What are the primary uses of Vitamin B12 injections. How is cyanocobalamin administered for B12 deficiency. What are the potential side effects of B12 injections. Who should exercise caution when considering B12 supplementation.

Understanding Vitamin B12 and Cyanocobalamin Injections

Vitamin B12, also known as cobalamin, is a crucial nutrient that plays a vital role in various bodily functions. Cyanocobalamin, a man-made form of vitamin B12, is commonly used in injectable treatments to address B12 deficiencies. These injections are particularly beneficial for individuals who have difficulty absorbing B12 through oral supplements or dietary sources.

What is Cyanocobalamin?

Cyanocobalamin is a synthetic form of vitamin B12 that is widely used in medical settings. It is designed to mimic the natural B12 found in food sources and is highly effective in treating and preventing B12 deficiency.

Why are B12 Injections Necessary?

B12 injections become necessary when an individual’s body cannot adequately absorb the vitamin through traditional means. This can occur due to various factors, including:

• Pernicious anemia
• Gastrointestinal disorders
• Certain medications
• Strict vegetarian or vegan diets
• Age-related decreased absorption

The Vital Functions of Vitamin B12 in the Body

Vitamin B12 is essential for numerous bodily processes. Its primary functions include:

1. Red blood cell formation
2. DNA synthesis
3. Neurological function
4. Energy production
5. Fatty acid metabolism

A deficiency in B12 can lead to serious health complications, affecting multiple body systems. Recognizing the importance of this vitamin can help individuals understand why supplementation, including injections, may be necessary.

How Does B12 Support Energy Production?

Vitamin B12 plays a crucial role in energy metabolism. It helps convert the food we eat into glucose, which cells use for energy. Without adequate B12, individuals may experience fatigue, weakness, and a lack of energy.

Identifying B12 Deficiency: Symptoms and Risk Factors

Recognizing the signs of B12 deficiency is crucial for timely intervention. Common symptoms include:

• Fatigue and weakness
• Shortness of breath
• Heart palpitations
• Pale or jaundiced skin
• Neurological changes (tingling, numbness)
• Vision problems
• Mood changes
• Smooth tongue

Certain groups are at higher risk for B12 deficiency, including older adults, individuals with gastrointestinal disorders, and those following strict plant-based diets.

Can B12 Deficiency Be Diagnosed Through Blood Tests?

Yes, B12 deficiency can be diagnosed through blood tests. Healthcare providers typically order a serum B12 test to measure the levels of vitamin B12 in the blood. Additional tests, such as methylmalonic acid (MMA) and homocysteine levels, may be used to confirm a deficiency, especially in borderline cases.

Administration and Dosage of Cyanocobalamin Injections

Cyanocobalamin injections are typically administered intramuscularly or subcutaneously. The dosage and frequency of injections depend on the severity of the deficiency and the individual’s response to treatment.

Typical Dosing Schedule for B12 Injections

A common initial dosing schedule for severe B12 deficiency might include:

• Daily injections of 1000 mcg for 1-2 weeks
• Weekly injections for 4-8 weeks
• Monthly injections for maintenance

It’s important to note that dosing schedules can vary significantly based on individual needs and should always be determined by a healthcare professional.

How Quickly Do B12 Injections Take Effect?

The effects of B12 injections can often be felt within a few days to a week after starting treatment. However, it may take several weeks or months of consistent treatment to fully correct a deficiency and alleviate all symptoms.

Potential Side Effects and Precautions of B12 Injections

While B12 injections are generally considered safe, they can cause side effects in some individuals. Common side effects may include:

• Pain or redness at the injection site
• Mild diarrhea
• Itching
• Swelling sensation

More serious side effects, though rare, can include allergic reactions, low potassium levels, and complications in individuals with certain pre-existing conditions.

Are There Any Contraindications for B12 Injections?

While B12 injections are safe for most people, there are some contraindications to consider. Individuals with the following conditions should exercise caution and consult their healthcare provider before receiving B12 injections:

• Allergy to cobalt or any components of the injection
• Leber’s disease (a rare eye disorder)
• Polycythemia vera (a blood disorder)
• Severe kidney disease

Interactions Between B12 Injections and Other Medications

B12 injections can interact with certain medications, potentially affecting their efficacy or increasing the risk of side effects. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re taking.

Common Medications That May Interact with B12

Some medications that may interact with vitamin B12 include:

• Metformin (used for diabetes)
• Proton pump inhibitors (used for acid reflux)
• H2 receptor antagonists (used for ulcers and acid reflux)
• Colchicine (used for gout)
• Chloramphenicol (an antibiotic)

These interactions can affect B12 absorption or metabolism, potentially necessitating adjustments in dosage or monitoring.

