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Hydroxocobalamin (vitamin B12 supplement and cyanide antidote): Drug information

Hydroxocobalamin (vitamin B12 supplement and cyanide antidote): Drug information
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For additional information see "Hydroxocobalamin (vitamin B12 supplement and cyanide antidote): Patient drug information" and "Hydroxocobalamin (vitamin B12 supplement and cyanide antidote): Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Special Alerts
Hydroxocobalamin Safety Alert April 2025

BTG International is informing health care providers that Cyanokit (hydroxocobalamin) manufacturing has been suspended due to a quality defect causing potential microbial contamination. This defect could compromise the product's sterility, possibly causing systemic infection or sepsis. BTG International and the FDA are working to make impacted batches available during the shortage. Health care providers should weigh the benefits of using Cyanokit against the infection risk and closely monitor patients for signs of systemic infection or sepsis. Health care providers should administer these batches using an infusion set with a 0.2-micron inline filter with a membrane surface of at least 10 cm2.

Further information may be found at https://cyanokit.com/getmedia/cfa820be-df7e-48b3-9b5b-a129bc5d6cf5/cyanokit_us_btg_dhcp_letter.pdf.

Brand Names: US
  • Cyanokit
Brand Names: Canada
  • Cyanokit;
  • Hydro Cobex [DSC]
Pharmacologic Category
  • Antidote;
  • Vitamin, Water Soluble
Dosing: Adult
Cyanide poisoning

Cyanide poisoning (preferred): Note: Clinical considerations: If cyanide poisoning is suspected, antidotal therapy should be given immediately; do not wait for confirmatory testing (Ref). Hydroxocobalamin is the preferred antidote for the treatment of acute cyanide poisoning due to its rapid onset, simplicity of use, and improved safety over alternative cyanide antidotes, especially in patients who have concurrent carbon monoxide poisoning (eg, smoke inhalation), significant anemia, or G6PD deficiency (Ref).

IV/IO: Initial: 5 g as single infusion over 15 minutes; may repeat a second 5 g dose over 15 minutes to 2 hours (total dose: 10 g) depending on the severity of poisoning and clinical response.

Hydrogen sulfide poisoning

Hydrogen sulfide poisoning (off-label use): Note: May be beneficial if administered immediately following exposure to hydrogen sulfide (Ref); use has not been validated in clinical trials (Ref). The dosing regimen used to treat cyanide poisoning should be utilized (Ref). Consultation with a clinical toxicologist or poison center is highly recommended.

IV/IO: Initial: 5 g over 15 minutes; may repeat a second 5 g dose depending on the severity of poisoning and clinical response. Maximum cumulative dose: 10 g (Ref).

Vasoplegic syndrome

Vasoplegic syndrome (off-label use): Note: Consider in patients who are refractory to methylene blue or as an alternative to methylene blue in patients who are at risk of serotonin syndrome or have glucose-6-phosphate dehydrogenase deficiency (Ref). Dosing is not standardized; refer to institutional protocols.

IV: 5 to 10 g over 10 to 15 minutes (Ref).

Continuous IV infusion: Initial: IV bolus 125 to 250 mg, followed by continuous IV infusion rate of 250 to 500 mg/h (Ref).

Vitamin B12 deficiency, treatment

Vitamin B12 deficiency, treatment:

Note: Folic acid supplementation may also be required. Oral vitamin B12 (eg, cyanocobalamin) may be used for less severe deficiency and/or maintenance therapy (Ref).

Severe/symptomatic anemia or neurologic/neuropsychiatric findings:

Initial therapy: IM: 1,000 mcg every other day or once daily for 1 to 2 weeks, then 1,000 mcg once weekly for 4 to 8 weeks (Ref). Alternatively, if neurologic symptoms are present, may initiate 1,000 mcg every other day for up to 3 weeks or until no further improvement in signs or symptoms, then switch to 1,000 mcg once weekly for up to 12 weeks (Ref).

Maintenance therapy:

Note: Continue parenteral therapy until the deficiency has been corrected and signs and symptoms have resolved before switching to oral therapy (cyanocobalamin) (Ref).

