Cyanocobalamin (vitamin B12)

DEA Class; Rx

Common Brand Names; vitamin B12, Nascobal, Athlete, Calomist, cobalamin, Cobex, Crystamine, Prime, Rubramin PC, Vibisone, Eligen B12

• B Vitamins; 
• Vitamins, Water-Soluble

Nasal/oral/parenteral B vitamin
Used to treat pernicious anemia and prevent and treat vitamin B12 deficiency, as well as to determine vitamin B12 absorption in the Schilling test
Equal in biologic activity to hydroxocobalamin

Indicated for nutritional supplementation.

Hypersensitivity to product; sensitivity to cobalt

• Arthralgia (12%)
• Dizziness (12%)
• Headache (12%)
• Nasopharyngitis (12%)
• Anaphylaxis
• Angioedema
• Congestive heart failure
• Peripheral vascular disease
• Pulmonary edema
• Diarrhea
• Dyspepsia
• Polycythemia vera
• Sore throat
• Nervousness
• Rhinitis
• Glossitis
• Hypoesthesia

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

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

Vitamin B12 is present in human milk; administration of approved recommended dose is not expected to cause harm to a breastfed child

Cyanocobalamin 

tablet

• 100mcg
• 250mcg
• 500mcg
• 1000mcg

tablet, extended release

• 1000mcg

tablet, sublingual

• 2500mcg

injectable solution

• 1000mcg/mL

nasal spray

• 500mcg/spray