Long-Term Benefits and Considerations of B12 Supplementation

Regular B12 supplementation, when necessary, can provide numerous long-term health benefits. These may include:

• Improved energy levels and reduced fatigue
• Enhanced cognitive function
• Better cardiovascular health
• Improved mood and mental well-being
• Healthier skin, hair, and nails

However, it’s important to maintain regular check-ups and blood tests to ensure that B12 levels remain within the optimal range and that supplementation continues to be necessary and beneficial.

Can Long-Term B12 Supplementation Have Any Negative Effects?

While vitamin B12 is generally considered safe, even in high doses, long-term supplementation should be monitored by a healthcare professional. In rare cases, excessive B12 intake may lead to:

• Acne or rosacea flare-ups
• Increased risk of lung cancer in male smokers (observed with high-dose B12 supplements)
• Potential interaction with other medications

Regular blood tests can help ensure that B12 levels are maintained within a healthy range, avoiding potential overconsumption.

Alternative Forms of B12 Supplementation

While injections are highly effective, particularly for those with absorption issues, there are other forms of B12 supplementation available. These include:

1. Oral tablets and capsules
2. Sublingual tablets or liquids
3. Nasal gels
4. Transdermal patches

The effectiveness of these alternatives can vary depending on the individual’s ability to absorb B12. In some cases, a combination of methods may be recommended by healthcare providers.

How Do Sublingual B12 Supplements Compare to Injections?

Sublingual B12 supplements, which dissolve under the tongue, offer an alternative to injections. While they can be effective for some individuals, they may not be as reliable for those with severe malabsorption issues. Sublingual supplements have the advantage of being non-invasive and can be self-administered, but they may require more frequent dosing to maintain optimal B12 levels compared to injections.

Dietary Sources of Vitamin B12

While supplementation is necessary for many individuals, it’s also important to consider dietary sources of B12. Rich sources include:

• Animal liver and kidneys
• Clams and other shellfish
• Beef and poultry
• Fish, especially salmon and trout
• Eggs
• Dairy products
• Fortified plant-based milk and cereals

For individuals following plant-based diets, careful planning and potentially supplementation are crucial to ensure adequate B12 intake.

Can a Balanced Diet Provide Sufficient B12 for Everyone?

While a balanced diet can provide sufficient B12 for many people, certain groups may still require supplementation. These include:

• Strict vegetarians and vegans
• Older adults with decreased absorption capacity
• Individuals with gastrointestinal disorders
• Those taking certain medications that interfere with B12 absorption

In these cases, dietary sources alone may not be sufficient, and supplementation, potentially including injections, may be necessary to maintain optimal B12 levels.

Vitamin B-12 Injection: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

Cyanocobalamin is a man-made form of vitamin B12 used to treat low levels (deficiency) of this vitamin. Vitamin B12 helps your body use fat and carbohydrates for energy and make new protein. It is also important for normal blood, cells, and nerves. Most people get enough vitamin B12 in their diet, but a deficiency may occur in certain health conditions (such as poor nutrition, stomach/intestinal problems, infection, cancer). Serious vitamin B12 deficiency may result in anemia, stomach problems, and nerve damage.

How to use Vitamin B-12 100 Mcg/Ml Injection Solution

If you are using this medication at home, learn all preparation and usage instructions from your health care professional.

Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid.

This medication is given by injection into a muscle or under the skin as directed by your doctor.

Dosage is based on your medical condition and response to treatment. Injections may be given daily when you first start treatment. Certain medical conditions (such as pernicious anemia) may require you to continue receiving injections every month.

Learn how to store and discard needles and medical supplies safely. Consult your pharmacist.

Side Effects

Pain/redness at the injection site, mild diarrhea, itching, or a feeling of swelling all over the body may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may cause low potassium levels in the blood (hypokalemia). Tell your doctor right away if any of these serious side effects occur: muscle cramps, weakness, irregular heartbeat.

People who have a rare blood disorder (polycythemia vera) may rarely have symptoms related to this disorder while taking cyanocobalamin. Get medical help right away if any of these very serious symptoms occur: chest pain (especially with shortness of breath), weakness on one side of the body, sudden vision changes, trouble speaking.