IM: 1,000 mcg every 3 months; in patients with neurologic or neuropsychiatric symptoms, administer 1,000 mcg every 2 months (Ref).

Mild symptoms or asymptomatic: IM: 1,000 mcg once weekly for 4 weeks; maintenance dose: 1,000 mcg once every 2 to 3 months (Ref).

Duration of therapy: Continue indefinitely in patients with pernicious anemia or other irreversible cause of deficiency (eg, bariatric surgery); may discontinue therapy if a reversible cause of deficiency (eg, reduced dietary intake) has been addressed (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in manufacturer's labeling (has not been studied).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Hydroxocobalamin (vitamin B12 supplement and cyanide antidote): Pediatric drug information")

Dosage guidance:

Dosing: Verify dosing units due to large difference in dose for different indications; dosage may be presented in mg or mcg.

Cobalamin metabolism disorders

Cobalamin metabolism disorders (eg, cobalamin C disease, transcobalamin C deficiency): Very limited data available, optimal dose not established.

Infants, Children, and Adolescents: Usual initial dose: IM: 1,000 mcg/dose; higher doses have been reported and tailored to individual clinical and biochemical response. Frequency varies based on clinical condition and vitamin/metabolic parameters; consultation with metabolic specialist is advised. Case reports have described dosing frequency ranging from daily, three times weekly, or once weekly (Ref).

Cyanide poisoning

Cyanide poisoning (Cyanokit): Limited data available: Note: If cyanide poisoning is suspected, antidotal therapy should be initiated immediately; do not wait for confirmatory testing (Ref). Hydroxocobalamin is the preferred antidote for the treatment of acute cyanide poisoning due to its rapid onset, simplicity of use, and improved safety over alternative cyanide antidotes, especially in patients who have concurrent carbon monoxide poisoning (eg, smoke inhalation), significant anemia, or G6PD deficiency (Ref).

Infants, Children, and Adolescents: IV/Intraosseous: 70 mg/kg as a single infusion; maximum dose: 5,000 mg/dose; may repeat a second dose of 70 mg/kg (maximum dose: 5,000 mg/dose) depending on the severity of poisoning and clinical response (Ref).

Pernicious anemia

Pernicious anemia: Note: Concurrent folic acid supplementation may also be needed.

Mild to moderate: Infants, Children, and Adolescents: IM: Initial: 100 mcg daily for ≥2 weeks to target total dose range: 1,000 to 5,000 mcg; maintenance: 30 to 50 mcg monthly.

Severe, complicated (eg, neurologic involvement): Multiple regimens reported, optimal dose not established: Infants, Children, and Adolescents: IM: Initial: 1,000 mcg daily for 7 days or every other day for 7 to 14 days (Ref); some experts suggest treatment until clinical improvement of neurologic symptoms observed (Ref); then follow with maintenance: 1,000 mcg every 2 to 3 months (Ref). For infants and young children, some experts have recommended doses as low as 50 to 100 mcg (Ref).

Vitamin B12 deficiency

Vitamin B12 deficiency: Limited data available; dosing regimens variable:

Dietary deficiency: Infants (breastfed with vitamin B12 deficient mothers): Infants ≥6 weeks: IM: 400 mcg once (Ref).

Malabsorption: Infants, Children, and Adolescents: IM: 250 to 1,000 mcg daily or every other day for 1 week, then weekly for 4 to 8 weeks, and then monthly for life; younger children should receive monthly doses of 100 mcg (Ref). For infants and young children, some experts have recommended doses as low as 50 to 100 mcg (Ref).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling (has not been studied).

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in manufacturer's labeling (has not been studied).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

IM inje ction:

Frequency not defined:

Dermatologic: Transient skin rash

Gastrointestinal: Diarrhea (transient)

Hypersensitivity: Anaphylaxis

Local: Pain at injection site

Miscellaneous: Swelling

IV infu sion:

>10%:

Cardiovascular: Increased blood pressure (18% to 28%)

Dermatologic: Erythema of skin (94% to 100%), skin rash (20% to 44%; primarily acneiform eruption)

Gastrointestinal: Nausea (6% to 11%)

Genitourinary: Urine discoloration (100%)

Hematologic & oncologic: Lymphocytopenia (8% to 17%)

