Cyanocobalamin oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations containing cyanocobalamin.
Drugs List
Therapeutic Indications
Uses
Vitamin B12 deficiency
Treatment of vitamin B12 deficiency of several origins, including nutritional, following partial gastrectomy, tropical sprue, impaired resorption and pernicious anaemia.
Dosage
Adults
1mg tablets
Remission treatment: 2 tablets twice a day until full remission. To be taken between meals.
Maintenance treatment/prophylaxis: 1 tablet daily.
50microgram tablets
1 to 3 tablets daily, or more at the discretion of the physician. To be taken between meals.
35micrograms/5ml oral liquid
5ml to 10ml up to three times per day, or more at the discretion of the physician. To be taken between meals.
For treatment of pernicious anaemia, an oral dose of at least 300micrograms daily should be given.
Children
50microgram tablets
1 tablet daily, or more at the discretion of the physician. To be taken between meals.
35micrograms/5ml oral liquid
5ml up to three times per day, or more at the discretion of the physician. To be taken between meals.
For treatment of pernicious anaemia, an oral dose of at least 300micrograms daily should be given.
Contraindications
None known
Precautions and Warnings
Diabetes mellitus
Galactosaemia
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Lactose intolerance
Exclude folate deficiency as cause of megaloblastic anaemia
Some formulations contain lactose
Some formulations contain sucrose
Diabetic control may need adjustment
Monitor blood values regularly
When used for pernicious anaemia, an adequate dose must be administered and blood should be monitored regularly (at least every three months for the first 18 months until stabilised, and annually thereafter).
Indiscriminate administration of cyanocobalamin may mask precise diagnosis.
Cyanocobalamin should not be used to treat megaloblastic anaemia of pregnancy because this is due to folate deficiency.
Some formulations contain sugar, in long term treatment ensure adequate dental hygiene is maintained.
Parenteral treatment should be used if neuropathy is suspected.
Pregnancy and Lactation
Pregnancy
Cyanocobalamin is considered safe for use during pregnancy.
The manufacturer advises cyanocobalamin may be used safely during pregnancy.
Lactation
Cyanocobalamin is considered safe for use during breastfeeding.
The manufacturer states cyanocobalamin may be used safely when breastfeeding. No effects on exposed infants are anticipated.
Counselling
Some formulations contain sugar. Advise patient to maintain adequate dental hygiene in long term treatment.
Advise patient to take cyanocobalamin between meals.
Side Effects
Acne-like eruptions
Anaphylactic shock
Angioedema
Bullous eruption
Exanthema
Exanthematous rash
Fever
Hypersensitivity reactions
Itching
Skin reactions
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2016
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Joint Formulary Committee. British National Formulary. 70th ed. London: BMJ Group and Pharmaceutical Press; 2015.
Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.
Summary of Product Characteristics: Cytacon tablets 50mcg. Amdipharm Mercury Company Ltd. Revised May 2014.
Summary of Product Characteristics: Cytacon liquid 35mcg/5ml. Amdipharm Mercury Company Ltd. Revised May 2014.
Summary of Product Characteristics: Orobalin 1mg tablets. Northumbria Pharma Ltd. Revised January 2019.
UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 7 January 2016
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