Parenteral Manual

Cyanocobalamin

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
VITAMIN B12
Classification: 
Hematopoietic vitamin/anemia therapy
Original Date: 
December 2019
Indications: 
  • Vitamin B12 deficiency and malabsorptive states
  • Dietary supplementation
  • Treatment of pernicious anemia
Reconstitution and Stability: 
  • Stable at room temperature
  • Protect from light
Compatibility: 

- Solutions Compatible: dextrose solutions up to D20W, 0.9% NaCl, dextrose-saline combinations, ringers solution, ringers lactate

- Additives/Above Cassette Compatible: no information

- Y-site Compatible: KCl (up to 40 mEq/L), morphine, TPN (amino acids/dextrose - consult Pharmacy)

- Incompatible: no information

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES, deep SC
IM YES
IV Push

NO
IV Intermittant Infusion NO
IV Continuous Infusion YES, as a component of TPN
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

  • Individualized on basis of patient's condition and response

Pediatric:
- Pernicious anemia: 

  • 30-50 mcg/day IM/SC for 2 or more weeks (to a total dose of 1000-5000 mcg), then follow with:
  • Maintenance: 100 mcg/month

- Vitamin B12 deficiency:    

  • 0.2 mcg/kg IM/SC for 2 days followed by 1000 mcg/day for 2-7 days followed by 100 mcg/week for one month

- Malabsorption: 

  1. 100 mcg/month or
  2. 100 mcg/day for 10-15 days (total dose of 1-1.5 mg), then once or twice weekly for several months; may taper to 60 mcg every month

Adult:  
- Pernicious anemia: 

  • 100 mcg/day IM/SC for 6-7 days; if improvement, give same dose on alternate days for 7 doses; then every 3-4  days for 2-3 weeks
  • Maintenance: 100 mcg/month IM/SC

 - Vitamin B12 Deficiency:

  • Uncomplicated (initial): 100 mcg/day IM/SC for 5-10 days, followed by 100-200 mcg monthly until remission complete OR 100 mcg/day for 7 days, followed by 100 mcg every other day for 2 weeks, followed by 100 mcg every 3-4 days until remission complete
  • Complicated (severe): 1000 mcg IM/SC with 15 mg of folic acid IM/IV as single doses, followed by 1000 mcg/day plus oral folic acid 5 mg/day for 1 week
  • Maintenance: 100-200 mcg/month IM/SC
Potential hazards of parenteral administration: 
  • Generally nontoxic; however, mild transient diarrhea, peripheral vascular thrombosis, itching, transitory exanthema, urticaria, anaphylaxis reported
  • Hypokalemia
Notes: 
  • A sensitivity history should be obtained prior to vitamin B12 administration
  • Monitor erythrocyte and reitculocyte count, hemoglobin, hematocrit and serum B12 level
  • Fatal hypokalemia may occur upon conversion of megaloblastic anemia to normal erythropoiesis; therefore, monitor serum potassium early in therapy.
  • IV route not recommended because cyanocobalamin is excreted more rapidly after IV injection
  • If given SC, care should be taken to avoid injection in the dermis or upper subcutaneous tissue

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