Adult Dosing

Maintenance of normal hematologic status in pernicious anemia patients

• 1 spray/nostril qwk

Vitamin B12 deficiency

• 1 spray/nostril qwk

Note:

• Administer the drug 1 hr before or after the intake of hot food or liquid

Pediatric Dosing

• Prescribe doses in the amount recommended by the Food and Nutrition Board, National Academy of Science-National Research Council

[Outline]

• Adult Dosing
• Pediatric Dosing

• Maintenance of normal hematologic status in pernicious anemia patients
• Vitamin B₁₂ deficiency

• Hypersensitivity to any of the ingredients of the product
• Hypersensitivity to cobalt

• N/A

Renal Dose Adjustment

• Renal Impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic Impairment: Dose adjustments not defined

See Supplemental Patient Information

• Patients having early Leber’s disease (hereditary optic nerve atrophy) have suffered from swift optic atrophy after treatment with cyanocobalamin
• Hypokalemia, sudden death may occur in megaloblastic anemia patients while on intensive therapy with Vit B12. Progressive and irreversible neurologic damage may occur by treating vitamin B12-deficient megaloblastic anemia exclusively with folic acid.
• Perform intradermal test to check cyanocobalamin sensitivity
• Due to the possibility of hypokalemia and thrombocytosis during therapy, periodically monitor serum potassium levels and platelet counts

Cautions: Use cautiously in

• Uremia
• Infection
• Bone marrow suppression
• Hereditary optic nerve atrophy
• Megaloblastic anemia
• Folate deficiency
• Polycythemia vera
• Significant nasal pathology
• Nasal congestion, rhinitis or upper respiratory infections

Supplemental Patient Information

• Advise patient with pernicious anemia that they have to take the spray for the rest of their lives and non compliance can lead to return of the anemia and development of incapacitating and irreversible damage of spinal cord nerves
• Instruct patients following a vegetarian diet that they will require weekly administration of nasal cyanocobalamin
• Advise patients to maintain regular follow-up blood tests every 3 to 6 months to confirm adequacy of therapy
• Advise patient to administer drug 1 hr before or after the intake of hot foods or liquid
• Demonstration or instruction on the actuator assembly, priming of the actuator, removal of safety clip, and dose administration should be given to the patient

Pregnancy Category:C

Breastfeeding: Present in the milk of nursing mothers in concentrations which approximate the mother's vitamin B₁₂ blood level. Lactating women should consume amounts recommended by the Food and Nutrition Board, National Academy of Science-National Research Council during lactation.

• CNS: Headache, paresthesia, asthenia
• GI: Nausea, glossitis
• RESP: Rhinitis, upper respiratory track infection
• METABOLIC: Hypokalemia
• HEMA: Thrombocytosis

• Antianemics (vitamin); use in the body in two forms Methylcobalamin and 5-deoxyadenosyl cobalamin; Methylcobalamin acts as a cofactor to convert amino acid homocysteine into methionine which is required for DNA methylation, and 5-deoxyadenosyl cobalamin acts as a cofactor to convert L-methylmalonyl-CoA to succinyl-CoA which is required for the production of hemoglobin
• Distributed and stored primarily in the liver and bone marrow
• Excreted in bile, urine
• Half-life: 6 days (400 days in liver)

US Trade Name(s)

• Nascobal

US Availability

Nascobal

• METERED nasal SPRAY: 500 mcg/actuation

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Nutrition/Electrolytes

Vitamins

Pricing data from www.DrugStore.com in U.S.A.

• Nascobal 500 MCG/0.1ML SOLN [Bottle] (PAR)
  1.3 0.1ml = $313.99
  3.9 0.1ml = $908.97

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.