Get medical help right away if you have any very serious side effects, including: symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before using cyanocobalamin, tell your doctor or pharmacist if you are allergic to it; or to cobalt; or if you have any other allergies. Your doctor may recommend that you receive a smaller test dose before starting your regular dose. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: low potassium blood levels (hypokalemia), gout, kidney disease, a certain blood disorder (polycythemia vera), a certain eye disease (Leber’s disease), other vitamin/mineral deficiencies (especially folic acid and iron).

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Based on information from related drugs, this medication may pass into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

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Overdose

Overdose with this medication is very unlikely. However, if someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Do not share this medication with others.

Lab and/or medical tests (such as blood potassium levels, complete blood count, hematocrit, vitamin B12 levels) should be done while you are using this medication. Keep all medical and lab appointments. Consult your doctor for more details.

This product is not a substitute for a proper diet. Remember that it is best to get your vitamins from healthy foods. Vitamin B12 is commonly found in many foods from animals, especially liver, kidney, fish and shellfish, meat, and dairy foods.

It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or pharmacist right away for a new dosing schedule. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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Cyanocobalamin – StatPearls – NCBI Bookshelf

Continuing Education Activity

Cyanocobalamin is a medication used to manage and treat vitamin B12 deficiencies. Chemically it belongs to a class called “corrinoids,” and it is a crystallizable cobalt complex. The name cyanocobalamin derives from the cyanide group attached to the molecule. This activity reviews the indications, action, and contraindications for cyanocobalamin as a valuable agent in managing vitamin B12 deficiencies and other off-label uses (and other applicable disorders). In addition, this activity will highlight the mechanism of action, adverse event profile, and other key factors (e. g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the care of patients with such conditions.

Objectives:

• Identify the indications of cyanocobalamin.

• Describe the mechanism of action of cyanocobalamin.

• Outline the potential adverse effects of cyanocobalamin therapy.

• Summarize the importance of collaboration amongst physicians, nurse practitioners, nutritionists, and specialists like hematologists, gastroenterologists, geriatricians, and others in evaluating cyanocobalamin therapy.

Access free multiple choice questions on this topic.

Indications

Cyanocobalamin is a synthetic compound of vitamin B12 used mainly to treat vitamin deficiencies.[1] Chemically it belongs to a class called “corrinoids,” and it is a crystallizable cobalt complex. The name cyanocobalamin derives from the cyanide group attached to the molecule. [2] It has a role in several methylation reactions in the body.[3] In the body, the form of methylcobalamin acts as a cofactor in the conversion of homocysteine to methionine. In the form of adenosylcobalamin, it plays a role in converting methylmalonyl-CoA to succinyl-CoA. Both these reactions are vital for cell division and growth.

FDA Approved Indications

• Pernicious anemia: this condition is an autoimmune disorder against gastric parietal cells. These cells are responsible for the production of the intrinsic factor – as the parietal cells are destroyed, there is no intrinsic factor to which dietary B12 can bind; this leads to a deficiency of vitamin B12

• Malabsorption: Impairment of B12 absorption

• Atrophic gastritis: Impairment of intrinsic factor production, causing impaired vitamin B12 absorption

• Long-term metformin use[4]

• Chronic acid-reducing medication use[5]

• Small bowel bacteria overgrowth: competition for vitamin B12 leads to vitamin deficiency

• Total or partial gastrectomy: eliminates site of intrinsic factor production

• Diphyllobothrium latum infection: parasite utilizes luminal B12

• Helicobacter pylori infection

• Pancreatic insufficiency: causes failure to inactivate cobalamin-binding proteins

• Malignancy of pancreas or bowel

• Dietary deficiency of vitamin B12: eating strictly vegan foods without animal origin can lead to such deficiency[6]

• Transcobalamin II deficiency: causes impairment in transmembrane transport of B12

Non-FDA Approved Indications

• Smoke inhalation

• Cyanide poisoning[7]

• Surgery-associated vasoplegia[8]

• Vasodilatory shock

• Folic acid deficiency

• A potentially reversible cause of cognitive impairment and dementia. However, more research is required.[9]

• Nitrous oxide myelopathy[10]

Mechanism of Action

The synthetic form of supplemental vitamin B12 has long been available as cyanocobalamin for oral and injectable use.[11] Cyanocobalamin absorption occurs through the small intestine after binding to intrinsic factors and other cobalamin binding proteins.[12] When given via the parenteral route, it reaches the blood immediately.[13] In the blood, it attaches itself to plasma proteins. Tissues absorb vitamin B12 by specific B12 binding proteins, transcobalamin I and II, allowing it to enter the cells. Most of the vitamin is stored in the liver. Vitamin B12 is essential for DNA synthesis and energy production, particularly in erythroid progenitor cells.

