Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Vitamin B12 is an essential vitamin found in foods such as meat, fish, and dairy. It can also be made in a lab and is often taken with other B vitamins.

Vitamin B12 is required for the function and development of many parts of the body, including the brain, nerves, and blood cells. Methylcobalamin is the active form of vitamin B12. Cyanocobalamin, which must be processed by the body into the active form, is the most common type used in supplements.

People commonly use vitamin B12 for vitamin B12 deficiency, cyanide poisoning, and high levels of homocysteine in the blood. It is also used for canker sores, cataracts, Alzheimer disease, osteoporosis, fatigue, and many other conditions, but there is no good scientific evidence to support most of these other uses.

Uses & Effectiveness ?

Effective for

• A rare inherited condition marked by vitamin B12 deficiency (Imerslund-Grasbeck disease). Injecting vitamin B12 as a shot for 10 days followed by monthly injections is effective for treating this condition. Vitamin B12 shots can only be given by a healthcare provider.
• Vitamin B12 deficiency. Taking vitamin B12 by mouth, as a shot, or inhaling through the nose can treat and prevent vitamin B12 deficiency. Vitamin B12 shots can only be given by a healthcare provider.

Likely Effective for

• Cyanide poisoning. Administering hydroxocobalamin (Cyanokit), a natural form of vitamin B12, as a shot is likely effective for treating cyanide poisoning. It has been approved by the US FDA for this use. Vitamin B12 shots can only be given by a healthcare provider.

Possibly Effective for

• Canker sores. Applying an ointment containing vitamin B12 or taking vitamin B12 under the tongue seems to help reduce canker sore symptoms.
• High levels of homocysteine in the blood (hyperhomocysteinemia). Taking vitamin B12 by mouth, along with folic acid and sometimes pyridoxine (vitamin B6), can lower blood levels of homocysteine.
• Nerve pain caused by shingles (postherpetic neuralgia). Injecting vitamin B12 in the form of methylcobalamin under the skin six times weekly for up to 4 weeks reduces pain in people with nerve damage from shingles. Vitamin B12 injections can only be given by a healthcare provider.

Possibly Ineffective for

• Decline in memory and thinking skills that occurs normally with age. Taking vitamin B12 by mouth, alone or with folic acid and vitamin B6, doesn’t seem to improve mental function in elderly people.
• Alzheimer disease. Taking vitamin B12 by mouth, alone or with folic acid and vitamin B6, doesn’t seem to improve mental function in people with Alzheimer disease.
• Cataracts. Taking vitamin B12 by mouth along with vitamin B6 and folic acid doesn’t seem to prevent cataracts in females. It might even increase the risk of needing to have cataracts removed.
• Disorders that affect when a person sleeps and when they are awake. Taking vitamin B12 by mouth does not seem to help people with sleep disorders.
• Decline in memory and thinking skills in older people that is more than what is normal for their age. Taking vitamin B12 by mouth, alone or with folic acid and vitamin B6, doesn’t seem to improve memory and thinking skills in elderly people who have a decline in these skills.
• Fall prevention. Taking folic acid with vitamin B12 by mouth doesn’t seem to prevent falls in older people also taking vitamin D.
• Weak and brittle bones (osteoporosis). Taking vitamin B12 and folic acid by mouth, with or without vitamin B6, doesn’t seem to reduce fractures in older people with osteoporosis.
• Physical performance in elderly adults. Taking vitamin B12 and folic acid by mouth doesn’t seem to help improve physical function in older people.

There is interest in using vitamin B12 for a number of other purposes, but there isn’t enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Vitamin B12 is likely safe for most people. Vitamin B12 is considered safe even in large doses.

When applied to the skin: Vitamin B12 is likely safe for most people when used appropriately.

When sprayed into the nose: Vitamin B12 is likely safe for most people. Vitamin B12 is considered safe even in large doses.

Special Precautions and Warnings

When taken by mouth: Vitamin B12 is likely safe for most people. Vitamin B12 is considered safe even in large doses.

When applied to the skin: Vitamin B12 is likely safe for most people when used appropriately.

When sprayed into the nose: Vitamin B12 is likely safe for most people. Vitamin B12 is considered safe even in large doses. Pregnancy and breast-feeding: Vitamin B12 is likely safe when taken by mouth during pregnancy or breast-feeding in the amounts recommended. The recommended amount for pregnancy is 2.6 mcg per day. Those breast-feeding should take 2.8 mcg per day. The safety of larger amounts is unknown.

Post-surgical stent placement: Avoid using a combination of vitamin B12, folate, and vitamin B6 after receiving a coronary stent. This combination may increase the risk of blood vessel narrowing.

