Cyanocobalamin (vitamin B12): Drug information

(For additional information see "Cyanocobalamin (vitamin B12): Patient drug information" and see "Cyanocobalamin (vitamin B12): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)

Brand Names: US

B-12 Compliance Injection [DSC];
Dodex;
Nascobal;
Physicians EZ Use B-12;
Vitamin Deficiency System-B12

Brand Names: Canada

Cobex [DSC];
Cyano Vit B12 [DSC];
JAMP-Cyanocobalamin [DSC]

Pharmacologic Category

Vitamin, Water Soluble

Dosing: Adult

Dosage guidance:

Dosage form information: The cyanocobalamin content of over-the-counter products varies; it is generally higher in B-complex products (eg, 50 to 500 mcg) or products containing only vitamin B₁₂ (eg, 500 to 1,000 mcg) than in multivitamin products (eg, 5 to 25 mcg) (Ref).

Aphthous stomatitis, simple, recurrent

Aphthous stomatitis, simple, recurrent (off-label use):

Note: May consider use regardless of serum vitamin B₁₂ levels (Ref).

Oral (sublingual): 1,000 mcg once daily for 6 months (Ref).

IM: 1,000 mcg once daily for 7 days, then 1,000 mcg once weekly for 1 month, then 1,000 mcg once monthly for 6 months (Ref).

Drug toxicity reduction

Drug toxicity reduction:

Pemetrexed:

IM: 1,000 mcg every 9 weeks, beginning 1 to 3 weeks prior to pemetrexed treatment initiation (Ref); in patients without preexisting anemia, some data suggest that pemetrexed and cyanocobalamin may be started simultaneously to avoid delaying pemetrexed initiation (Ref). After the initial dose, may administer cyanocobalamin on the same day as pemetrexed; administer with oral folic acid supplementation.

Pralatrexate:

IM: 1,000 mcg every 8 to 10 weeks, beginning within 10 weeks prior to pralatrexate treatment initiation; administer with oral folic acid supplementation (Ref). After the initial dose, may administer cyanocobalamin on the same day as pralatrexate.

Vitamin B₁₂ deficiency, treatment

Vitamin B₁₂ deficiency, treatment:

Note: Folic acid supplementation may also be required.

Severe/Symptomatic anemia or neurologic/neuropsychiatric findings:

Initial therapy:

IM, deep SUBQ: 1,000 mcg 1 to 3 times/week or once daily for 1 week, 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 (Ref).

IM, deep SUBQ: 1,000 mcg once monthly (Ref).

Oral, Sublingual: 1,000 to 2,000 mcg once daily (Ref).

Mild symptoms or asymptomatic:

IM, deep SUBQ: Initial: 1,000 mcg once weekly for 4 to 8 weeks; maintenance dose: 1,000 mcg once monthly (Ref).

Oral, Sublingual: 1,000 to 2,000 mcg once daily (Ref). Note: In patients with impaired GI absorption (eg, pernicious anemia, bariatric surgery), or in whom adherence must be assured, parenteral administration may be required (Ref).

Intranasal (Nascobal): Initial: 500 mcg (1 spray) in 1 nostril once weekly. Consider an alternative route if vitamin B₁₂ levels are persistently low after 1 month of treatment. Note: Some experts do not use intranasal formulations due to variable absorption (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).

Vitamin B₁₂ deficiency, prevention

Vitamin B₁₂ deficiency, prevention:

Note: For use in patients with risk factors for vitamin B₁₂ deficiency (eg, bariatric or gastric surgery, disorders of the stomach or terminal ileum, vegan or vegetarian diet) (Ref).

Oral, Sublingual: 350 to 1,000 mcg once daily; in patients with pernicious anemia, higher doses (eg, 1,000 to 2,000 mcg/day) are required (Ref).

IM, deep SUBQ: 1,000 mcg once monthly or 1,000 to 3,000 mcg once every 6 to 12 months (Ref). Note: May be preferred in patients with impaired GI absorption (eg, pernicious anemia, bariatric surgery), or for whom adherence to oral therapy is challenging (Ref).