Vitamin B12 is a cofactor for two vital enzymes in the body: methylmalonyl-CoA mutase and methionine synthase. These methylation reactions are responsible for annealing Okazaki fragments during DNA synthesis. [2] The replenishment causes total improvement of megaloblastic anemia and the gastrointestinal manifestations of vitamin B12 deficiency. The reported but unconfirmed mechanism of action of hydroxocobalamin in vasoplegic shock is direct inhibition of nitric oxide and inhibition of guanylate cyclase.[14]

Pharmacokinetics 

Absorption: According to the manufacturer’s product labeling, cyanocobalamin is rapidly absorbed from injection sites; and reaches its peak within 1 hour after intramuscular injection.

Distribution: Absorbed vitamin B12 is transported via B12 binding proteins, transcobalamin I and II. 

Metabolism: As described above, cyanocobalamin is converted in tissues into a cofactor for various metabolic processes. 

Excretion: Cynocobaline is primarily excreted through the kidney. Approximately 50 to 98% of the injected cyanocobalamin is present in the urine. A significant portion is excreted within the first eight hours. About 3-8 mcg of cyanocobalamin is secreted into the GI tract daily via the bile, and a majority is absorbed back.

Administration

Cyanocobalamin administration can be through oral, sublingual, intramuscular, subcutaneous, and intranasal routes. The choice of oral and other parenteral routes depends on the cause as well as the presentation of the patient.[15] A severe deficiency requires treatment with parenteral therapy (IM/SC). A patient with malabsorption cannot benefit from treatment with the oral formulation due to impaired absorption.[16] 

The initial replacement of overt deficiency is usually through parenteral therapy. Typically, 100 mcg cyanocobalamin is given daily for one week, weekly for a month, and monthly for life. Oral/sublingual treatment is given after the initial correction of vitamin deficiency.

An intradermal test dose is an option for patients suspected of cyanocobalamin sensitivity before any parenteral treatment. Due to the possibility of anaphylaxis, cyanocobalamin should never be given intravenously (I. V.).[17] The vitamin is light-sensitive, so the vials should be protected from light and stored at room temperature. There are several case reports of hydroxocobalamin therapy for vasoplegic shock. The dose used in these case reports was 5 g over 15 min intravenously, with some instances of it being repeated in six hours.[18]

Use in Specific Patient Population

Patients with Hepatic Impairment: No information regarding the use of cyanocobalamin in patients with hepatic impairment has been provided in the manufacturer’s product labeling. Vitamin B12 therapy has not been linked to transaminase elevations or clinically apparent acute liver injury.[19]

Patients with Renal Impairment:  No information regarding the use of cyanocobalamin in patients with renal impairment has been provided in the manufacturer’s product labeling. However, according to kidney disease improving global outcomes (KDIGO) guidelines, vitamin b12 supplementation may be helpful in patients with anemia in chronic kidney disease. [20]

Pregnancy Considerations: Vitamin B12 deficiency increases the risk of adverse pregnancy outcomes.[21] Prophylactic vitamin B12 supplementation, especially in vegetarian mothers, is required.[22][23]

Breastfeeding Considerations: Vitamin B12 is present in human milk. However, risk factors for vitamin b12 deficiency in infants are exclusively breastfeeding by nursing mothers having vitamin B12 deficiency due to minimal intake of animal products or malabsorption. Adverse health outcomes in infants with vitamin B12 deficiency include anemia, failure to thrive, and neurological complications. Hence it is important to improve vitamin B12 status in infants through maternal supplementation during lactation.[24]

Adverse Effects

Though only a vitamin, cyanocobalamin can cause several adverse drug reactions, including allergic reactions like itching, erythema, and wheals.[25] Cyanocobalamin therapy’s cutaneous adverse drug reactions include acne, rosacea, and anaphylaxis with cyanocobalamin injections. Cobalt is a component of cobalamin; consequently, patients with cobalt sensitivity have been reported to have allergic manifestations when receiving cobalamin replacement therapy.[26]

Other common adverse effects include:

• Shortness of breath (even with mild exertion), swelling, rapid weight gain

• Pulmonary edema, congestive heart failure; peripheral vascular thrombosis

• Hypokalemia–leg cramps, irregular heartbeats, tingling/numbness, muscle weakness, or limp feeling

• Numbness or tingling and joint pain

• Fever

• Swollen tongue

• Itching or rash

• Polycythemia; cyanocobalamin can unmask the underlying polycythemia. Patients with myeloproliferative disorders like polycythemia vera have an increased prevalence of vitamin B12 deficiency, despite high serum vitamin B12 levels.

