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

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

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Interactions

Interaction Checker

and cyanocobalamin

No Results

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    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

                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

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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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                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

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                B-12 DOTS oral
                -
                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
                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 (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
                -
                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
                -
                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
                -
                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
                Vitamin B-12 oral
                -
                250 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) sublingual
                -
                1,000 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                500 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                2,500 mcg tablet
                cyanocobalamin (vitamin B-12) sublingual
                -
                5,000 mcg tablet

                Copyright © 2010 First DataBank, Inc.

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                Patient Education
                cyanocobalamin (vit B-12) injection

                CYANOCOBALAMIN - INJECTION

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

                COMMON BRAND NAME(S): Cobal, Cyanoject, Vitamin B-12

                USES: Cyanocobalamin is a man-made form of vitamin B12 used to treat low levels (deficiency) of this vitamin. Vitamin B12 helps your body use fat and carbohydrates for energy and make new protein. It is also important for normal blood, cells, and nerves. Most people get enough vitamin B12 in their diet, but a deficiency may occur in certain health conditions (such as poor nutrition, stomach/intestinal problems, infection, cancer). Serious vitamin B12 deficiency may result in anemia, stomach problems, and nerve damage.

                HOW TO USE: If you are using this medication at home, learn all preparation and usage instructions from your health care professional.Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.This medication is given by injection into a muscle or under the skin as directed by your doctor.Dosage is based on your medical condition and response to treatment. Injections may be given daily when you first start treatment. Certain medical conditions (such as pernicious anemia) may require you to continue receiving injections every month.Learn how to store and discard needles and medical supplies safely. Consult your pharmacist.

                SIDE EFFECTS: Pain/redness at the injection site, mild diarrhea, itching, or a feeling of swelling all over the body may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because 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.This medication may cause low potassium levels in the blood (hypokalemia). Tell your doctor right away if any of these unlikely but serious side effects occur: muscle cramps, weakness, irregular heartbeat.People who have a rare blood disorder (polycythemia vera) may rarely have symptoms related to this disorder while taking cyanocobalamin. Seek immediate medical attention if any of these rare but very serious symptoms occur: chest pain (especially with shortness of breath), weakness on one side of the body, sudden vision changes, trouble speaking.Get medical help right away if you have any very serious side effects, including: symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).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 using cyanocobalamin, tell your doctor or pharmacist if you are allergic to it; or to cobalt; or if you have any other allergies. Your doctor may recommend that you receive a smaller test dose before starting your regular dose. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low potassium blood levels (hypokalemia), gout, kidney disease, a certain blood disorder (polycythemia vera), a certain eye disease (Leber's disease), other vitamin/mineral deficiencies (especially folic acid and iron).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.Based on information from related drugs, this medication may pass into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: drugs that may affect blood cell production (such as chloramphenicol, anti-cancer drugs, HIV drugs), other vitamins/nutritional supplements (especially folic acid).Certain other drugs may interfere with laboratory tests for vitamin B12 levels, possibly causing false test results. Tell laboratory personnel and all your doctors if you take any of the following: anti-infective drugs (such as amoxicillin, erythromycin), methotrexate, pyrimethamine.

                OVERDOSE: Overdose with this medication is very unlikely. However, 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: Do not share this medication with others.Laboratory and/or medical tests (such as serum potassium levels, complete blood count, hematocrit, vitamin B12 levels) should be performed to monitor your progress or check for side effects. Consult your doctor for more details.This product is not a substitute for a proper diet. Remember that it is best to get your vitamins from healthy foods. Vitamin B12 is commonly found in many foods from animals, especially liver, kidney, fish and shellfish, meat, and dairy foods.

                MISSED DOSE: It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

                STORAGE: Store at room temperature away from light and moisture. Do not freeze. Do not store in the bathroom. Keep all medications 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.

                Information last revised March 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.

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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.
                Additional Offers
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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.