Local: Infusion-site reaction (6% to 39%)

Nervous system: Headache (6% to 33%)

Renal: Calcium oxalate nephrolithiasis (56% to 61%)

Frequency not defined:

Cardiovascular: Peripheral edema

Dermatologic: Urticaria

Endocrine & metabolic: Hot flash

Gastrointestinal: Abdominal distress, diarrhea, dyspepsia, hematochezia, vomiting

Nervous system: Dizziness, memory impairment, restlessness

Ophthalmic: Eye irritation, eye redness, swelling of eye

Respiratory: Dry throat, dyspnea, pharyngeal edema

Postmarketing: (any route of administration)

Cardiovascular: Chest discomfort (Uhl 2006)

Dermatologic: Pruritus (Uhl 2006)

Gastrointestinal: Dysphagia (Uhl 2006)

Hematologic & oncologic: Methemoglobinemia (Jiwani 2018)

Hypersensitivity: Hypersensitivity reaction (including angioedema) (Uhl 2006), nonimmune anaphylaxis (Vidal 1998)

Renal: Acute kidney injury (Pruskowski 2020), kidney impairment, renal tubular necrosis

Contraindications

IM: Hypersensitivity to hydroxocobalamin or any component of the formulation

IV (Cyanokit): There are no contraindications listed in the manufacturer's labeling.

Warnings/Precautions

Concerns related to adverse effects:

• Hypokalemia: According to the manufacturer, treatment of severe vitamin B12 megaloblastic anemia may result in severe hypokalemia, sometimes fatal, due to intracellular potassium shift upon anemia resolution; however, in more recent experience, while some patients may experience hypokalemia with initial treatment, it is transient and unlikely to be clinically significant (Carmel 2008).

• Hypertension: Cyanide poisoning: Increased BP (≥180 mm Hg systolic or ≥110 mm Hg diastolic) may occur with infusion; elevations usually noted at the beginning of the infusion, peak toward the end of the infusion, and return to baseline within 4 hours following the end of the infusion. May offset hypotension induced by nitrite administration or cyanide; monitor BP during treatment.

• Photosensitivity: May cause photosensitivity; avoid direct sunlight while skin remains discolored.

• Renal injury: Renal injury, requiring hemodialysis for recovery in some cases, has been reported and may include acute renal failure with acute tubular necrosis, renal impairment, and urine calcium oxalate crystals; monitor renal function for ≥7 days following therapy.

• Thrombocytosis: Treatment of severe vitamin B12 megaloblastic anemia may result in thrombocytosis.

Disease-related concerns:

• Megaloblastic anemia: May mask previously unrecognized folate deficiency; vitamin B12 is not a substitute for folic acid.

• Polycythemia vera: Vitamin B12 deficiency masks signs of polycythemia vera; vitamin B12 administration may unmask this condition.

Special populations:

• Fire victims: Hydroxocobalamin can discolor the skin and exudates, complicating the assessment of burn severity.

Dosage form specific concerns:

• Cyanokit: Use caution or consider alternatives in patients known to be allergic to, or who have experienced anaphylaxis with hydroxocobalamin or cyanocobalamin. If cyanide poisoning is suspected, antidotal therapy should be administered immediately; do not wait for confirmatory testing (AHA [Lavonas 2023]). Consider consultation with a poison center at 1-800-222-1222.

Other warnings/precautions:

• Hemodialysis: Hydroxocobalamin may interfere with and/or trip alarms in patients who use hemodialysis machines that rely on colorimetric technology.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intramuscular, as acetate:

Generic: 1000 mcg/mL (30 mL)

Solution Reconstituted, Intravenous:

Cyanokit: 5 g (1 ea [DSC])

Solution Reconstituted, Intravenous [preservative free]:

Cyanokit: 5 g (1 ea)

Generic Equivalent Available: US

May be product dependent

Pricing: US

Solution (Hydroxocobalamin Acetate Intramuscular)

1000 mcg/mL (per mL): $1.28

Solution (reconstituted) (Cyanokit Intravenous)

5 g (per each): $1,197.60

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intramuscular:

Generic: 1000 mcg/mL ([DSC])

Solution Reconstituted, Intravenous:

Cyanokit: 5 g (1 ea)

Administration: Adult

IM: Administer 1,000 mcg/mL solution by IM injection only.