Intranasal (Nascobal): 500 mcg (1 spray) in 1 nostril once weekly. Consider an alternative route if adequate vitamin B₁₂ levels cannot be maintained. Note: Some experts do not use intranasal formulations due to variable absorption (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Some formulations may also contain aluminum, which may accumulate in renal impairment.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Cyanocobalamin (vitamin B12): Pediatric drug information")

Pernicious anemia

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

Manufacturer's labeling: Infants, Children, and Adolescents: IM, SubQ: 100 mcg once daily for 6 to 7 days; if improvement occurs, administer 100 mcg on alternate days for 7 doses, then every 3 to 4 days for 2 to 3 weeks; once hematologic values have returned to normal, maintenance dose: 100 mcg monthly.

Alternate dosing: Limited data available: Infants, Children, and Adolescents: IM, SubQ: Initial: 1,000 mcg/day for 2 to 7 days based upon clinical response; followed by 100 mcg once weekly for 4 weeks and then maintenance dose: 100 mcg/month; for severe anemia, a lower initial dose of 0.2 mcg/kg/dose for 2 days followed by the above regimen has been recommended due to potential hypokalemia observed during initial treatment of adults with severe anemia (Ref); however, in more recent experience, while some adult patients may experience hypokalemia with initial treatment, this is unlikely to be clinically significant (Ref). For infants and young children, some experts have recommended doses as low as 50 to 100 mcg (Ref).

Vitamin B12 deficiency, severe

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

Dietary deficiency: Infants (breastfed with vitamin B12 deficient mothers): IM: 250 to 1,000 mcg once daily for 1 to 2 weeks, followed by weekly dosing until patient recovers (Ref); patients with neurologic symptoms have been treated with doses of 1,000 mcg (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 the manufacturer's labeling. Some formulations may also contain aluminum, which may accumulate in renal impairment.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

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

>10%:

Central nervous system: Headache (IM: 20%; intranasal: 4%)

Infection: Infection (12% to 13%)

Neuromuscular & skeletal: Asthenia (IM: 16%; intranasal: 4%)

1% to 10%:

Central nervous system: Paresthesia (4%)

Gastrointestinal: Glossitis (nasal: 4%), nausea (4%)

Respiratory: Rhinitis (4% to 8%)

Frequency not defined:

Cardiovascular: Cardiac failure, thrombosis (peripheral)

Dermatologic: Pruritus, skin rash (transient)

Endocrine & metabolic: Hypokalemia

Gastrointestinal: Diarrhea

Hematologic & oncologic: Polycythemia vera, thrombocythemia

Hypersensitivity: Anaphylactic shock (IM/SubQ)

Respiratory: Pulmonary edema

Miscellaneous: Swelling

Contraindications

Hypersensitivity to cyanocobalamin (vitamin B₁₂), cobalt, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• CNS effects: Vitamin B₁₂ deficiency for >3 months results in irreversible degenerative CNS lesions; neurologic manifestations will not be prevented with folic acid unless vitamin B₁₂ is also given. Spinal cord degeneration might also occur when folic acid used as a substitute for vitamin B₁₂ in anemia prevention.

• 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, this is unlikely to be clinically significant (Carmel 2008).

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

Disease-related concerns:

• Leber disease: Patients with Leber disease who received vitamin B₁₂ treatment have suffered from severe rapid optic atrophy. Use of cyanocobalamin in these patients is not recommended.

• Megaloblastic anemia: Vitamin B₁₂ doses >10 mcg daily may produce a hematologic response in patients with folate deficient megaloblastic anemia and 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.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer's labeling.

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

• Intranasal administration: The effectiveness of intranasal cyanocobalamin in patients with allergic rhinitis, nasal congestion, and upper respiratory tract infections has not been determined. Defer treatment until symptoms have subsided.

Other warnings/precautions:

• IV administration: Avoid intravenous route; anaphylactic shock has occurred.

• Test dose: Intradermal test dose of vitamin B₁₂ is recommended for any patient suspected of cyanocobalamin hypersensitivity prior to administration.

Dosage Forms Considerations

Note: Not all available strengths or formulations may be represented in Dosage Forms.

