Cyanocobalamin

What is Cyanocobalamin?

• Cyanocobalamin is a form of vitamin B 12 used to treat vitamin B 12 deficiency except in the presence of cyanide toxicity.
• Cobalamin cannot be synthesized by humans and its presence in meat and eggs is due to its synthesis by microorganisms in the intestines of animals.
• Vitamin B12 absorption from the diet requires a cofactor (intrinsic factor) produced by parietal cells of the stomach.
• The major cause of cobalamin deficiency in humans is lack of intrinsic factor due to gastric atrophy caused by autoimmune destruction of parietal cells.
• Classic vitamin B12 deficiency causes profound anemia and symptoms of anorexia, irritability, apathy, weakness and a distinctive neurologic syndrome with paresthesias in the hands and feet, unsteady gait, moodiness, confusion and memory loss.

Cyanocobalamin

Cyanocobalamin-3D-sticks

What are the uses of this medicine?

Cyanocobalamin is used for vitamin B12 deficiencies due to malabsorption which may be associated with the following conditions:

• Addisonian (pernicious) anemia
• Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomy
• Fish tapeworm infestation
• Malignancy of pancreas or bowel
• Folic acid deficiency

• Cyanocobalamin Injection, USP is also suitable for the vitamin B12 absorption test (SCHILLING TEST).

• Cyanocobalamin injection is in a class of medications called vitamins. Because it is injected straight into the bloodstream, it can be used to supply vitamin B12 to people who cannot absorb this vitamin through the intestine.

How does this medicine work?

• Cyanocobalamin (sye" an oh koe bal' a min) is a water soluble B vitamin found in dairy products and meat.
• The cobalamins are complex organometallic compounds with a central cobalt atom within a porphyrin-like corrin ring.
• Cobalamins act as essential cofactors for several enzymes including methionine synthase and methylmalonyl-coenyzme A-mutase.
• The activities of these enzymes are important in RNA, protein and lipid metabolism and in hemoglobin synthesis.
• Gastrointestinal absorption of vitamin B12 depends on the presence of sufficient intrinsic factor and calcium ions. Intrinsic factor deficiency causes pernicious anemia, which may be associated with subacute combined degeneration of the spinal cord. Prompt parenteral administration of vitamin B12 prevents progression of neurologic damage.
• Vitamin B12 is not present in foods of plant origin, but is abundant in foods of animal origin.
• In people with normal absorption, deficiencies have been reported only in strict vegetarians who consume no products of animal origin (including no milk products or eggs).
• Vitamin B12 is bound to intrinsic factor during transit through the stomach; separation occurs in the terminal ileum in the presence of calcium, and vitamin B12 enters the mucosal cell for absorption. It is then transported by the transcobalamin binding proteins.
• Cyanocobalamin is the most widely used form of vitamin B12, and has hematopoietic activity apparently identical to that of the antianemia factor in purified liver extract. Hydroxycobalamin is equally as effective as cyanocobalamin, and they share the cobalamin molecular structure.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• Sensitivity to cobalt and/or vitamin B12

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following: antibiotics such as chloramphenicol

• colchicine
• folic acid
• methotrexate (Rheumatrex, Trexall)
• para-aminosalicylic acid (Paser)
• pyrimethamine (Daraprim)

Is this medicine FDA approved?

• Cyanocobalamin was first manufactured in the 1940s.
• It is available as a generic medication and over the counter.
• In 2020, it was the 105th most commonly prescribed medication in the United States, with more than 6 million prescriptions.

How should this medicine be used?

Recommended dosage: Pernicious Anemia:

• A dose of 100 mcg daily for 6 or 7 days should be administered by intramuscular or deep subcutaneous injection. If there is clinical improvement and if a reticulocyte response is observed, the same amount may be given on alternate days for seven doses, then every 3 to 4 days for another 2 to 3 weeks.
• This regimen should be followed by 100 mcg monthly for life.
• Folic acid should be administered concomitantly if needed.