Allergy or sensitivity to cobalt or cobalamin: Do not use vitamin B12 if you have this condition.

Interactions ?

We currently have no information for VITAMIN B12 overview.

Dosing

Vitamin B12 is an essential nutrient. Fish, shellfish, meat, eggs, and dairy products are good sources of vitamin B12. The amount that should be consumed on a daily basis is called the recommended dietary allowance (RDA). The RDA is 2.4 mcg daily for people 18 years and older. While pregnant, the RDA is 2.6 mcg daily. While breastfeeding, the RDA is 2.8 mcg daily. In children, the RDA depends on age.

People over 50 years of age are advised to eat foods fortified with vitamin B12 or to take a vitamin B12 supplement. 25-100 mcg daily has been taken by mouth to maintain vitamin B12 levels in older adults. Speak with a healthcare provider to find out what dose might be best for a specific condition.

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

This copyrighted material is provided by Natural Medicines Comprehensive Database Consumer Version. Information from this source is evidence-based and objective, and without commercial influence. For professional medical information on natural medicines, see Natural Medicines Comprehensive Database Professional Version.
© Therapeutic Research Faculty 2020.

B12 Side Effects and Interactions

Like all good things, too much of any vitamin or mineral can stir up trouble. Vitamin B12 is no exception and can cause side effects.

Vitamin B12 is essential for DNA production, red blood cell formation, DNA synthesis, and brain health. But if you take B12 supplements, you risk ingesting more B12 than you actually need. Here are the deets.

B12 supplements come in a variety of forms, including capsules, tablets, soft gels, gummies, and drops or sprays.

Taking these B12 supplements when you aren’t deficient may cause side effects like:

• nausea
• vomiting
• headache
• diarrhea
• tiredness
• feeling weak
• tingling or numbness in your extremities

If you notice any of these side effects, stop taking B12. And call your doc if anything gets worse.

While not fully proven side effects, research has also linked the following health risks to taking high dose B12 supplements when you aren’t deficient, like:

• Skin conditions. A 2015 research review linked taking too much B12 to acne, rosacea, vitiligo, and atopic dermatitis.
• Colon cancer risk. A 2019 study found that older adults supplementing high doses of vitamin B12 were at an increased risk of colon cancer.
• More hospital time and death. A 2016 study involving hospitalized people found that the participants with high B12 levels needed longer hospital stays and had a higher chance of dying. The participants included folks with cancer, liver disease, kidney diseases, and who were older adults and critically ill.
• Failed chemo treatment. A 2019 study involving people with breast cancer found less favorable chemotherapy outcomes for the participants taking B12 supplements.

Just note, we still need more research to know these outcomes are actually linked to B12 supplements. If anything, it’s a good reminder that you should def chat with your doc about finding out if you’re deficient in B12 before you take a supplement.

If you’ve got a more serious case of vitamin B12 deficiency, your doctor may recommend B12 shots to boost those B12 levels. These injections send a high dose of vitamin B12 straight into your system, helping to counteract the effects of a deficiency.

B12 injections are generally considered safe if you’re deficient, and side effects are super rare. Still, you may experience mild side effects like diarrhea and swelling. Call your doc if these symptoms don’t go away or get worse.

You can also encounter rare, serious side effects like:

• skin rash or hives
• weak muscles or cramps
• itching
• vomiting
• nausea
• headache
• leg pain or warm, tender pain in one leg
• dizziness and fatigue
• frequent peeing
• feeling super thirsty
• fast heart rate
• swelling of your extremities

It’s important to call your doc ASAP if you notice any of these negative effects.

Call 911 if you have an allergic reaction!

While also super duper rare, it is possible to have an allergic reaction to vitamin B12 injections.

If you have any symptoms of an allergic reaction (aka anaphylaxis), call 911 stat! These include:

• swollen face, tongue, and throat
• difficulty swallowing
• difficulty breathing

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While B12 is fairly safe on its own, it doesn’t always play well with certain drugs or supplements. These meds can lower your body’s B12 levels by affecting absorption, so you might need to take a B12 supplement to keep those red blood cells in tip-top shape.

Common meds that B12 may interact with include:

• folic acid
• metformin
• vitamin C
• h3 blockers
• chloramphenicol
• proton pump inhibitors
• aminosalicylic acid
• colchicine
• gastric acid inhibitors

Talk with your doc before adding B12 to your diet if you’re currently taking any medications. To avoid any serious interactions, they may recommend specific dosage amounts or suggest taking medications and B12 supplements at different times.