Dosage Forms: US

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

Kit, Injection:

B-12 Compliance Injection: 1000 mcg/mL [DSC] [contains benzyl alcohol]

Physicians EZ Use B-12: 1000 mcg/mL [contains benzyl alcohol]

Vitamin Deficiency System-B12: 1000 mcg/mL [contains benzyl alcohol]

Liquid, Sublingual:

Generic: 3000 mcg/mL (52 mL)

Lozenge, Oral:

Generic: 50 mcg (100 ea); 100 mcg (100 ea); 250 mcg (100 ea, 250 ea); 500 mcg (100 ea, 250 ea)

Solution, Injection:

Dodex: 1000 mcg/mL (1 mL, 10 mL, 30 mL) [contains benzyl alcohol]

Generic: 1000 mcg/mL (1 mL, 10 mL, 30 mL)

Solution, Nasal:

Nascobal: 500 mcg/0.1 mL (1 ea) [contains benzalkonium chloride]

Tablet, Oral:

Generic: 100 mcg, 250 mcg, 500 mcg, 1000 mcg

Tablet, Oral [preservative free]:

Generic: 1000 mcg

Tablet Extended Release, Oral:

Generic: 1000 mcg

Tablet Sublingual, Sublingual [preservative free]:

Generic: 2500 mcg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Cyanocobalamin Injection)

1000 mcg/mL (per mL): $3.28 - $8.74

Solution (Dodex Injection)

1000 mcg/mL (per mL): $8.52

Solution (Nascobal Nasal)

500 mcg/0.1 mL (per each): $212.79

Tablet, controlled release (Vitamin B-12 ER Oral)

1000 mcg (per each): $0.05

Tablets (Vitamin B-12 Oral)

1000 mcg (per each): $0.04 - $0.21

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, Injection:

Cobex: 1000 mcg/mL ([DSC])

Generic: 100 mcg/mL ([DSC]); 1000 mcg/mL (1 mL, 10 mL, 30 mL)

Administration: Adult

Injection solution: For IM or deep SUBQ administration only; do not administer IV.

Intranasal: Nasal spray (Nascobal): Administer 1 hour before or 1 hour after ingestion of hot foods/liquids.

Oral: Some tablets are available for sublingual administration.

Bariatric surgery: Tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Do not cut, crush, or chew. Switch to an IR tablet, chewable tablet, orally disintegrating or sublingual tablet, oral solution drops, or a nonoral formulation such as injection or nasal spray.

Administration: Pediatric

Oral: Not generally recommended for treatment of severe vitamin B12 deficiency due to poor oral absorption (lack of intrinsic factor); oral administration may be used in less severe deficiencies and maintenance therapy; may be administered without regard to food

Parenteral: IM or deep SubQ are preferred routes of administration: Avoid IV administration due to a more rapid system elimination with resulting decreased utilization

Use: Labeled Indications

Vitamin B₁₂ deficiency: Treatment of pernicious anemia or vitamin B₁₂ deficiency due to dietary deficiencies, gastrointestinal malabsorption, folic acid deficiency, parasitic infestation, inadequate secretion of intrinsic factor, or inadequate utilization of B₁₂ (eg, during neoplastic treatment); prevention of vitamin B₁₂ deficiency in patients with increased B₁₂ requirements (eg, due to pregnancy, thyrotoxicosis, hemorrhage, malignancy, liver or kidney disease).

Use: Off-Label: Adult

Aphthous stomatitis, simple, recurrent

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Chloramphenicol (Systemic): May diminish the therapeutic effect of Vitamin B12. Risk C: Monitor therapy

Food Interactions

Heavy ethanol consumption >2 weeks may impair vitamin B₁₂ absorption.

Pregnancy Considerations

Water soluble vitamins cross the placenta. Absorption of vitamin B₁₂ may increase during pregnancy. Vitamin B₁₂ requirements may be increased in pregnant women compared to nonpregnant women. Serum concentrations of vitamin B₁₂ are higher in the neonate at birth than the mother (IOM 1998).

Breastfeeding Considerations

Vitamin B₁₂ is found in breast milk. Milk concentrations are similar to maternal serum concentrations and concentrations may be decreased in women who are vegetarians. Vitamin B₁₂ requirements may be increased in nursing women compared to nonbreastfeeding women (IOM 1998).

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

Vitamin B₁₂, hemoglobin, hematocrit, erythrocyte and reticulocyte count; obtain serum folate and iron levels prior to treatment; vitamin B₁₂ and peripheral blood counts should be monitored 1 month after beginning treatment (and vitamin B₁₂ 1 month after each dosage adjustment if using intranasal formulation), then every 3 to 6 months thereafter.

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, serum potassium and platelet counts should be monitored during therapy. 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 150 to 900 pg/mL; 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: >150 pmol/L), or more commonly between 100 to 200 pg/mL (SI: 75 to 150 pmol/L).

