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Drug overview for NASCOBAL (cyanocobalamin (vitamin b-12)):
Generic name: CYANOCOBALAMIN (VITAMIN B-12) (SYE-an-oh-koe-BAL-a-min)
Drug class: Cobalamines
Therapeutic class: Electrolyte Balance-Nutritional Products
Vitamin B12, a cobalt-containing B complex vitamin, is commercially available as cyanocobalamin and hydroxocobalamin, which are synthetic forms of vitamin B12. Hydroxocobalamin (Cyanokit(R)) is an antidote for cyanide poisoning.
No enhanced Uses information available for this drug.
Generic name: CYANOCOBALAMIN (VITAMIN B-12) (SYE-an-oh-koe-BAL-a-min)
Drug class: Cobalamines
Therapeutic class: Electrolyte Balance-Nutritional Products
Vitamin B12, a cobalt-containing B complex vitamin, is commercially available as cyanocobalamin and hydroxocobalamin, which are synthetic forms of vitamin B12. Hydroxocobalamin (Cyanokit(R)) is an antidote for cyanide poisoning.
No enhanced Uses information available for this drug.
DRUG IMAGES
NASCOBAL 500 MCG NASAL SPRAY
The following indications for NASCOBAL (cyanocobalamin (vitamin b-12)) have been approved by the FDA:
Indications:
Prevention of vitamin B12 deficiency
Vitamin B12 deficiency
Professional Synonyms:
Cyanocobalamin deficiency
Indications:
Prevention of vitamin B12 deficiency
Vitamin B12 deficiency
Professional Synonyms:
Cyanocobalamin deficiency
The following dosing information is available for NASCOBAL (cyanocobalamin (vitamin b-12)):
For the treatment of pernicious anemia, the usual initial IM or subcutaneous dosage of cyanocobalamin is 100 mcg daily for 6-7 days. If clinical manifestations have improved and a reticulocyte response is observed, cyanocobalamin can then be administered in a dosage of 100 mcg every other day for 7 doses and then 100 mcg every 3-4 days for 2-3 weeks. Once hematologic values have returned to normal, cyanocobalamin can be administered IM or subcutaneously in a dosage of 100 mcg once monthly for life.
Folic acid should be used concomitantly if necessary.
For the treatment of vitamin B12 deficiency in adults, the usual IM dosage of hydroxocobalamin is 30 mcg daily for 5-10 days. Once clinical symptoms have subsided and the blood components have returned to normal, monthly IM maintenance doses of 100-200 mcg appear to be sufficient to maintain a normoblastic bone marrow. For the treatment of vitamin B12 deficiency in children, the usual total IM dose of hydroxocobalamin is 1-5 mcg over 2 or more weeks, given in single doses of 100 mcg.
For maintenance, the IM or subcutaneous pediatric dosage is at least 60 mcg per month; however, smaller doses may often suffice for deficiency states not caused by pernicious anemia.
The commercially available cyanocobalamin metered-dose pump delivers 0.1 mL of solution containing 500 mcg of the drug per actuation. The recommended initial dosage of cyanocobalamin nasal spray is 500 mcg (one actuation) administered intranasally once weekly.
The dosage may need to be increased in patients who experience a decline in serum vitamin B12 concentrations after 1 month of therapy with this preparation. Therapy with a parenteral vitamin B12 preparation may be necessary in patients who do not achieve a satisfactory response to intranasal cyanocobalamin.
Folic acid should be used concomitantly if necessary.
For the treatment of vitamin B12 deficiency in adults, the usual IM dosage of hydroxocobalamin is 30 mcg daily for 5-10 days. Once clinical symptoms have subsided and the blood components have returned to normal, monthly IM maintenance doses of 100-200 mcg appear to be sufficient to maintain a normoblastic bone marrow. For the treatment of vitamin B12 deficiency in children, the usual total IM dose of hydroxocobalamin is 1-5 mcg over 2 or more weeks, given in single doses of 100 mcg.
For maintenance, the IM or subcutaneous pediatric dosage is at least 60 mcg per month; however, smaller doses may often suffice for deficiency states not caused by pernicious anemia.
The commercially available cyanocobalamin metered-dose pump delivers 0.1 mL of solution containing 500 mcg of the drug per actuation. The recommended initial dosage of cyanocobalamin nasal spray is 500 mcg (one actuation) administered intranasally once weekly.
The dosage may need to be increased in patients who experience a decline in serum vitamin B12 concentrations after 1 month of therapy with this preparation. Therapy with a parenteral vitamin B12 preparation may be necessary in patients who do not achieve a satisfactory response to intranasal cyanocobalamin.
Cyanocobalamin is administered by IM or deep subcutaneous injection. Cyanocobalamin also is administered orally and intranasally. Hydroxocobalamin is administered by IM injection or IV infusion. Oral therapy with vitamin B12 preparations is markedly inferior to parenteral therapy and should be used only for the treatment of dietary vitamin B12 deficiency in patients with normal GI absorption.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| NASCOBAL 500 MCG NASAL SPRAY | Maintenance | Adults spray 1 spray (500 mcg) into one nostril by intranasal route once weekly at least 1 hour before or 1 hour after hot foods or liquids |
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| CYANOCOBALAMIN 500 MCG SPRAY | Maintenance | Adults spray 1 spray (500 mcg) into one nostril by intranasal route once weekly at least 1 hour before or 1 hour after hot foods or liquids |
The following drug interaction information is available for NASCOBAL (cyanocobalamin (vitamin b-12)):
There are 0 contraindications.
There are 0 severe interactions.
There are 0 moderate interactions.
The following contraindication information is available for NASCOBAL (cyanocobalamin (vitamin b-12)):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 1 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Leber's hereditary optic atrophy |
There are 0 severe contraindications.
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Hypokalemia |
The following adverse reaction information is available for NASCOBAL (cyanocobalamin (vitamin b-12)):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 4 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Anaphylaxis Angioedema Hypokalemia Thrombocytosis |
There are 20 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Arthralgia Dizziness General weakness Glossitis Headache disorder Infection Nausea Paresthesia Pharyngitis Rhinitis Rhinorrhea Skin rash |
Nasal passage irritation Sore throat |
| Rare/Very Rare |
|---|
|
Bronchitis Cough Dental abscess Malaise Pain Sinus headache |
The following precautions are available for NASCOBAL (cyanocobalamin (vitamin b-12)):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Adequate and well-controlled studies have not been conducted in pregnant women. However, vitamin B12 requirements are increased in pregnant women. Parenteral preparations should be used during pregnancy only when the potential benefits justify the potential risks to the fetus.
Vitamin B12 is distributed into human milk. Vitamin B12 requirements are increased in lactating women. Hydroxocobalamin may be administered to lactating women with suspected or known cyanocobalamin poisoning. There is no data available to determine when breastfeeding may be restarted following administration of IV hydroxocobalamin.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for NASCOBAL (cyanocobalamin (vitamin b-12)):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for NASCOBAL (cyanocobalamin (vitamin b-12))'s list of indications:
| Vitamin b12 deficiency | |
| D51 | Vitamin b12 deficiency anemia |
| D51.0 | Vitamin b12 deficiency anemia due to intrinsic factor deficiency |
| D51.1 | Vitamin b12 deficiency anemia due to selective vitamin b12 malabsorption with proteinuria |
| D51.2 | Transcobalamin II deficiency |
| D51.3 | Other dietary vitamin b12 deficiency anemia |
| D51.8 | Other vitamin b12 deficiency anemias |
| D51.9 | Vitamin b12 deficiency anemia, unspecified |
| E53.8 | Deficiency of other specified B group vitamins |
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