IV/ Intraosseous: Cyanokit: Administer IV using vented tubing. Hydroxocobalamin is chemically incompatible with sodium thiosulfate and sodium nitrite and separate IV lines must be used if concomitant administration is desired (the safety and efficacy of coadministration are not established) ; however, cases of favorable outcomes following severe poisonings have been reported (Ref). Use of intraosseous administration has been reported in patients in whom IV administration is not possible (Ref); animal studies also support intraosseous administration as a viable alternative route of administration (Ref). Rate of IV administration varies based on dose and indication; refer to indication-specific infusion rates in dosing for detailed recommendations.

Administration: Pediatric

Parenteral:

IM: Administer 1,000 mcg/mL injection IM only; do not administer SubQ

IV/Intraosseous (Cyanokit): Administer IV using vented tubing. Administer as IV infusion over 15 minutes; if second dose is needed, administer second dose over 15 minutes to 2 hours depending upon the patient's clinical state; intraosseous may be used in pediatric patients (Ref). Hydroxocobalamin is chemically incompatible with sodium thiosulfate and sodium nitrite; separate IV lines must be used if concomitant administration is desired. Use of intraosseous administration has been reported in adult patients in whom IV administration is not possible (Ref); animal studies also support intraosseous administration as a viable alternative route of administration (Ref).

Use: Labeled Indications

IM injection:

Vitamin B12 deficiency, treatment: Treatment of pernicious anemia; treatment of vitamin B12 deficiency due to dietary deficiencies or malabsorption diseases, inadequate secretion of intrinsic factor, competition for vitamin B12 by intestinal parasites/bacteria, or inadequate utilization of B12 (eg, during neoplastic treatment).

IV infusion (Cyanokit):

Cyanide poisoning: Treatment of cyanide poisoning (known or suspected).

Note: The preferred antidote for the treatment of acute cyanide poisoning is hydroxocobalamin due to its rapid onset, simplicity of use, and improved safety over alternative cyanide antidotes, especially in patients who have concurrent carbon monoxide poisoning (eg, smoke inhalation), significant anemia, or G6PD deficiency (AHA [Lavonas 2023]; Anseeuw 2013). An alternative antidote (ie, sodium nitrite and sodium thiosulfate) should be considered only if hydroxocobalamin is unavailable, there is a contraindication to the use of hydroxocobalamin, or if the patient has a known sensitivity to hydroxocobalamin or vitamin B12 analogues. Consider consultation with a clinical toxicologist or poison center.

Use: Off-Label: Adult

Hydrogen sulfide poisoning; Vasoplegic syndrome

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Chloramphenicol (Systemic): May decrease therapeutic effects of Vitamin B12. Risk C: Monitor

Pregnancy Considerations

Hydroxocobalamin crosses the placenta (Huemer 2005; Roderique 2012).

Data on the use of hydroxocobalamin in pregnancy for the treatment of cyanide poisoning and cobalamin defects are limited (Brunel-Guitton 2010; Huemer 2005; Roderique 2012).

Cyanide crosses the placenta. Cyanide poisoning can be fatal for the pregnant female and fetus if untreated; treatment should not be withheld due to pregnancy. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant females if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003).

Breastfeeding Considerations

Hydroxocobalamin is present in breast milk.

Endogenous vitamin B12 milk concentrations are similar to maternal serum concentrations (IOM 1998). Breastfeeding is not recommended by the manufacturer during maternal treatment for cyanide poisoning. Hydroxocobalamin is considered compatible with breastfeeding when used for treatment of anemia (WHO 2002).

Dietary Considerations

Strict vegetarian or vegan diets (eg, without eggs or dairy products) may result in vitamin B12 deficiency (NIH 2021; manufacturer's labeling).

Adequate intake (IOM 1998):

1 to 6 months: 0.4 mcg daily.

7 to 12 months: 0.5 mcg daily.

Recommended intake (IOM 1998):

1 to 3 years: 0.9 mcg daily.

4 to 8 years: 1.2 mcg daily.

9 to 13 years: 1.8 mcg daily.

