Cyanocobalamin nasal (for use in the nose) is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.

Cyanocobalamin nasal is usually given after treatment with an injection form of cyanocobalamin.

Cyanocobalamin nasal may also be used for purposes not listed in this medication guide.

You should not use cyanocobalamin if you are allergic to cobalt, or if you have Leber's disease.

Cyanocobalamin nasal is usually given once per week. Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Read and carefully follow any Instructions for Use provided with your medicine. Ask your doctor or pharmacist if you do not understand these instructions.

You may need blood tests every 3 to 6 months, and your doctor may change your dose based on the results.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.

Tell your doctor if you have sinus congestion. cyanocobalamin may not work as well if you have a stuffy nose.

For pernicious anemia, you may have to use cyanocobalamin for the rest of your life. Do not stop using the medicine unless your doctor tells you to. Untreated vitamin B12 deficiency can lead to anemia or irreversible nerve damage.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. Folic acid alone will not treat Vitamin B12 deficiency or prevent possible damage to the spinal cord. Use all medications as directed.

Store in an upright position at room temperature. Protect from light and do not freeze.

Usual Adult Dose for Pernicious Anemia:

Initial dose: 100 mcg intramuscularly or deep subcutaneous once a day for 6 to 7 days
If clinical improvement and reticulocyte response is seen from the above dosing:
-100 mcg every other day for 7 doses, then:
-100 mcg every 3 to 4 days for 2 to 3 weeks, then:
Maintenance dose: 100 to 1000 mcg monthly
Duration of therapy: Life

Comments:
-Administer concomitant folic acid if needed.
-Chronic treatment should be done with an oral preparation in patients with normal intestinal absorption.

Usual Adult Dose for B12 Nutritional Deficiency:

25 to 2000 mcg orally daily

Usual Adult Dose for Schilling Test:

1000 mcg intramuscularly is the flushing dose

Usual Pediatric Dose for B12 Nutritional Deficiency:

0.5 to 3 mcg daily

You should not use this medicine if you are allergic to cyanocobalamin or cobalt, or if you have Leber's disease (an inherited form of vision loss). Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber's disease.

Tell your doctor if you have ever had:

• eye problems or Leber's disease (in you or a family member); or

• an iron or folic acid deficiency.

Tell your doctor if you are pregnant or breast-feeding. Your dose needs may be different during pregnancy or while you are nursing a baby.

Cyanocobalamin nasal is not approved for use by anyone younger than 18 years old.

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Do not drink hot liquid or eat hot food within 1 hour before or 1 hour after you use cyanocobalamin nasal.

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have :

• easy bruising, unusual bleeding, purple or red spots under your skin; or

• low potassium level--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common side effects of cyanocobalamin may include:

• runny nose;

• cold or flu symptoms such as stuffy nose, sore throat, sinus pain;

• headache;

• tingling in your hands or feet;

• weakness;

• nausea; or

• swelling in your tongue.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Other drugs may affect cyanocobalamin nasal, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.