Adult Dosing
Pernicious Anemia
- Initial: 100 mcg IM/deep SC q24 hrs x 6-7 days
- Then 100 mcg IM/deep SC q48 hrs x 7 doses, followed by 100 mcg IM/deep SC q3-4 days x 2-3 wks, and then 100 mcg IM/deep SC monthly for life
- Administer folic acid concomitantly if needed
Vitamin B
12 Deficiency
- Initial: 100 mcg IM/deep SC q24 hrs x 6-7 days
- Then 100 mcg IM/deep SC q48 hrs x 7 doses, followed by 100 mcg IM/deep SC q3-4 days x 2-3 wks
- Chronic treatment should be with an oral B12 preparation
- Appropriately treat other vitamin deficiencies if present
Schilling Test
- Flushing dose 1000 mcg IM
Pediatric Dosing
Pernicious Anemia
- 30-50 mcg/day IM/deep SC x 2 wks
Vitamin B
12 Deficiency [Not FDA approved]
- Start 100 mcg IM/deep SC qd x 2 wks followed by 60 mcg every month
[Outline]
See Supplemental Patient Information
- Severe and swift optic nerve atrophy has been reported when patients with early Leber's disease i.e hereditary optic nerve atrophy were treated with cyanocobalamin
- Severe megaloblastic anemia, treated intensely, can cause hypokalemia and sudden death
- An intradermal test dose is recommended before cyanocobalamin injection because anaphylactic shock and death have been reported after parenteral administration
- Benzyl alcohol, one of the content of cyanocobalamin injection, may be associated with a fatal "Gasping Syndrome" in premature infants
- Cyanocobalamin injection contains aluminum; prolonged parenteral administration in patients with impaired renal function can cause toxic levels of aluminum leading to CNS and bone toxicity. Premature infants are at greater risk as their kidneys are immature
- Hematologic remission may occur in patients with vitamin B12 deficiency treated with folic acid greater than 0.1 mg per day
- Vitamin B12 deficiency allowed to progress for more than 3 months can produce permanent degenerative lesions of the spinal cord; hence, should be treated at the earliest
- Folic acid will not prevent neurologic manifestations, and if not treated with vitamin B12, irreversible damage may result. Doses of cyanocobalamin >10 mcg/day may produce hematologic response in patients with folate deficiency
- Patients with pernicious anemia should be advised to take monthly vitamin B12 injections through out their lives, as 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
- Measure all hematologic parameters, including hematocrit, reticulocyte count, vitamin B12, folate, and iron levels prior to treatment. Monitor serum B12, CBC, and also serum potassium levels periodically during therapy
Cautions: Use cautiously in
Supplemental Patient Information
- Caution patients about the danger of taking folic acid in place of vitamin B12 as the former, although prevents anemia, may allow progression of sub-acute combined degeneration
- Advise patients who follow vegetarian diet, which contains no animal products including milk products or eggs, to take oral vitamin B12 regularly; also advise about the increased need for vitamin B12 during pregnancy and lactation
Pregnancy Category:C
Breastfeeding: Vitamin B12 is excreted in human milk. Food and Nutrition Board, National Academy of Science-National Research Council has recommended a vitamin B12 dose of 4 mcg daily in lactating women.
Pricing data from www.DrugStore.com in U.S.A.
- Cyanocobalamin 1000 MCG/ML SOLN [Vial] (AMERICAN REGENT)
30 ml = $35.99
90 ml = $82.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