≥14 years: 2.4 mcg daily.

Pregnancy: 2.6 mcg daily.

Lactation: 2.8 mcg daily.

Monitoring Parameters

Cyanide poisoning: Blood pressure and heart rate during and after infusion, serum lactate levels, venous-arterial PO2 gradient. Pretreatment cyanide levels may be useful as post infusion levels may be inaccurate. Renal function, including but not limited to BUN and SCr, for ≥7 days following therapy.

Vitamin B12 deficiency: Vitamin B12, hematocrit, hemoglobin, reticulocyte count, RBC, obtain serum folate and iron levels prior to treatment and periodically during treatment. Evaluate serum methylmalonic acid and total homocysteine levels at baseline (prior to supplementation) in untreated patients to confirm vitamin B12 deficiency (and extent of deficiency); repeat to confirm adequate supplementation (Stabler 2013).

Megaloblastic/pernicious anemia: In addition to normal hematological parameters, monitor serum potassium and platelet counts during therapy, particularly in the first 48 hours of treatment. Note: Some patients may develop hypokalemia during initial treatment; however, this is unlikely to be clinically significant (Carmel 2008).

Bariatric surgery: Vitamin B12 levels at baseline and once a year postoperatively then every 3 to 6 months if supplemented; every trimester during pregnancy (Mechanick 2020). In patients on chronic administration of medications known to increase risk of B12 deficiency (eg, colchicine, metformin, neomycin, nitrous oxide, proton pump inhibitors, seizure medication), screen every 3 months for the initial postoperative year and then annually (Parrott 2017). Serum methylmalonic acid is the recommended assay to evaluate vitamin B12 levels for patients who are asymptomatic, symptomatic, have a history of B12 deficiency, or preexisting neuropathy (Parrott 2017). Monitor for early signs/symptoms of B12 deficiency, including pernicious anemia (pale skin/eyes, glossitis, fatigue, anorexia, diarrhea) or neuropathy (numbness, paresthesia in extremities, ataxia, decreased reflexes), lightheadedness or vertigo, dyspnea, tinnitus, palpitations, and /or increased heart rate; monitor for advanced signs/symptoms of B12 deficiency, including angina, heart failure symptoms and/or mental status changes (Parrott 2017).

Reference Range

Normal range of serum B12 is 200 to 800 pg/mL (SI: 147.5 to 589.8 pmol/L); this represents 0.1% of total body content. Metabolic requirements are 2 to 5 mcg/day; years of deficiency are required before hematologic and neurologic signs and symptoms are seen. Occasional patients with significant neuropsychiatric abnormalities may have no hematologic abnormalities and normal serum cobalamin levels, 200 pg/mL (SI: 147.5 pmol/L), or more commonly between 100 to 200 pg/mL (SI: 73.7 to 147.5 pmol/L).

Patients who have undergone gastric bypass surgery: Normal B12 range: 200 to 1,000 pg/mL (SI: 147.5 to 737.3 pmol/L); Deficiency critical range: B12: <400 pg/mL (SI: <294.9 pmol/L) (suboptimal) and <200 pg/mL (SI: <147.5 pmol/L) (deficient) (Parrott 2017).

Mechanism of Action

Hydroxocobalamin (vitamin B12a) is a precursor to cyanocobalamin (vitamin B12). Cyanocobalamin acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis, used in cell replication and hematopoiesis. In the presence of cyanide, each hydroxocobalamin molecule can bind one cyanide ion by displacing it for the hydroxo ligand linked to the trivalent cobalt ion, forming cyanocobalamin, which is then excreted in the urine.

