cyanocobalamin

Generic Name: cyanocobalamin (oral) (sye AN oh koe BAL a min)

Brand Names: B-12 Resin, Vitamin B-12, Vitamin B12

What is oral cyanocobalamin?

Cyanocobalamin is a man-made form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.

Cyanocobalamin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about oral cyanocobalamin?

You should not use this medication if you are allergic to cobalt, or if you have Leber's disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber's disease.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Take all of your medications as directed.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.

What should I discuss with my healthcare provider before taking oral cyanocobalamin?

You should not use this medication if you are allergic to cobalt, or if you have Leber's disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber's disease.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take oral cyanocobalamin:

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  any type of infection;

  
  


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  iron or folic acid deficiency;

  
  


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  kidney or liver disease; or

  
  


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  if you are receiving any medication or treatment that affects bone marrow.

  
  

FDA pregnancy category C. It is not known whether cyanocobalamin is harmful to an unborn baby. Before using this medication, tell your doctor if you are pregnant or plan to become pregnant during treatment. Cyanocobalamin passes into breast milk, but it is not known whether cyanocobalamin could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take oral cyanocobalamin?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition. Take oral cyanocobalamin with a full glass of water.

The sublingual tablet should be placed under your tongue where it will dissolve.

Do not crush, chew, break an extended-release tablet. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

To be sure this medication is helping your condition, your blood will need to be tested every 3 to 6 months. This will help your doctor determine the correct dose and how long to treat you with cyanocobalamin. Do not miss any scheduled appointments.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Take all of your medications as directed.

Store this medication at room temperature away from moisture, heat, and light.

See also: Cyanocobalamin dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of cyanocobalamin is not likely to cause life-threatening symptoms.

What should I avoid while taking oral cyanocobalamin?

Avoid drinking large amounts of alcohol while you are being treated with cyanocobalamin.

Oral cyanocobalamin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

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  chest pain;

  
  


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  feeling short of breath, even with mild exertion;

  
  


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  swelling, rapid weight gain; or

  
  


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  unusual warmth, redness, or pain in an arm or leg.

  
  

Less serious side effects may include:

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  headache, dizziness, weakness;

  
  


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  nausea, upset stomach, diarrhea;

  
  


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  numbness or tingling;

  
  


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  fever;

  
  


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  joint pain;

  
  


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  swollen tongue;

  
  


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  swelling; or

  
  


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  itching or rash.

  
  

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Cyanocobalamin Dosing Information

Usual Adult Dose for Pernicious Anemia:

Parenteral:
Initial dose: 100 mcg intramuscularly once a day for 7 days. If there is clinical improvement and a reticulocyte response, 100 mcg intramuscularly once every other day for 7 days, then once every 3 to 4 days for another 2 to 3 weeks is recommended. Most patients require monthly injections of 100 to 1000 mcg intramuscularly for life.

Nasal Spray or Gel:
Alternatively, cyanocobalamin (Nascobal) nasal spray or nasal gel 500 mcg intranasally to one nostril once a week may be administered to patients with pernicious anemia who require maintenance of normal hematologic status following intramuscular vitamin B12 and who have no nervous system involvement. However, if the patient is not adequately maintained with cyanocobalamin nasal, intramuscular vitamin B12 administration must be resumed.

Usual Adult Dose for B12 Nutritional Deficiency:

Oral: 25 to 250 mcg once a day.
Nasal Spray or Gel:
(Nascobal) 500 mcg intranasally in one nostril once a week
(CaloMist) 25 mcg in each nostril once a day (total dose 50 mcg). May be increased to 50 mcg in each nostril once a day.

Usual Adult Dose for Schilling Test:

1 mcg radiolabeled cyanocobalamin orally once after urinary voiding. A 24-hour urinary collection is immediately begun. At 2 hours an injection of cyanocobalamin 1,000 mcg intramuscularly is given to "flush" the patient of absorbed radiolabeled drug. The percentage of radiolabeled B12 excreted in the urine is a measure of how much labeled drug was absorbed. Normally 7% or more of a dose is excreted in 24 hours (

Usual Pediatric Dose for Pernicious Anemia:

Neonates and Infants: Intramuscular or Subcutaneous: 0.2 mcg/kg for 2 days, followed by 1000 mcg/day for 2 to 7 days; maintenance: 100 mcg/month.
Children: Intramuscular or Subcutaneous: 30 to 50 mcg/day for 2 or more weeks (to a total dose of 1000 mcg), then follow with 100 mcg/month.

Usual Pediatric Dose for B12 Nutritional Deficiency:

Intramuscular or Subcutaneous: Initial: 0.2 mcg/kg for 2 days followed by 1000 mcg/day for 2 to 7 days followed by 100 mcg/week for a month or 100 mcg/day for 10 to 15 days (total dose of 1 to 1.5 mg), then once or twice weekly for several months. May taper to 60 mcg every month. For malabsorptive causes of B12 deficiency, monthly maintenance doses of 100 mcg have been recommended.

What other drugs will affect oral cyanocobalamin?

Before taking cyanocobalamin, tell your doctor if you are taking any of the following medications:

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  antibiotics;

  
  


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  methotrexate (Rheumatrex);

  
  


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  pyrimethamine (Daraprim);

  
  


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  colchicine; or

  
  


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  if you drank a lot of alcohol within the past 2 weeks.

  
  

This list is not complete and there may be other drugs that can interact with cyanocobalamin. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More cyanocobalamin resources

• Cyanocobalamin Side Effects (in more detail)
• Cyanocobalamin Dosage
• Cyanocobalamin Use in Pregnancy & Breastfeeding
• Cyanocobalamin Drug Interactions
• Cyanocobalamin Support Group
• 5 Reviews for Cyanocobalamin - Add your own review/rating

• Cyanocobalamin Prescribing Information (FDA)


• Calomist Consumer Overview


• Calomist Prescribing Information (FDA)


• Nascobal Monograph (AHFS DI)


• Nascobal Prescribing Information (FDA)


• Nascobal Spray MedFacts Consumer Leaflet (Wolters Kluwer)


• Vitamin b12


• vitamin b12 Nasal, Oral, Parenteral Advanced Consumer (Micromedex) - Includes Dosage Information

Compare cyanocobalamin with other medications

• B12 Nutritional Deficiency
• Pernicious Anemia
• Schilling Test
• Vitamin B12 Deficiency

Where can I get more information?

• Your pharmacist can provide more information about oral cyanocobalamin.

See also: cyanocobalamin side effects (in more detail)