VITAMINB ₁₂ (Systemic)

Some commonly used brand names are:

In the U.S.?

• Alphamin ²
• Cobex ¹
• Cobolin-M ¹
• Crystamine ¹
• Crysti-12 ¹
• Cyanoject ¹
• Cyomin ¹
• Hydrobexan ²
• Hydro-Cobex ²
• Hydro-Crysti-12 ²
• Hydroxy-Cobal ²
• LA-12 ²
• Neuroforte-R ¹
• Nascobal ¹
• Primabalt ¹
• Rubramin PC ¹
• Shovite ¹
• Vibal ¹
• Vibal LA ²
• Vitabee 12 ¹

In Canada?

• Anacobin ¹
• Bedoz ¹

Category

• Antianemic?Cyanocobalamin; Hydroxocobalamin
• Diagnosticaid, vitamin B ₁₂ deficiency?Cyanocobalamin; Hydroxocobalamin
• Nutritional supplement, vitamin?Cyanocobalamin; Hydroxocobalamin

Description

Vitamins (VYE-ta-mins)are compounds that you must have for growth andhealth. They are needed in small amounts only and are usually available inthe foods that you eat. Vitamin B ₁₂ is necessaryfor healthy blood. Cyanocobalamin and hydroxocobalamin are man-made formsof vitamin B ₁₂.

Some people have a medical problem called pernicious anemia in which vitaminB ₁₂ is not absorbed from the intestine. Othersmay have a badly diseased intestine or have had a large part of their stomachor intestine removed, so that vitamin B ₁₂ cannotbe absorbed. These people need to receive vitamin B ₁₂ by injection.

Some conditions may increase your need for vitamin B ₁₂. These include:

• Alcoholism
• Anemia, hemolytic
• Fever (continuing)
• Genetic disorders such as homocystinuria and/or methylmalonic aciduria
• Intestine diseases
• Infections (continuing or chronic)
• Kidney disease
• Liver disease
• Pancreas disease
• Stomach disease
• Stress (continuing)
• Thyroid disease
• Worm infections

In addition, persons that are strict vegetarians or have macrobiotic dietsmay need vitamin B ₁₂ supplements.

Increased need for vitamin B ₁₂ should bedetermined by your health care professional.

Lack of vitamin B ₁₂ may lead to anemia (weakblood), stomach problems, and nerve damage. Your health care professionalmay treat this by prescribing vitamin B ₁₂ foryou.

Claims that vitamin B ₁₂ is effective fortreatment of various conditions such as aging, allergies, eye problems, slowgrowth, poor appetite or malnutrition, skin problems, tiredness, mental problems,sterility, thyroid disease, and nerve diseases have not been proven. Manyof these treatments involve large and expensive amounts of vitamins.

Injectable vitamin B ₁₂ is given by or underthe supervision of a health care professional. Some strengths of oral vitaminB ₁₂ are available only with your health careprofessional's prescription. Others are available without a prescription.

Vitamin B ₁₂ is available in the followingdosage forms:

Nasal
• Cyanocobalamin
  • Nasal gel (U.S.)

Oral
• Cyanocobalamin
  • Extended-release tablets (U.S.)
  • Tablets (U.S. and Canada)

Parenteral
• Cyanocobalamin
  • Injection (U.S. and Canada)
• Hydroxocobalamin
  • Injection (U.S.)

Importance of Diet

Vitamin B ₁₂ is found in various foods, includingfish, egg yolk, milk, and fermented cheeses. It is not found in any vegetables. Ordinary cooking probably does not destroythe vitamin B ₁₂ in food.

Vitamins alone will not take the place of a good diet and will not provideenergy. Your body also needs other substances found in food, such as protein,minerals, carbohydrates, and fat. Vitamins themselves often cannot work withoutthe presence of other foods.

The daily amount of vitamin B ₁₂ needed isdefined in several different ways.

For U.S.?
• Recommended Dietary Allowances (RDAs) are the amount of vitaminsand minerals needed to provide for adequate nutrition in most healthy persons.RDAs for a given nutrient may vary depending on a person's age, sex, and physicalcondition (e.g., pregnancy).
• Daily Values (DVs) are used on food and dietary supplement labelsto indicate the percent of the recommended daily amount of each nutrient thata serving provides. DV replaces the previous designation of United StatesRecommended Daily Allowances (USRDAs).

For Canada?
• Recommended Nutrient Intakes (RNIs) are used to determine the amountsof vitamins, minerals, and protein needed to provide adequate nutrition andlessen the risk of chronic disease.

Normal daily recommended intakes in micrograms (mcg) for vitamin B ₁₂ are generally defined as follows:

Persons	U.S. (mcg)	Canada (mcg)
Infantsand children Birth to 3 years of age	0.3-0.7	0.3-0.4
4 to 6 years of age	1	0.5
7 to 10 years of age	1.4	0.8-1
Adolescent and adult males	2	1-2
Adolescentand adult females	2	1-2
Pregnant females	2.2	2-3
Breast-feeding females	2.6	1.5-2.5

Before Using This Dietary Supplement

If you are taking this dietary supplement without a prescription, carefullyread and follow any precautions on the label. For vitamin B ₁₂, the following should be considered:

Allergies?Tell your health care professional if you have everhad any unusual or allergic reaction to vitamin B ₁₂. Also, tell your health care professional if you are allergic toany other substances, such as foods, preservatives, or dyes.