B12 is a water-soluble vitamin that is absorbed in your intestines. That means any extra your body doesn’t need is flushed out of your system when you sweat or pee. (Science!)

Because of this, there’s actually no tolerable upper intake level (UL) for B12 (the max dose you can take before you experience side effects). But if you’re not deficient in B12, taking a B12 supplement is still linked to side effects.

On top of that, B12 is a unique water soluble vitamin because your body is great at storing it. An average person can have enough stored B12 to last them 3 to 5 years! That said, deficiency is rare and can only be confirmed through a lab test.

If you have any questions or concerns about what dose of B12 is best for you, talk with your doc for guidance.

First things first: If you start experiencing any side effects from taking B12 supplements, stop taking them ASAP.

Symptoms continuing to pester you or getting worse? Time to dial up your doc.

They can help figure out what’s going on (like if you’re taking doses that are too high or if another supplement is interfering with your B12 levels) and help you figure out the best course of action. This may include adjusting dosage amounts, adding more B12-rich foods to your diet, or simply skipping supplements altogether.

The National Institutes of Health shares the following recommended dietary allowances (RDAs) in micrograms (mcg) when it comes to vitamin B12:

• Teens and adults more than 14 years old: 2.4 mcg
• Pregnant women: 2.6 mcg
• Breastfeeding women: 2.8 mcg

Food is also a great source of nutritional goodness, and many people are able to fulfill all of their B12 needs through diet alone. You can get your RDA of this vital vitamin by eating B12-rich foods, like:

• red meat
• lamb
• chicken or turkey
• fish
• shellfish
• milk
• eggs
• liver
• cheese

We know, we know: Many of these foods aren’t fit for the awesome vegans and vegetarians among us. For our more plant-based friends, there are a variety of fortified foods that can give you that B12 boost, such as certain soy products, foods containing yeast extracts, and even many bread and cereals (yums!).

Vitamin B12 is necessary for your body’s overall wellness needs. You can get most of your B12 intake from common foods, like meat, dairy, fish, or fortified foods like bread or cereal.

But if you need an extra B12 boost thanks to a deficiency, supplements or injections may help. If you aren’t deficient, you may experience side effects taking a supplement.

While rare, you may also experience not-so-fun side effects, or even a life threatening allergic reaction, from a B12 injection.

If you experience any adverse effects from your B12 supplement, stop taking it. Symptoms should go away on their own. If they don’t subside or they get worse, talk with your doc. They can see what’s up and recommend treatment.

Cyanocobalamin – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English title

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Cyanocobalamin

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• Application of the substance Cyanocobalamin

• Contraindications

• Application restrictions

• Side effects of the substance Cyanocobalamin

• Interaction

• Dosage and administration

• Precautionary measures

• Trade names with the active substance Cyanocobalamin

• List of dietary supplements

Structural formula

Russian name

Cyanocobalamin

English name

Cyanocobalamin

Latin name

Cyanocobalaminum ( genus Cyanocobalamini)

Chemical name

alpha-(5,6-dimethylbenzimidazolyl)cobamide cyanide

Gross formula

C ₆₃ H ₈₈ CoN ₁₄ O ₁₄ P

Pharmacological group of the substance Cyanocobalamin

Stimulants of hematopoiesis

Vitamins and vitamin-like products

Nosological classification

ICD-10 code list

• D51 Vitamin B12 deficiency anemia

• D61 Other aplastic anemias

• E53. 8.1* Vitamin B12 deficiency

• G12.2 Motor neuron disease

• G35 Multiple sclerosis

• G50.0 Trigeminal neuralgia

• G54. 1 Disorders of the lumbosacral plexus

• G54.6 Phantom limb syndrome with pain

• G62 Other polyneuropathies

• G63.2 Diabetic polyneuropathy (E10-E14+ with common fourth character . 4)

• G80 Infantile cerebral palsy

• G95 Other diseases of the spinal cord

• K52 Other noninfectious gastroenteritis and colitis

• K73 Chronic hepatitis, not elsewhere classified

• K74 Fibrosis and cirrhosis of the liver

• L13. 0 Dermatitis herpetiformis

• L20 Atopic dermatitis

• L40 Psoriasis

• L56 Other acute skin changes caused by ultraviolet radiation

• M79. 2 Neuralgia and neuritis, unspecified

• Q90 Down syndrome

CAS code

68-19-9

Pharmacological activity

Pharmacological activity –

hematopoietic , metabolic , antianemic , erythropoietic .