Patients with Normal Intestinal Absorption:

• Initial treatment similar to that for patients with pernicious anemia may be indicated depending on the severity of the deficiency. Chronic treatment should be with an oral B12 preparation.

Schilling Test: The flushing dose is 1,000 mcg.

Administration:

• Cyanocobalamin comes as a solution (liquid) to be injected into a muscle or just under the skin.
• It is usually injected by a healthcare provider in an office or clinic.
• You will probably receive cyanocobalamin injection once a day for the first 6-7 days of your treatment.
• As your red blood cells return to normal, you will probably receive the medication every other day for 2 weeks, and then every 3-4 days for 2-3 weeks.
• After your anemia has been treated, you will probably receive the medication once a month to prevent your symptoms from coming back.
• Cyanocobalamin injection will supply you with enough vitamin B12 only as long as you receive injections regularly.
• You may receive cyanocobalamin injections every month for the rest of your life.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Cyanocobalamin Injection, USP
• Each mL contains 1,000 mcg cyanocobalamin.

This medicine is available in fallowing brand namesː

• Berubigen
• Betalin 12
• Cobavite
• Redisol
• Rubivite
• Ruvite
• Vi-twel
• Vibisone

What side effects can this medication cause?

The most common side effects of this medicine include:

• diarrhea
• Feeling of swelling of entire body

Cyanocobalamin may cause serious side effects which may include:

• Anaphylactic shock
• Pulmonary edema and congestive heart failure
• peripheral vascular thrombosis
• Polycythemia vera
• transient diarrhea
• Itching
• transitory exanthema

What special precautions should I follow?

• Patients with pernicious anemia should be informed that they will require monthly injections of vitamin B12 for the remainder of their lives. Failure to do so will result in return of the anemia and in development of incapacitating and irreversible damage to the nerves of the spinal cord.
• patients should be warned about the danger of taking folic acid in place of vitamin B12, because the former may prevent anemia but allow progression of subacute combined degeneration.
• A vegetarian diet which contains no animal products (including milk products or eggs) does not supply any vitamin B12. Patients following such a diet, should be advised to take oral vitamin B12 regularly.
• The need for vitamin B12 is increased by pregnancy and lactation. Deficiency has been recognized in infants of vegetarian mothers who were breast fed, even though the mothers had no symptoms of deficiency at the time.
• Tell your doctor if you drink or have ever drunk large amounts of alcohol and if you have or have ever had Leber's hereditary optic neuropathy (slow, painless loss of vision, first in one eye and then in the other) or kidney disease.
• Hypokalemia and sudden death may occur in severe megaloblastic anemia which is treated intensely.
• This product contains Benzyl Alcohol. Benzyl Alcohol has been reported to be associated with a fatal "Gasping Syndrome" in premature infants.
• This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.

What to do in case of emergency/overdose?

Symptoms of overdose may include:

• No overdosage has been reported with this drug.

Management of overdosage:

• In case of overdose, call the poison control helpline of your country. In the United States, call 1-800-222-1222.

• Overdose related information is also available online at poisonhelp.org/help.
• In the event that the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services. In the United States, call 911.

Can this medicine be used in pregnancy?

• Pregnancy Category C.
• Adequate and well-controlled studies have not been done in pregnant women.
• However, vitamin B12 is an essential vitamin and requirements are increased during pregnancy.

Can this medicine be used in children?

• Intake in children should be in the amount (0.5 to 3 mcg daily) recommended by the Food and Nutrition Board, National Academy of Science-National Research Council.

What are the active and inactive ingredients in this medicine?

Active Ingredients:

• CYANOCOBALAMIN

Inactive Ingredients:

• WATER
• BENZYL ALCOHOL
• SODIUM CHLORIDE

Who manufactures and distributes this medicine?

• AMERICAN REGENT, INC.
• SHIRLEY, NY 11967

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F).
• PROTECT THE PRODUCT FROM LIGHT.

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• Dailymed label info on Cyanocobalamin
• FDA Cyanocobalamin

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