Gastric bypass surgery patients: Normal B₁₂ range: 200 to 1,000 pg/mL; Deficiency critical range: B₁₂: <400 pg/mL (suboptimal) and <200 pg/mL (deficient) (Parrott 2017).

Mechanism of Action

Coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis, used in cell replication and hematopoiesis

Pharmacokinetics (Adult Data Unless Noted)

Onset of action:

Megaloblastic anemia: IM:

Conversion of megaloblastic to normoblastic erythroid hyperplasia within bone marrow: 8 hours.

Increased reticulocytes: 2 to 5 days,

Complicated vitamin B₁₂ deficiency: IM, SUBQ: Resolution of:

Psychiatric sequelae: 24 hours.

Thrombocytopenia: 10 days.

Granulocytopenia: 2 weeks.

Absorption: Oral: Variable from the terminal ileum; requires the presence of calcium and gastric "intrinsic factor" to transfer the compound across the intestinal mucosa.

Distribution: Principally stored in the liver and bone marrow, also stored in the kidneys and adrenals.

Protein binding: Transcobalamins.

Metabolism: Converted in tissues to active coenzymes, methylcobalamin and deoxyadenosylcobalamin; undergoes some enterohepatic recycling.

Bioavailability: Intranasal (Nascobal): 6.1% (relative to IM); Oral: Pernicious anemia: 1.2%.

Time to peak, serum: IM, SUBQ: 30 minutes to 2 hours; Intranasal: 1.25 ± 1.9 hours.

Excretion: Urine (50% to 98%, unchanged drug).