Feature

Vitamin B ₁₂ . Crystalline hygroscopic powder of dark red color, odorless. It is difficult to dissolve in water, the solutions are red (or pink) in color. Prolonged autoclaving, oxidizing or reducing substances (ascorbic acid), salts of heavy metals contribute to inactivation; is quickly destroyed by microflora, so the solutions must be stored under aseptic conditions.

Pharmacology

Possesses high biological activity and is involved in carbohydrate, protein and lipid metabolism. Increases tissue regeneration, normalizes hematopoiesis, liver and nervous system functions, activates the blood coagulation system, lowers blood cholesterol (with atherosclerosis). In the body (mainly in the liver) it turns into a cofactor – cobamide, which is part of numerous enzymes, incl. into the reductase, which reduces folic acid to tetrahydrofolic acid. Cobamide is involved in the transfer of methyl and other one-carbon fragments and is therefore necessary for the formation of deoxyribose and DNA, creatine, methionine – a donor of methyl groups, in the synthesis of the lipotropic factor – choline, for the conversion of methylmalonic acid into succinic acid, which is part of myelin, for the utilization of propionic acid. It promotes the accumulation of compounds containing sulfhydryl groups in erythrocytes, which explains the increase in their tolerance to hemolysis.

Absorption occurs throughout the small intestine (and partly in the large intestine). In the ileum, it combines with a special intrinsic factor and becomes inaccessible to intestinal microorganisms; the complex in the wall of the small intestine transfers cyanocobalamin to the receptor, which transports it into the cell (the activity of the receptor depends on the structure and function of the mucosa supported by folic acid, as well as on the presence of calcium ions and the pH of the medium). In the blood, vitamin B ₁₂ binds to transcobalamins I and II, which transport it to tissues. Deposition occurs mainly in the liver, excreted from the liver with bile into the intestine and reabsorbed. Elimination occurs predominantly by the kidneys.

The use of the substance Cyanocobalamin

Chronic anemia occurring with vitamin B deficiency ₁₂ (Addison-Birmer, alimentary macrocytic), in the complex treatment of anemia – iron deficiency, post-hemorrhagic, aplastic, caused by toxic substances and drugs , myelosis, traumatic injuries and inflammatory processes of peripheral nerves (wound, radiculoneuritis, neuritis, neuralgia, causalgia, phantom pain), amyotrophic lateral sclerosis, encephalomyelitis, multiple sclerosis, diabetic neuropathy, cerebral palsy, Down’s disease, skin diseases (psoriasis, photodermatosis, dermatitis herpetiformis, neurodermatitis) , traumatic injuries of bones and conditions after surgical operations on the musculoskeletal system with a slowdown in bone consolidation, acute and chronic hepatitis, cirrhosis of the liver, radiation sickness. For prophylactic purposes – when prescribing biguanides, para-aminosalicylic acid, high doses of vitamin C, with pathologies of the stomach and intestines that prevent normal absorption of the vitamin (resection of a part of the stomach, small intestine, Crohn’s disease, celiac disease, sprue).

Contraindications

Hypersensitivity, hypercoagulation (including in acute thrombosis), erythremia, erythrocytosis.

Restrictions on use

Use with caution and in smaller doses for angina pectoris, benign and malignant neoplasms (used only in cases accompanied by megaloblastic anemia and vitamin B deficiency ₁₂ ).

Side effects of the substance Cyanocobalamin

Headache, dizziness, agitation, pain in the heart area, tachycardia, allergic reactions (urticaria).

Interactions

Pharmaceutical (in one syringe) incompatible with vitamin solutions, B ₁ and B ₆ (cobalt ion contributes to the destruction of other vitamins). Increases the likelihood of allergic reactions caused by vitamin B ₁ .

Method of administration and doses

Inside, s / c, / m, / in and intralumbally. For Addison-Birmer anemia – 100-200 mcg every other day; with Addison-Birmer anemia with symptoms of funicular myelosis and with macrocytic anemia with disorders of the nervous system – 500 mcg or more per injection (in the first week – daily, and then – with intervals between injections of up to 5-7 days). Simultaneously appoint folic acid. In the period of remission, in the absence of funicular myelosis phenomena, 100 mcg is administered for maintenance therapy 2 times a month, and in the presence of neurological phenomena, 200-400 mcg 2-4 times a month. With iron deficiency and posthemorrhagic anemia – 30-100 mcg 2-3 times a week. With aplastic anemia (especially in children) – 100 mcg until the onset of clinical and hematological improvement. With alimentary anemia in children at an early age and in premature babies – 30 mcg per day for 15 days; in diseases of the central nervous system and neurological diseases with pain syndrome, they are administered in increasing doses from 200 to 500 mcg per injection, and when the condition improves, 100 mcg per day; course – up to 2 weeks; with traumatic lesions of peripheral nerves – 200–400 mcg every other day for 40–45 days. For hepatitis and cirrhosis of the liver – 30-60 mcg per day or 100 mcg every other day for 25-40 days; with dystrophies in young children, Down’s disease and cerebral palsy – 15-30 mcg every other day; with sprue, radiation sickness, diabetic neuropathy, 60–100 mcg is prescribed daily for 20–30 days. With funicular myelosis, amyotrophic lateral sclerosis, multiple sclerosis, sometimes 15-30 mcg is injected into the spinal canal (gradually increasing the dose to 200-250 mcg).

