Cyanocobalamin

Registered South African indications:

• Vitamin B12 deficiency

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Should not be given before diagnosis has been fully established
• Megaloblastic anaemia of pregnancy
• IV route of administration

Cautions

• Pregnancy
• Renal impairment
• Leber's disease
• Polycythemia vera
• High doses
• Prolonged use

Forms avail. in SA and covered in this monograph: inj

Megaloblastic anaemia
Subacute combined degeneration of the spinal cord
Intestinal malabsorption
Diet-related deficiency
Post-gastrectomy

With neurological involvement

• IM: 1000μg, on alt. days; Treatment duration: until improvement occurs

Without neurological involvement

• IM: Initial: 1mg, dly for 5 days; Then weekly for 3 doses; Maintenance: 1mg, alternate months

Pernicious anaemia

With neurological involvement

• IM: 1000μg, on alt. days; Treatment duration: until improvement occurs

Without neurological involvement

• IM: Initial: 1mg, dly for 5 days; Then weekly for 3 doses; Maintenance: 1mg, alternate months; Treatment duration: lifelong

Prophylaxis of anaemia secondary to gastrectomy or malabsorption syndromes

• IM: 1mg, alternate months

Paed. forms avail. in SA and covered in this monograph: inj

Megaloblastic anaemia
Pernicious anaemia
Subacute combined degeneration of the spinal cord
Intestinal malabsorption
Diet related deficiency
Post-gastrectomy

• IM: 500μg, monthly

Pregnancy

• Caution
• Cyanocobalamin should not be used for the treatment of megaloblastic anaemia of pregnancy unless vitamin B12 deficiency has been demonstrated

Breastfeeding

• Compatible
• Cyanocobalamin is secreted into breast milk but this is unlikely to harm the infant and may be beneficial if the mother and infant are vitamin B12 deficient

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended 

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Abnormal gait
• Anxiety
• Ataxia
• Dizziness
• Headache
• Hypoaesthesia
• Pain
• Paraesthesia

Cardiovascular Disorders

• Congestive cardiac failure
• Peripheral vascular disease
• Thrombosis

Respiratory Disorders

• Dyspnoea
• Pulmonary oedema
• Rhinitis

Gastrointestinal Disorders

• Diarrhoea
• Dyspepsia
• Glossitis
• Nausea and vomiting
• Pharyngitis

Musculoskeletal Disorders

• Arthritis
• Back pain
• Myalgia 
• Weakness

Immune, Blood and Lymphatic System Disorders

• Allergic reactions
• Polycythemia vera

• Chloramphenicol
• Colchicine
• Alcohol
• Oral contraceptives
• Folate

Full blood count

Vitamin B12 is used in the body in two forms, namely methylcobalamin and 5-deoxyadenosyl cobalamin. Both these substances are cofactors needed in enzymatic processes. Methylcobalamin is essential for eventual DNA methylation, while 5-deoxyadenosyl cobalamin is needed in the extraction of energy from proteins and fats and for the production of haemoglobin. 

Cyanocobalamin is available in several formulations. Please note the list below gives examples of products which are available and is not necessarily comprehensive. The listing of a product does not constitute endorsement of the product by EMGuidance; likewise, failure to list a product does not imply that EMGuidance disapproves of the product. This information is put together on the basis of the National Government's Medicines Price Registry at the time of publication

Injection (per ml) 1mg

• A-Lennon-Vitamin B12 (Pharmacare)