Contraindications

Sensitivity to cobalt and/or vitamin B12 due to the risk of anaphylaxis. [27]

Patients with early Leber disease suffered severe and rapid optic atrophy when they received treatment with cyanocobalamin.[28]

Aluminum is present in the preparation of cyanocobalamin. CNS and bone toxicity secondary to aluminum accumulation is possible in patients with renal impairment. Thus, it is a relative contraindication to cyanocobalamin.

According to the manufacturer’s product labeling, cyanocobalamin formulation contains benzyl alcohol. Benzyl Alcohol is associated with fatal “Gasping Syndrome” in premature infants.[29]

Monitoring

The clinician should obtain CBC, vitamin B12, folate, iron levels, hematocrit, and reticulocyte count before treatment. CBC usually reveals a macrocytic pattern (MCV > 100 fL) and hypersegmented neutrophils.[30] Folic acid supplementation is also necessary if folate levels are low. Folic acid may improve vitamin B12-deficient megaloblastic anemia, but it is not a substitute. If the clinician only uses folic acid to treat vitamin B12 ­deficient megaloblastic anemia, progressive and irreversible neurologic damage could result because it can aggravate vitamin B12 deficiency by increasing demand for the vitamin.

When giving cyanocobalamin to treat vitamin B12 deficiency, there is an increase in erythrocyte metabolism, which leads to hypokalemia. As the anemia is corrected, thrombocytosis could also occur. Therefore, clinicians should carefully monitor serum potassium levels and platelet count during therapy. Recommendations are to monitor vitamin B12 blood levels and peripheral blood counts for one month. Methylmalonic acid levels and Serum Transcobalamin II are the most specific laboratory markers of vitamin b12 deficiency. However, hypersegmented neutrophils have a sensitivity of 98% compared to serum cyanocobalamin, with a sensitivity of 90–95%. Thus,  peripheral blood smear analysis is a cost-effective tool for diagnosing and monitoring response to vitamin B12 deficiency.[31]

The neurological symptoms of vitamin B12 deficiency can range from paraesthesia and numbness to subacute combined degeneration(dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts), which improves upon cyanocobalamin administration. [32][31] Still, the improvement level depends on the deficiency’s duration and severity, and clinicians should monitor the improvement.[33]

Clinicians should also monitor for dermatological manifestations of vitamin b12 deficiency, such as hyperpigmentation, hair and nail changes, and glossitis and improvement with therapy.[26] The clinicians should always ask about a history of allergies as there is a risk of anaphylaxis if a patient is allergic to cobalt or other medication components. In addition, decreased therapeutic response to vitamin B12 may be due to uremia, infection, marrow suppressants like chloramphenicol, methotrexate, and concomitant iron or folic acid deficiency.[34] Monitor the patients diagnosed with vitamin b12 deficiency due to pernicious anemia, as pernicious anemia increases the risk of gastric carcinoid tumors and gastric adenocarcinoma.[35]

Toxicity

Cyanocobalamin secretion is usually in bile. With higher doses of cyanocobalamin, it undergoes rapid elimination in the urine. No overdosage occurs with cyanocobalamin. There is no antidote to vitamin B12.

Enhancing Healthcare Team Outcomes

Cyanocobalamin treats a variety of different conditions related to vitamin B12 deficiency. The interprofessional healthcare team must coordinate activities to manage the condition, including clinicians (MDs, DOs, NPs, PAs), nurses, pharmacists, and nutritionists. Early detection will prevent severe and permanent complications, as prolonged vitamin B12 deficiency may lead to permanent degenerative spinal cord lesions.[36] Due to the risk of hypokalemia early in treatment, electrolytes should be tested during follow-up visits, which requires rigorous lab review after the office visit. Clinicians can do this surveillance so as not to miss any abnormality. This is where all interprofessional team members can engage in coordinated activity and open communication regarding the patient’s condition and response to treatment so that everyone involved in the case operates from the same information base, driving better patient outcomes. [Level 5]

As there are several completely unrelated causes of this deficiency, a physician is responsible for not only identifying the probable cause but also for tailoring therapy and further management for different individuals depending on case to case basis.[37]

The involvement of specialists may prove necessary in several instances. For example,

• A patient with D. latum infection may need follow-up with an infectious disease specialist. 

• A patient with a dietary deficiency may need to see a dietician or a nutritionist.

