Adult Dosing

Vitamin B

• 30 mcg qd IM x 5-10 days followed by 100-200 mcg IM qmonth
• Higher doses may be indicated in critically ill patients or in those with neurologic disease, hyperthyroidism, infections

Cyanide poisoning (Cyanokit)

• Initial dose: 5 g IV over 15 minutes (approximately 15 mL/min)
• May administer a second dose of 5 g IV at the rate of 15 minutes to 2 hrs as clinically indicated

Schilling test

• Flushing dose: 1000 mcg IM

Note:

• Administer dose in conjunction with appropriate airway, ventilatory and circulatory support

Pediatric Dosing

Vitamin B

• Initial dose: Total dose of 1-5 mg IM given over a period of 2 wks or more in doses of 100 mcg
• Maintenance dose: 30-50 mcg IM q4 wks

Cyanide poisoning (Cyanokit) [Non FDA approved]

• 70 mg/kg IV x 1 has been used in non-US marketing experience

Note:

• Administer dose in conjunction with appropriate airway, ventilatory and circulatory support

• Pernicious anemia
• Dietary deficiency of vitamin B₁₂
• Malabsorption of vitamin B₁₂ resulting from structural or functional damage to the stomach or to the ileum
• Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa and conditions associated with gastric atrophy
• Competition for vitamin B₁₂ by intestinal parasites or bacteria
• Inadequate utilization of vitamin B₁₂
• Schilling test
• Treatment of known or suspected cyanide poisoning (Cyanokit)

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Progressive and irreversible neurologic damage may occur if folic acid is used exclusively in treating vitamin B₁₂ deficient megaloblastic anemia
• Blunted or impeded therapeutic response to vitamin B₁₂ may occur due to infection, uremia, drugs having bone marrow suppressant properties, and concurrent iron or folic acid deficiency
• Therapy may cause hypokalemia and thrombocytosis upon conversion of severe megaloblastic to normal erythropoiesis; closely monitor serum potassium levels and platelet count during therapy
• Vitamin B₁₂ deficiency may suppress the signs of polycythemia vera; treatment with vitamin B₁₂ may unmask this condition
• Allergic reactions such as anaphylaxis, chest tightness, edema, urticaria, pruritus, dyspnea, and rash may occur with the use of hydroxocobalamin; use cautiously in the management of patients with anaphylactic reactions to hydroxocobalamin and consider use of alternative therapies
• Transient hypertension may occur with the use of hydroxocobalamin
• Treatment of cyanide poisoning must include immediate attention to airway patency, adequacy of oxygenation and hydration, cardiovascular support, and management of any seizure activity. Decontamination measures should be considered based on route of exposure (Cyanokit)
• Pretreatment blood sample may be useful for documenting cyanide poisoning as sampling post-Cyanokit use may be inaccurate (Cyanokit)
• Due to its deep red color, therapy may interfere with colorimetric determination of certain laboratory parameters such as clinical chemistry, hematology, coagulation, and urine parameters. Therapy may cause hemodialysis machines to shut down due to an erroneous detection of a blood leak
• Avoid the intravenous route (generic hydroxocobalamin)
• Therapy may cause photosensitivity reactions

Cautions: Use cautiously in

• Hypersensitivity to cyanocobalamin
• Hemodialysis

Supplemental Patient Information

• Inform patients that skin redness may last up to 2 weeks and urine coloration may last for up to 5 weeks after therapy administration; advise patients to avoid sun exposure while their skin remains discolored

Pregnancy Category:C

Breastfeeding: Safety unknown. Therapy may be administered in life-threatening situations, and therefore, breast-feeding is not a contraindication to its use. Manufacturer recommends discontinuation of nursing after receiving therapy.

• CV: Hypertension, transiently elevated blood pressure, peripheral edema, chest discomfort
• CNS: Headache, memory impairment, dizziness
• PSYCHIATRIC: Restlessness
• GI: Mild transient diarrhea, nausea, dysphagia, abdominal discomfort, vomiting, dyspepsia, hematochezia
• GU: Chromaturia
• HEMA: Decreased lymphocyte count
• DERM: Itching, transitory exanthema, erythema, acneiform rash, urticaria, pruritus, photosensitivity
• EENT: Throat tightness, dry throat, ocular irritation
• RESP: Dyspnea
• LOCAL: Infusion site reactions
• MISC: Feeling of swelling of entire body, allergic reactions, flushing

• Vitamin; essential component for cell growth, reproduction, nucleoprotein, myelin synthesis, and normal erythropoiesis. The action of Cyanokit in the treatment of cyanide poisoning is based on its ability to bind cyanide ions. Each hydroxocobalamin molecule can bind one cyanide ion by substituting it for the hydroxo ligand linked to the trivalent cobalt ion, to form cyanocobalamin, which is then excreted in the urine
• Metabolized by liver; CYP450: Unknown
• Excreted in urine (60-70%)
• Half-life: 26-31 hrs (Cyanokit)

US Trade Name(s)

• Cyanokit

US Availability

hydroxocobalamin (generic)

• INJ: 1 mg/mL [30 mL vial]

Cyanokit

• PWDR for INJ: 5 g/vial

Canadian Trade Name(s)

• Cyanokit
• Hydro Cobex
• Hydroxy Cobal

Canadian Availability

Cyanokit

• PWDR for INJ: 2.5 g/vial

Hydro Cobex, Hydroxy Cobal

• LIQ: 1 mg/mL

UK Trade Name(s)

• Cobalin-H
• Cyanokit

UK Availability

hydroxocobalamin (generic)

• INJ: 1 mg/mL

Cobalin-H

• INJ: 1000 mcg/mL

Cyanokit

• PWDR for INJ: 2.5 g/vial
• PWDR for INJ: 5 g/vial

Australian Trade Name(s)

• Hydroxo-B12
• Neo-B12

Australian Availability

Hydroxo-B12, Neo-B12

• INJ: 1 mg/mL (1 mL amp)

Nutrition/Electrolytes

Vitamins