Precautions

During treatment, the blood picture and coagulation should be monitored regularly.

Trade names with active substance Cyanocobalamin

Reset filters

Lek. form
All lek. forms semi-finished product-granulate solution for injection substance-powder suppositories rectal tablets, coated

Dosage
All dosages 0.1% 0.2 mg/mL 0.5 mg 0.5 mg/mL 1 mg 1% 200 mcg/mL 500 mcg/mL No dosage

Manufacturer
All manufacturers Altpharm Artezan Pharma BASF Health & Nutrition Borisov Plant of Medical Preparations OJSC (BZMP OJSC) Dalchimpharm Yerevan CFF Lvovdialek subsidiary of SJSC Ukrmedprom Merind Moskhimfarmpreparaty im. ON THE. Semashko Novosibkhimfarm JSC Novosibkhimfarm JSC Renovation of PFC Ozon CJSC Sanofi Shimi LLC North China Pharmaceutical Company “Victor” Co. CSP Oui Pharmaceutical Co. Hubei Maxpharm Industries Co.

List of dietary supplements

Polysaccharide-Iron Complex, Vitamin B12, and Folic Acid

Adult Medication

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This document, provided by Lexicomp ^® , contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: USA

Folvite-Fe [DSC]; Hematogen Forte [DSC]; Hematogen Forte [OTC]; IFerex 150 Forte; Irofol [OTC]; Myferon 150 Forte [DSC]; Poly-Iron 150 Forte; Trigels-F Forte

Warning

• Accidental overdose of iron supplements is one of the most common causes of fatal poisoning in children under 6 years of age. Keep out of the reach of children. If you accidentally take this drug, call your doctor or poison control center right away.

What is this drug used for?

• It is used in the treatment of certain types of anemia.

What should I tell my doctor BEFORE taking this drug?

• If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
• In one of the following cases: anemia caused by causes other than iron deficiency; excess iron in the body or thalassemia.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

• Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists.
• This drug interferes with the absorption of many other drugs. If you are taking other drugs, ask your doctor or pharmacist if you should take them at a different time than this drug.
• This drug may affect the results of some lab tests. Tell all your health care workers and laboratory staff that you are taking this drug.
• If you are allergic to tartrazine (FD&C Yellow No. 5), talk to your doctor. Some products contain tartrazine.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor or get medical help right away if you have any of the following signs or symptoms that could be associated with serious side effects:

• Signs of an allergic reaction, such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly accompanied by fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
• Black, tarry or bloody stools.
• Heat.
• Vomiting blood or coffee grounds.
• Gastric colic.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Talk to your doctor or get medical help if these or any other side effects bother you or don’t go away:

• Constipation, diarrhea, abdominal pain, nausea or vomiting.
• Change in stool color to green.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

• Take with or without food. Take with food if medicine causes nausea.

What if I miss a dose of a drug?

• Take the missed dose as soon as you can.
• If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
• Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

• Store at room temperature in a dry place. Do not store in the bathroom.
• The lid must be tightly closed.
• Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General drug information

• If your health does not improve or even worsens, see your doctor.
• Do not give your medicine to anyone and do not take other people’s medicines.
• Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• Some medicines may come with other patient information leaflets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
• If you think you have overdosed, call a poison control center or get medical help right away. Be prepared to tell or show what drug you took, how much, and when it happened.

Consumer Use of Information and Limitation of Liability

This summary information includes a summary of the diagnosis, treatment and/or drug product. It is not intended to be a comprehensive source of data and should be used as a tool to help the user understand and/or evaluate potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a particular patient. It should not be considered medical advice or a substitute for medical advice, diagnosis or treatment provided by a physician based on a medical examination and assessment of the patient’s specific and unique circumstances. Patients should consult with their physician for full information about their health, medical issues, and treatment options, including any risks or benefits regarding the use of medications.