• A patient with H.pylori infection, atrophic gastritis, malabsorption, pancreatic insufficiency, or Crohn disease may need to see a gastroenterologist or a GI surgeon.

• A patient with malignancy of bowel/pancreas may need oncology follow-up.

• Due to the correlation of pernicious anemia with carcinoma of the stomach, an appropriate gastroenterology workup may be recommended.[35]

• Vitamin B12 deficiency suppresses the signs of polycythemia vera, which may be unmasked after treatment. It is also possible to have vitamin B12 deficiency with a normal MCV due to co-existent thalassemia/iron deficiency anemia. Hence, a hematologist may guide further treatment for such patients. 

Due to the possibility of hypersensitivity to the drug, it is essential that the provider administers it with necessary precautions and performs an intradermal test if an allergy is suspected. Education about allergic reactions and other side effects is necessary for optimal outcomes and the prevention of anaphylactic shock. [Level 5]

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LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda (MD): May 27, 2021. Vitamin B. [PubMed: 31644020]

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Drüeke TB, Parfrey PS. Summary of the KDIGO guideline on anemia and comment: reading between the (guide)line(s). Kidney Int. 2012 Nov;82(9):952-60. [PubMed: 22854645]

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Finkelstein JL, Guillet R, Pressman EK, Fothergill A, Guetterman HM, Kent TR, O’Brien KO. Vitamin B₁₂ Status in Pregnant Adolescents and Their Infants. Nutrients. 2019 Feb 13;11(2) [PMC free article: PMC6413223] [PubMed: 30781902]

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Rashid S, Meier V, Patrick H. Review of Vitamin B12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. Eur J Haematol. 2021 Apr;106(4):450-455. [PubMed: 33341967]

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Hovdenak N, Haram K. Influence of mineral and vitamin supplements on pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2012 Oct;164(2):127-32. [PubMed: 22771225]

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Drugs and Lactation Database (LactMed®) [Internet]. National Institute of Child Health and Human Development; Bethesda (MD): May 15, 2023. Vitamin B₁₂. [PubMed: 30489717]

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Chittaranjan Y. Vitamin B12: An Intergenerational Story. Nestle Nutr Inst Workshop Ser. 2020;93:91-102. [PubMed: 31991435]

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Brescoll J, Daveluy S. A review of vitamin B12 in dermatology. Am J Clin Dermatol. 2015 Feb;16(1):27-33. [PubMed: 25559140]

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Caballero MR, Lukawska J, Lee TH, Dugué P. Allergy to vitamin B12: two cases of successful desensitization with cyanocobalamin. Allergy. 2007 Nov;62(11):1341-2. [PubMed: 17822451]

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Oliveira C. Toxic-Metabolic and Hereditary Optic Neuropathies. Continuum (Minneap Minn). 2019 Oct;25(5):1265-1288. [PubMed: 31584537]

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Ekabe CJ, Kehbila J, Abanda MH, Kadia BM, Sama CB, Monekosso GL. Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report. BMC Res Notes. 2017 Jan 28;10(1):72. [PMC free article: PMC5273828] [PubMed: 28129784]

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Disclosure: Advait Vasavada declares no relevant financial relationships with ineligible companies.

Disclosure: Devang Sanghavi declares no relevant financial relationships with ineligible companies.

Vitamin B12 ampoules: instructions for use

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• Vitamin B12 in ampoules: instructions for use

Content:

1. The role of vitamin B12 in the body
2. Indications for use of cyanocobalamin
3. Treatment regimen with cyanocobalamin
4. How to inject
5. Storage conditions of vitamin B12 in ampoules
6. Dosage of vitamin B12 in ampoules
7. Contraindications and side effects

Lack of vitamin B12 leads to a number of diseases. This is an important substance for the functioning of all systems, which reduces susceptibility to infections, increases endurance, physical and mental activity.

The role of vitamin B12 in the body

Cyanocobalamin (vitamin B12) was first discovered in 1948. Scientists isolated a new substance from raw liver and prescribed it to treat pernicious anemia.

Over the past 70 years, cyanocobalamin has been well studied by scientists and physicians, as a result of which it was possible to establish its effect on the body:

• blocking the stress hormone;
• improvement of blood clotting;
• synthesis of amino acids;
• decrease in the amount of cholesterol in the blood;
• detoxification of the body with alcoholism;
• improvement of liver function.

Cyanocobalamin helps athletes withstand heavy loads, accelerates weight loss and prevents the development of cardiovascular diseases.