Pregnancy?It is especially important that you are receivingenough vitamins when you become pregnant and that you continue to receivethe right amount of vitamins throughout your pregnancy. Healthy fetal growthand development depend on a steady supply of nutrients from mother to fetus.However, taking large amounts of a dietary supplement in pregnancy may beharmful to the mother and/or fetus and should be avoided.

You may need vitamin B ₁₂ supplements ifyou are a strict vegetarian (vegan-vegetarian). Too little vitamin B ₁₂ can cause harmful effects such as anemia or nervoussystem injury.

Breast-feeding?It is especially important that you receive theright amounts of vitamins so that your baby will also get the vitamins neededto grow properly. If you are a strict vegetarian, your baby may not be gettingthe vitamin B ₁₂ needed. However, taking largeamounts of a dietary supplement while breast-feeding may be harmful to themother and/or baby and should be avoided.

Children?Problems in children have not been reported withintake of normal daily recommended amounts.

Older adults?Problems in older adults have not been reported withintake of normal daily recommended amounts.

Medicines or other dietary supplements?Although certain medicines or dietary supplements should not be used togetherat all, in other cases they may be used together even if an interaction mightoccur. In these cases, your health care professional may want to change thedose, or other precautions may be necessary. Tell your health care professionalif you are taking any other dietary supplement or any prescription or nonprescription(over-the-counter [OTC]) medicine.

Other medical problems?The presence of other medicalproblems may affect the use of vitamin B ₁₂.Make sure you tell your health care professional if you have any other medicalproblems, especially:

• Leber's disease (an eye disease)?Vitamin B ₁₂ may make this condition worse

Proper Use of This Dietary Supplement

Dosing?If you are taking vitamin B ₁₂ intranasal gel:

• Take it at least one hour before or one hourafter hot foods or liquids.
• Check with your doctor for follow-up blood testsevery 3 to 6 months.

The amount of vitamin B ₁₂ needed to meetnormal daily recommended intakes will be different for different individuals.The following information includes only the average amounts of vitamin B ₁₂.

• For nasal dosage form (intranasal gel):
  • To prevent deficiency, you are given this dosage form only if youhave received vitamin B ₁₂ by injection intothe muscle and are in remission state.
    • Adults?500 mcg (0.5 mg) into the nostrils once a week.
• For oral dosage form (tablets or extended-releasetablets):
  • To prevent deficiency, the amount taken by mouth is based on normaldaily recommended intakes:
    For the U.S.
    • Adults and teenagers?2 micrograms (mcg) per day.
    • Pregnant females?2.2 mcg per day.
    • Breast-feeding females?2.6 mcg per day.
    • Children 7 to 10 years of age?1.4 mcg per day.
    • Children 4 to 6 years of age?1 mcg per day.
    • Children birth to 3 years of age?0.3 to 0.7 mcg per day.
    For Canada
    • Adults and teenagers?1 to 2 mcg per day.
    • Pregnant females?2 to 3 mcg per day.
    • Breast-feeding females?1.5 to 2.5 mcg per day.
    • Children 7 to 10 years of age?0.8 to 1 mcg per day.
    • Children 4 to 6 years of age?0.5 mcg per day.
    • Children birth to 3 years of age?0.3 to 0.4 mcg per day.
  • To treat deficiency:
    • Adults, teenagers, and children?Treatment dose is determinedby prescriber for each individual based on the severity of deficiency.

For patients receiving vitamin B ₁₂ by injection for pernicious anemia or if part of the stomach orintestine has been removed:

• You will have to receive treatment for the rest of your life. Youmust continue to receive vitamin B ₁₂ even ifyou feel well, in order to prevent future problems.

Missed dose?If you miss taking a vitamin for one or more daysthere is no cause for concern, since it takes some time for your body to becomeseriously low in vitamins. However, if your health care professional has recommendedthat you take this vitamin, try to remember to take it as directed.

Storage?To store this dietary supplement:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the dietary supplement to break down.
• Do not keep outdated dietary supplement or those no longer needed.Be sure that any discarded dietary supplement is out of the reach of children.

Side Effects of This Dietary Supplement

Along with its needed effects, a dietary supplement may cause some unwantedeffects. Cyanocobalamin or hydroxocobalamin does not usually cause any sideeffects.

However, check with yourhealth care professional immediately if any of the following side effectsoccur:

Rare?soon after receiving injection only

Skin rash or itching; wheezing

Check withyour health care professional as soon as possible if either of the followingside effects continues or is bothersome:

Less common

Diarrhea; itching of skin

Other side effects not listed abovemay also occur in some individuals. If you notice any other effects, checkwith your health care professional.