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Beto 12 | Betolvex | Campolon | Cobal | Cynovit | Nature made b12 vitamin | Vitamin b12;
(AR) Argentina: Be positive b 12 | Lisoneurin b12 10.000 | Sl b12 | Veg 12 | Vegaone | Vitam doce;
(AU) Australia: Cytamen | Nanocelle b12 | Natures own activated methyl b12 | Sublingual B12 | Swisse Ultiboost Vitamin B12 | Ultra b12 | Vit b12 | Vita Science B12 | Vitamin b12 | Vitaqik liposomal vitamin b12;
(BD) Bangladesh: Cynomin | Cynovit | Cytamen | Vitamin b12;
(BE) Belgium: Neogenyl;
(BF) Burkina Faso: Vit b12 | Vitamine b12 tm;
(BG) Bulgaria: Vitamin b12;
(BR) Brazil: Amicored | Bedozil | Sidney oliveira vitamina b12 | Vitamin b-12 | Vitamina B 12 | Vitamina b12 | Vitaminas b12;
(CH) Switzerland: Betolvex | Vitamin b12 amino | Vitamin B12 Gattiker | Vitarubin;
(CN) China: Qing gu an | Vitamin b12;
(CO) Colombia: Cianocobalamina | Iloban | Vitamina b12;
(CZ) Czech Republic: Neurobene | Vitamin b12 | Vitamin B12 gamma;
(DE) Germany: Apovital Vitamin B12 | B12 | B12 ankermann | B12 Direct | B12 steigerwald | B12 Vicotrat | Cytobion | Sovita Vitamin B12 Opti | Vita aktiv b12 | Vita1 vitamin b12 | Vitamin b12 | Vitamin b12 compact | Vitamin B12 opti | Vitamin-b12-ratiopharm;
(DO) Dominican Republic: Cobal | Vitamina b12;
(EC) Ecuador: Rojamin | Vitamina b12;
(EE) Estonia: B 12 Rotexmedica | B12 ankermann | Bethover b12 | Room vitamiin b12 | Vitamin b12 | Vitatabs b12;
(EG) Egypt: Beto 12 | Betolvex | Deltavit b12 | Depofort | Naso cyanocobalamin | Rubivamine | Vitamin b12;
(ES) Spain: B12 latino | Optovite b12;
(FI) Finland: B12 vitamiini ratiopharm | B12 vitamin star | B12-vitamin | Betolvex;
(FR) France: Vitamine b12 aguettant | Vitamine B12 Bayer | Vitamine B12 Delagrange | Vitamine B12 Lavoisier | Vitamine b12 renaudin | Vitamine b12 roche;
(GB) United Kingdom: Cobalin | Cytacon | Cytamen | Orobalin;
(HK) Hong Kong: Balamin | Bitamin | Cobalamin | Cobamin | Sunferbol | Uni Cynomin | Vitamin b12 | Vitamin b12 t p;
(HU) Hungary: B12 vitamin ankermann | Vitamin b12;
(ID) Indonesia: Arcored | Cobamin | Cyanovit | Vitamin b12;
(IE) Ireland: Behepan | Cytacon | Cytamen;
(IL) Israel: Bedodeka | Bevitex;
(IN) India: Cyanocobalamine | Regen | Siocobin | Vib 12;
(IT) Italy: Bitamina | Dobetin | Reticulogen | Tonocian | Vitamina b12;
(JO) Jordan: Cyanofix | Vitamin b12;
(JP) Japan: Fresmin | Hichion B12 | Redisol | Vitamin b12 kobayashi kako;
(KE) Kenya: Cynamed;
(KR) Korea, Republic of: Nascobal;
(KW) Kuwait: Betolvex | Ecavit B12 | Vitamin b-12 | Vitamin b12;
(LB) Lebanon: B12 | Betolvex | Cobalex | Vitamin b 12 | Vitamin b12;
(LT) Lithuania: Swanson b12 | Vitamin b complex | Vitamin b12 | Vitatabs b12;
(LU) Luxembourg: Neogenyl;
(LV) Latvia: Olimp labs b12 max | Vitamin b12 | Vitatabs b12;
(MY) Malaysia: Betamin 12 | Cyanocobalamine | Norvit | Prime B12 | Vitamin b12;
(NL) Netherlands: B12 1000 sr | Vitamin b12;
(NO) Norway: Behepan | Betolvex | Nycoplus b12 vitamin | Vitamin b12;
(NZ) New Zealand: B12 | Bioceuticals b12 | Country life vitamin b12 | Nanocelle b12 | Vitamin b12;
(PE) Peru: B-12 | B12 ankermann | Gnc vitamin b-12 | Sundown naturals b12 | Vitamina b12;
(PH) Philippines: Hyper b | Hyper b12 | Rubramin | Vitamin b12;
(PK) Pakistan: Bentamen | Cyanamin | Cyanocobalamine | Cynovit | Cytamen | Elkomin | Ephacobal | Hydromin | Newbal | Rexavit | Zolomine;
(PL) Poland: Cytobion | Molekin b12 | Vitamin b12;
(PR) Puerto Rico: B 12 | B-12 | B-12 Dots | Calomist | Depinar | Nature made b12 vitamin | Neurin | Neuro b-12 forte s | Neuro B12 forte | Neuroforte-r | Poyamin | Rapid B-12 Energy | Vit B 12 | Vitamin b 12 | Vitamin b12 | Vitamina b12;
(PT) Portugal: Bedoze | Betolvex | Cianocobalamina medinfar | Permadoze | Vitamina b12;
(PY) Paraguay: Cianocobalamina;
(RO) Romania: Vitamina b12 zentiva;
(SA) Saudi Arabia: Betolvex | Cynovit | Ecavit B12;
(SE) Sweden: Behepan | Betolvex | Betolvidon | Cykobemin | Nascobal | Novavita | Vitamin B 12 Recip;
(SG) Singapore: B 12 | Cobamine | Gnc vitamin b 12 | Vitamin b12;
(SI) Slovenia: B12 ankermann | Vitamin b12;
(SK) Slovakia: Vitamin b12;
(TH) Thailand: Bemego | Calvin | Cavin | Cyanomine | Cyavit | Cycon | Cycovit | Redisol | Sirepar | Vitamin b12;
(TN) Tunisia: Dodex;
(TR) Turkey: Avicenna vitamin b12 | Beduzin | Cobalex | Cytamen | Dodex | Doppelherz aktiv vitamin b12 | Monovit B12 | Nevra b12 | Newita vitamin b12 | Nutrigen vitamin b12 | Tuesto vitamin b12 | Vit B 12 | Vitakobal | Vitatabs b12 | Voonka vitamin b12;
(TW) Taiwan: Cobaltomin | Coblamin-b12 | Cyanocobalamine | Hepacon B12 | Hichion B12 | Hicobalamin | Redisol | Vitamin b12;
(UY) Uruguay: B12 20 mil | Vitamina b12;
(VE) Venezuela, Bolivarian Republic of: Cianocobalamina | Cytacon | Dobetin | Vitamina b12;
(ZA) South Africa: Essentials vitamin b12 | Vitamin b12;
(ZM) Zambia: Parecon forte;
(ZW) Zimbabwe: Parecon forte

Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
Aluminum in large and small volume parenterals used in total parenteral nutrition. Fed Regist. 2002;67(244):77792-77793. To be codified at 21 CFR §201.323.
Andres E, Noel E, and Goichot B, “Metformin-Associated Vitamin B₁₂ Deficiency,” Arch Intern Med, 2002, 162(19):2251-2. [PubMed 12390080]
Bjørke-Monsen AL and Ueland PM. Cobalamin status in children. J Inherit Metab Dis. 2011;34(1):111-119. [PubMed 20508991]
Centers for Disease Control and Prevention (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm. Last accessed: May 4, 2017. [PubMed 6810084]
Carmel R. How I treat cobalamin (vitamin B12) deficiency. Blood. 2008;112(6):2214-2221. doi: 10.1182/blood-2008-03-040253. [PubMed 18606874]
Chan CQ, Low LL, Lee KH. Oral vitamin B12 replacement for the treatment of pernicious anemia. Front Med (Lausanne). 2016;3:38. doi:10.3389/fmed.2016.00038 [PubMed 27602354]
Cyanocobalamin injection [prescribing information]. E. Windsor, NJ: AuroMedics Pharma LLC; May 2020.
Department Health and Human Services, Food Drug Administration. Aluminum in large and small volume parenterals used in total parenteral nutrition. Federal Register. 2000;65(17):4103-4111.
Goodman M, Chen XH, Daarwish D, “Are U.S. Lower Normal B₁₂ Limits Too Low?,” J Am Geriatr Soc, 1996, 44(10):1274-5. [PubMed 8856015]
Guez S, Chiarelli G, Menni F, Salera S, Principi N, Esposito S. Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC Pediatr. 2012;12:85. [PubMed 22726312]
Gulcan E, Toker S, Hatipoğlu H, Gulcan A, Toker A. Cyanocobalamin may be beneficial in the treatment of recurrent aphthous ulcers even when vitamin B12 levels are normal. Am J Med Sci. 2008;336(5):379-382. doi:10.1097/MAJ.0b013e31816a05f2 [PubMed 19011392]
Horwitz SM, Kim YH, Foss F, et al. Identification of an active, well-tolerated dose of pralatrexate in patients with relapsed or refractory cutaneous T-cell lymphoma. Blood. 2012;119(18):4115-4122. doi:10.1182/blood-2011-11-390211 [PubMed 22394596]
"Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
IOM (Institute of Medicine), Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B₆, Folate, Vitamin B₁₂, Pantothenic Acid, Biotin and Choline, Washington, DC: National Academy Press, 1998.
Kaushansky K, Kipps TJ. Hematopoietic Agents: Growth Factors, Minerals, and Vitamins. Goodman & Gilman's: The Pharmacological Basis of Therapeutics, 12e New York, NY: McGraw-Hill; . http://accessmedicine.mhmedical.com/content.aspx?bookid=1613&sectionid=102161502. Accessed November 27, 2017.
Kliegman RM, Stanton BMD, St. Geme J, Schor NF, eds. Nelson' s Textbook of Pediatrics. 20th ed. Philadelphia, PA: Saunders Elsevier; 2016.
Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-2442. [PubMed 24327038]
Lane LA and Rojas-Fernandez C, “Treatment of Vitamin B₁₂-Deficiency Anemia: Oral versus Parenteral Therapy,” Ann Pharmacother, 2002, 36(7-8):1268-72. [PubMed 12086562]
Langan RC, Goodbred AJ. Vitamin B12 deficiency: recognition and management. Am Fam Physician. 2017;96(6):384-389. [PubMed 28925645]
Langan RC, Zawistoski KJ, “Update on Vitamin B12 Deficiency,” Am Fam Physician, 2011, 83(12):1425-30. [PubMed 21671542]
Lindenbaum J, Healton EB, Savage DG, et al, “Neuropsychiatric Disorders Caused by Cobalamin Deficiency in the Absence of Anemia or Macrocytosis,” N Engl J Med, 1988, 318(26):1720-8. [PubMed 3374544]
Mangels AR and Messina V, "Considerations in Planning Vegan Diets: Infants," J Am Diet Assoc, 2001, 101(6):670-7. [PubMed 11424546]