It plays a special role in the functioning of the central nervous system. Vitamin complements the main therapy for cerebral palsy in children, Down’s disease, intercostal neuralgia, etc.

Back to article content

Indications for use of cyanocobalamin

Vitamin B12 in ampoules is used as an additional therapy. It enhances the effect of drugs, helps the body to overcome many diseases. In rare cases, it is prescribed as the only remedy for the prevention of anemia.

Indication for vitamin B12:

• chronic migraine;
• Down syndrome;
• cerebral palsy;
• neuralgia;
• radiation sickness;
• alcohol poisoning;
• dystrophy;
• anemia;
• radiculitis;
• diseases of the pancreas and liver;
• gastritis;
• photodermatosis;
• sclerosis.

Reception of cyanocobalamin is indicated for beriberi, frequent respiratory diseases. The lack of a substance in the body leads to a deterioration in the condition of hair, nails and teeth. For this reason, the drug is taken in ampoules not only for medical purposes, but also for cosmetic purposes.

Back to article content

Cyanocobalamin regimen

When vitamin B12 is prescribed, the instructions for use will help calculate the correct dosage. The treatment regimen looks like this:

• For the prevention of anemia and vitamin deficiency – from 200 to 500 mcg per day. The course of treatment is from 7 to 15 days.
• For the treatment of diseases of the central nervous system – 200 mcg per day daily for the first 3 days. Then 300 mcg daily for 4 days.
• If cyanocobalamin is used in complex therapy, then the dosage is from 200 to 500 mcg per day.

Vitamin B12 should only be taken at the dosage recommended by your doctor. It is not recommended to use the drug on its own, since it is rather difficult to determine an individual treatment regimen.

Back to article content

How to inject

Vitamin B12 shots can be given in different ways:

• subcutaneously;
• intramuscularly;
• intravenously;
• into the spinal cord.

The instructions say that cyanocobalamin cannot be used simultaneously with drugs that increase blood clotting, as well as with vitamins B1 and B6. If there is an allergy to B1, then B12 can exacerbate it.

You can administer intramuscularly and intravenously on your own. For injection into the spinal cord, you should consult an experienced doctor.

Back to article content

Storage conditions for vitamin B12 ampoules

Vitamin B12 in ampoules should be stored in a dry, dark place, at an air temperature of no more than 25 degrees. Some complex preparations require storage in the refrigerator. This point must be specified in the instructions.

Do not use the substance after the expiry date stated on the packaging.

Return to the content of article

Vitamin B12 dosage in ampoules

The dosage of vitamin B12 is determined individually and depends on the age of the patient. The maximum daily dose is:

• children – 400 mcg;
• adults – 1000 mcg.

The dosage increases gradually, you need to start with a small portion of the drug. This is necessary to exclude allergic reactions.

Back to article content

Contraindications and side effects

Subject to the instructions for use and the doctor’s recommendations, the drug has no side effects. In exceptional cases, unpleasant symptoms may occur:

• nervous excitement;
• tachycardia;
• headache;
• pain in the region of the heart;
• increased blood pressure;
• dizziness.

If there is an individual intolerance to the drug, then an allergic reaction occurs in the form of skin itching, rash, runny nose. In the event of side effects, the injection is stopped, the treatment method is reviewed together with the doctor.

Before starting injections, you should study the list of contraindications:

• angina;
• erythrocytosis;
• thrombosis;
• varicose veins;
• pregnancy and lactation;
• haemorrhoids;
• oncological diseases.

Another contraindication is individual intolerance to cyanocobalamin.

It is important to follow the instructions for use so that there is no overdose of vitamin B12 . In this case, the following conditions are observed:

• heart failure;
• arrhythmia;
• pulmonary edema;
• rash;
• anaphylactic shock.

Cyanocobalamin makes an invaluable contribution to the functioning of the body. With its deficiency, various diseases develop, the appearance and general well-being deteriorate. But you need to take it only after consulting a doctor and determining the individual dosage.

Return to the content of the article

09/21/2018

Vitamin B12 ampoules: instructions for use

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• Vitamin B12 in ampoules: instructions for use

Content:

1. The role of vitamin B12 in the body
2. Indications for use of cyanocobalamin
3. Treatment regimen with cyanocobalamin
4. How to inject
5. Storage conditions of vitamin B12 in ampoules
6. Dosage of vitamin B12 in ampoules
7. Contraindications and side effects

Lack of vitamin B12 leads to a number of diseases. This is an important substance for the functioning of all systems, which reduces susceptibility to infections, increases endurance, physical and mental activity.

