Nascobal (cyanocobalamin (vitamin B-12))

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Cyanocobalamin is administered by IM or deep subcutaneous injection. Cyanocobalamin also is administered orally and intranasally. Hydroxocobalamin is administered by IM injection or IV infusion. Oral therapy with vitamin B12 preparations is markedly inferior to parenteral therapy and should be used only for the treatment of dietary vitamin B12 deficiency in patients with normal GI absorption.

Safety of concomitant administration of other cyanide antidotes with hydroxocobalamin (Cyanokit(R)) has not been established. Caution is advised if another cyanide antidote is administered to patients receiving hydroxocobalamin.

Absorption of vitamin B12 from the GI tract may be decreased by aminoglycoside antibiotics, colchicine, extended-release potassium preparations, aminosalicylic acid and its salts, anticonvulsants (e.g., phenytoin, phenobarbital, primidone), cobalt irradiation of the small bowel, and by excessive alcohol intake lasting longer than 2 weeks. Neomycin-induced malabsorption of vitamin B12 may be increased by concurrent administration of colchicine.

Ascorbic acid may destroy substantial amounts of dietary vitamin B12 in vitro; this possibility should be considered when large doses of ascorbic acid are ingested within 1 hour of oral vitamin B12 administration.

Prednisone has been reported to increase the absorption of vitamin B12 and secretion of IF in a few patients with pernicious anemia, but not in patients with partial or total gastrectomy. The clinical importance of these findings is unknown.

Concurrent administration of chloramphenicol and vitamin B12 reportedly may antagonize the hematopoietic response to vitamin B12 in vitamin B12-deficient patients. The hematologic response to vitamin B12 in patients receiving both drugs should be carefully monitored and alternate anti-infectives should be considered.

There are no contraindication interactions for this drug.

There are no severe interactions for this drug.

There are no moderate interactions for this drug.

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• Leber's hereditary optic atrophy

There are no severe contraindications for this drug.

• Hypokalemia

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Rare or Very Rare

• Anaphylaxis
• Angioedema
• Hypokalemia
• Thrombocytosis

More Frequent

• Arthralgia
• Dizziness
• General weakness
• Glossitis
• Headache disorder
• Infection
• Nausea
• Paresthesia
• Pharyngitis
• Rhinitis
• Rhinorrhea
• Skin rash

Less Frequent

• Nasal passage irritation
• Sore throat

Rare or Very Rare

• Bronchitis
• Cough
• Dental abscess
• Malaise
• Pain
• Sinus headache

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Adequate and well-controlled studies have not been conducted in pregnant women. However, vitamin B12 requirements are increased in pregnant women. Parenteral preparations should be used during pregnancy only when the potential benefits justify the potential risks to the fetus.

Vitamin B12 is distributed into human milk. Vitamin B12 requirements are increased in lactating women.

Hydroxocobalamin may be administered to lactating women with suspected or known cyanocobalamin poisoning. There is no data available to determine when breastfeeding may be restarted following administration of IV hydroxocobalamin.

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