Pharmacokinetics (Adult Data Unless Noted)

Following IV administration of Cyanokit:

Distribution: Vdss:Free cobalamins-(III): 280.7 to 349.5 L; Total cobalamins-(III): 21.8 to 25.6 L

Protein binding: Significant; forms various cobalamin-(III) complexes

Metabolism: Does not undergo metabolism

Half-life elimination: 26 to 31 hours

Excretion: Urine (50% to 60% within initial 72 hours)

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Sex: When normalized for body weight, men and women revealed no major pharmacokinetic differences.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Depovit B12 | Forta b12;
  • (AR) Argentina: Dosixbe;
  • (AT) Austria: Cyanokit | Erycytol | Hepavit;
  • (AU) Australia: Cobal-b12 | Cyanokit | Hydroxo B12 | Neo cytamen | Vita b12;
  • (BD) Bangladesh: Cynomin H;
  • (BE) Belgium: Cyanokit;
  • (BR) Brazil: Cronobe | Rubranova;
  • (CH) Switzerland: Cyanokit | Novobedouze | Vitarubin;
  • (CN) China: Hydroxocobalamine hydrochloride;
  • (CO) Colombia: Decamil-b12;
  • (CZ) Czech Republic: Cyanokit;
  • (DE) Germany: Cefavit b12 depot | Cyanokit | Lophakomp B12;
  • (DO) Dominican Republic: Hydroxo;
  • (EE) Estonia: Cohemin | Cyanokit;
  • (EG) Egypt: Cobalamin depot | Depovit B12 | Hydrovit b12;
  • (ES) Spain: Cyanokit | Megamilbedoce;
  • (FI) Finland: Cohemin | Cyanokit;
  • (FR) France: Cyanokit | Dodecavit | Hydroxo | Novobedouze;
  • (GB) United Kingdom: Cobalin h | Cyanokit | Hydroxocobalam | Neo cytamen;
  • (GR) Greece: Dodecavite | Hydroxocobalamina | Neo cytamen;
  • (HU) Hungary: Cyanokit;
  • (IE) Ireland: Cobalin h | Cyanokit | Neo cytamen;
  • (IN) India: Neurobion h;
  • (IT) Italy: Cyanokit | Oh b12;
  • (JO) Jordan: Vitamin b12;
  • (JP) Japan: Anemisol h | Aquo b | B coba | B valet b12 | Bistin | Cobalamin h isei | Colsamine s towa | Dasvit h | Funacomin f | Hicobalamin | Hicobalan | Hydocomin | Hydroxomin | Ohb12 | Redisol h | Runova | Solco h aventis | Solco h tobishi | Takata b12 | Twelvmin s merck hoei | Vigolatin | Vitamilon a12;
  • (KE) Kenya: Cobalin h;
  • (KW) Kuwait: Forta b12;
  • (LB) Lebanon: Douzabine;
  • (LT) Lithuania: Cefavit b12 depot | Cyanokit;
  • (LU) Luxembourg: Forta b | Novobedouze;
  • (MA) Morocco: Novobedouze;
  • (MX) Mexico: Anevit | Axofor | Droxivit 12 | Duradoce | Hidroxocobalamina;
  • (MY) Malaysia: Cyanokit;
  • (NL) Netherlands: Cyanokit;
  • (NO) Norway: Cyanokit | Vitamin b12 | Vitamin b12 depot orifarm;
  • (NZ) New Zealand: Cobal b12 | Cobalin h | Cyanokit | Neo cytamen;
  • (PE) Peru: Cobavit 12 | Hidroxamin-12 | Hidroxocobalam | Hidroxocobalamina | Minedrox;
  • (PL) Poland: Cobalin h | Cyanokit | Dodecavit;
  • (PR) Puerto Rico: Cyanokit;
  • (PT) Portugal: Cyanokit | Hidroxocobalamina | Ohb 12 | Ohb12;
  • (QA) Qatar: Depofort B12 | Depovit B12 | Norogrizovim | Vitamin B12 Depot | Vitarubin Depot;
  • (SE) Sweden: Cyanokit | Hydroxocobalamin alternova;
  • (SI) Slovenia: Cyanokit;
  • (SK) Slovakia: Cyanokit;
  • (TW) Taiwan: Bistin | Cobalidrina | Cobamine-oh | Depo B12 | Depovitan B12 | Esesin | Hybramin | Hycomin | Hydroxe-b12 | Hydroxo | Hydroxobam | Hydroxocobalamine | Metroneuril | Ohb12 | Vitamin b12;
  • (UY) Uruguay: Droxofor | Hidroxocobalamina ion;
  • (VE) Venezuela, Bolivarian Republic of: Cozamon | Droxofor | Duradoce | Hidrodoce | Ibedox
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