The role of vitamin B12 in the body

Cyanocobalamin (vitamin B12) was first discovered in 1948. Scientists isolated a new substance from raw liver and prescribed it to treat pernicious anemia.

Over the past 70 years, cyanocobalamin has been well studied by scientists and physicians, as a result of which it was possible to establish its effect on the body:

• blocking the stress hormone;
• improvement of blood clotting;
• synthesis of amino acids;
• decrease in the amount of cholesterol in the blood;
• detoxification of the body with alcoholism;
• improvement of liver function.

Cyanocobalamin helps athletes withstand heavy loads, accelerates weight loss and prevents the development of cardiovascular diseases.

It plays a special role in the functioning of the central nervous system. Vitamin complements the main therapy for cerebral palsy in children, Down’s disease, intercostal neuralgia, etc.

Back to article content

Indications for use of cyanocobalamin

Vitamin B12 in ampoules is used as an additional therapy. It enhances the effect of drugs, helps the body to overcome many diseases. In rare cases, it is prescribed as the only remedy for the prevention of anemia.

Indication for vitamin B12:

• chronic migraine;
• Down syndrome;
• cerebral palsy;
• neuralgia;
• radiation sickness;
• alcohol poisoning;
• dystrophy;
• anemia;
• radiculitis;
• diseases of the pancreas and liver;
• gastritis;
• photodermatosis;
• sclerosis.

Reception of cyanocobalamin is indicated for beriberi, frequent respiratory diseases. The lack of a substance in the body leads to a deterioration in the condition of hair, nails and teeth. For this reason, the drug is taken in ampoules not only for medical purposes, but also for cosmetic purposes.

Back to article content

Cyanocobalamin regimen

When vitamin B12 is prescribed, the instructions for use will help calculate the correct dosage. The treatment regimen looks like this:

• For the prevention of anemia and vitamin deficiency – from 200 to 500 mcg per day. The course of treatment is from 7 to 15 days.
• For the treatment of diseases of the central nervous system – 200 mcg per day daily for the first 3 days. Then 300 mcg daily for 4 days.
• If cyanocobalamin is used in complex therapy, then the dosage is from 200 to 500 mcg per day.

Vitamin B12 should only be taken at the dosage recommended by your doctor. It is not recommended to use the drug on its own, since it is rather difficult to determine an individual treatment regimen.

Back to article content

How to inject

Vitamin B12 shots can be given in different ways:

• subcutaneously;
• intramuscularly;
• intravenously;
• into the spinal cord.

The instructions say that cyanocobalamin cannot be used simultaneously with drugs that increase blood clotting, as well as with vitamins B1 and B6. If there is an allergy to B1, then B12 can exacerbate it.

You can administer intramuscularly and intravenously on your own. For injection into the spinal cord, you should consult an experienced doctor.

Back to article content

Storage conditions for vitamin B12 ampoules

Vitamin B12 in ampoules should be stored in a dry, dark place, at an air temperature of no more than 25 degrees. Some complex preparations require storage in the refrigerator. This point must be specified in the instructions.

Do not use the substance after the expiry date stated on the packaging.

Return to the content of article

Vitamin B12 dosage in ampoules

The dosage of vitamin B12 is determined individually and depends on the age of the patient. The maximum daily dose is:

• children – 400 mcg;
• adults – 1000 mcg.

The dosage increases gradually, you need to start with a small portion of the drug. This is necessary to exclude allergic reactions.

Back to article content

Contraindications and side effects

Subject to the instructions for use and the doctor’s recommendations, the drug has no side effects. In exceptional cases, unpleasant symptoms may occur:

• nervous excitement;
• tachycardia;
• headache;
• pain in the region of the heart;
• increased blood pressure;
• dizziness.

If there is an individual intolerance to the drug, then an allergic reaction occurs in the form of skin itching, rash, runny nose. In the event of side effects, the injection is stopped, the treatment method is reviewed together with the doctor.

Before starting injections, you should study the list of contraindications:

• angina;
• erythrocytosis;
• thrombosis;
• varicose veins;
• pregnancy and lactation;
• haemorrhoids;
• oncological diseases.

Another contraindication is individual intolerance to cyanocobalamin.

It is important to follow the instructions for use so that there is no overdose of vitamin B12 . In this case, the following conditions are observed:

• heart failure;
• arrhythmia;
• pulmonary edema;
• rash;
• anaphylactic shock.

Cyanocobalamin makes an invaluable contribution to the functioning of the body.