Means RT, Fairfield KM. Treatment of vitamin B12 and folate deficiencies. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com. Accessed January 12, 2023.
Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247. doi:10.1016/j.soard.2019.10.025 [PubMed 31917200]
Nascobal (cyanocobalamin) [prescribing information]. Chestnut Ridge, NY: Par Pharmaceutical Companies; November 2018.
National Institutes of Health (NIH). Vitamin B12 - health professional. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. Updated April 6, 2021. Accessed August 30, 2021.
Nelson Textbook of Pediatrics, 17th ed, Behrman RE, Kliegman RM, and Jenson HB, eds, Philadelphia, PA: WB Saunders Co, 2004.
Oh R, Brown DL. Vitamin B₁₂ deficiency. Am Fam Physician. 2003;67(5):979-986. [PubMed 12643357]
Olszewski AJ, Szostak WB, Bialkowska M, et al, “Reduction of Plasma Lipid and Homocysteine Levels by Pyridoxine, Folate, Cobalamin, Choline, Riboflavin, and Troxerutin in Atherosclerosis,” Atherosclerosis, 1989, 75(1):1-6. [PubMed 2930611]
Orkin S, Nathan D, Ginsbirg, D, et al, eds. Nathan and Oski's Hematology and Oncology of Infancy and Childhood. 8th ed. Saunders; 2015.
Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. [PubMed 28392254]
Rasmussen SA, Fernhoff PM, and Scanlon KS, “Vitamin B₁₂ Deficiency in Children and Adolescents,” J Pediatr, 2001, 138(1):10-17. [PubMed 11148506]
Refer to manufacturer's labeling.
Regland B, Gottfries CG, and Lindstedt G, “Dementia Patients With Low Serum Cobalamin Concentration: Relationship to Atrophic Gastritis,” Aging (Milano), 1992, 4(1):35-41. [PubMed 1627675]
Roumeliotis N, Dix D, Lipson A. Vitamin B(12) deficiency in infants secondary to maternal causes. CMAJ. 2012;184(14):1593-1598. [PubMed 22711730]
Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21):3543-3551. doi:10.1200/JCO.2007.15.0375 [PubMed 18506025]
Schjonsby H, “Vitamin B₁₂ Absorption and Malabsorption,” Gut, 1989, 30(12):1986-91. [PubMed 2693230]
Schnyder G, Roffi M, Flammer Y, et al, “Effect of Homocysteine-Lowering Therapy With Folic Acid, Vitamin B12, and Vitamin B6 on Clinical Outcome After Percutaneous Coronary Intervention: The Swiss Heart Study: A Randomized Controlled Trial,” JAMA, 2002, 288(8):973-9. [PubMed 12190367]
Silbergleit R and Lee DC, “Bowel Obstruction and Radiopaque Vitamin B₁₂ “Pseudobezoar”,” Am J Emerg Med, 1995, 13(1):112-3. [PubMed 7832937]
Singh N, Baldi M, Kaur J, et al. Timing of folic acid/vitamin B12 supplementation and hematologic toxicity during first-line treatment of patients with nonsquamous non-small cell lung cancer using pemetrexed-based chemotherapy: the PEMVITASTART randomized trial. Cancer. 2019;125(13):2203-2212. doi:10.1002/cncr.32028 [PubMed 30825389]
Smith AD, Refsum H. Vitamin B-12 and cognition in the elderly. Am J Clin Nutr. 2009;89(2):707S-711S. [PubMed 19116332]
Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368(2):149-160. doi:10.1056/NEJMcp1113996 [PubMed 23301732]
Vogelzang NJ, Rusthoven JJ, Symanowski J, et al. Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol. 2003;21(14):2636-2644. doi:10.1200/JCO.2003.11.136 [PubMed 12860938]
Volkov I, Rudoy I, Freud T, et al. Effectiveness of vitamin B₁₂ in treating recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled trial. J Am Board Fam Med. 2009;22(1):9-16. doi:10.3122/jabfm.2009.01.080113 [PubMed 19124628]
Worthington-White DA, Behnke M, and Gross S, "Premature Infants Require Additional Folate and Vitamin B₁₂ to Reduce the Severity of the Anemia of Prematurity," Am J Clin Nutr, 1994, 60(6):930-5. [PubMed 7985636]

Topic 9302 Version 449.0

خرید پکیج

Cyanocobalamin (vitamin B12): Drug information