Cyanocobalamin products, not recommended for use in patients with Leber’s optic atrophy; for patients with Leber’s disease requiring vitamin B12, consider alternative therapy (eg, hydroxocobalamin) for B12 supplementation; severe and swift optic atrophy reported in patients with early Leber’s disease (hereditary optic nerve atrophy) treated with vitamin B12
Anaphylactic shock and death reported after parenteral vitamin B12 administration; if patients are to start nasal spray before having tolerated cyanocobalamin parenterally, consider administering an intradermal test doseof parenteral vitamin B12 to patients suspected of cyanocobalamin hypersensitivity
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.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)
Administration
Prior to treatment, obtain hematocrit, reticulocyte count, vitamin B12, folate, and iron levels; consider potential for concomitant drugs to interfere with vitamin B12 and folate diagnostic blood assays
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Vitamin B-12 oral - | 500 mcg tablet |  | |
| Vitamin B-12 oral - | 500 mcg tablet | | |
| Vitamin B-12 oral - | 100 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 - | 2,000 mcg tablet |  | |
| Vitamin B-12 oral - | 100 mcg tablet |  | |
| Vitamin B-12 oral - | 250 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 |  | |
| 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/15 mL liquid |  | |
| cyanocobalamin (vitamin B-12) oral - | 1,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 5,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 1,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 2,500 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 - | 1,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 500 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 2,500 mcg chewable tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 500 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 250 mcg tablet | | |
| cyanocobalamin (vitamin B-12) oral - | 1,000 mcg capsule |  | |
| cyanocobalamin (vitamin B-12) oral - | 1,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) oral - | 100 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) sublingual - | 500 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) sublingual - | 2,500 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) sublingual - | 1,000 mcg tablet |  | |
| cyanocobalamin (vitamin B-12) sublingual - | 5,000 mcg tablet |  | |
| 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 |  | |
| Nascobal nasal - | 500 mcg/spray liquid |  | |
| 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 |  | |
| B-12 DOTS oral - | 500 mcg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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 lasts or gets worse, 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 February 2022. Copyright(c) 2022 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.
Formulary
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.
