Minor/Significance Unknown.Ĭolestipol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.Ĭolchicine decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Ĭlonazepam decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Ĭimetidine decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Ĭholine magnesium trisalicylate decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Ĭhloramphenicol decreases effects of cyanocobalamin by pharmacodynamic antagonism. Minor/Significance Unknown.Ĭarbamazepine decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.īazedoxifene/conjugated estrogens decreases levels of cyanocobalamin by altering metabolism. Minor/Significance Unknown.īalsalazide decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Īspirin/citric acid/sodium bicarbonate decreases levels of cyanocobalamin by inhibition of GI absorption. Minor/Significance Unknown.Īspirin rectal decreases levels of cyanocobalamin by inhibition of GI absorption.
Minor/Significance Unknown.Īspirin decreases levels of cyanocobalamin by inhibition of GI absorption.
Minor/Significance Unknown.Īmikacin decreases levels of cyanocobalamin by inhibition of GI absorption. Separate dosing of tetracyclines from these products.Īcetazolamide decreases levels of cyanocobalamin by inhibition of GI absorption. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Use Caution/Monitor.Ĭyanocobalamin will decrease the level or effect of omadacycline by inhibition of GI absorption.
In patients with suspected cobalamin hypersensitivity, consider administering an intradermal test dose of parenteral vitamin B12 prior to use of nasal sprayĭichlorphenamide and cyanocobalamin both decrease serum potassium. Consider measures to treat underlying condition associated with vitamin B12 deficiency in addition to treatment with nasal spray. Administer iron in addition to the nasal spray in patients with concurrent iron and vitamin B12 deficiency. In patients with concurrent folate and vitamin B12 deficiency, administer folic acid in addition to the nasal spray. Cyanide poisoning: See Hydroxycobalamin AD. PO absorption requires intrinsic factor. In patients whose underlying cause of vitamin B12 deficiency has been corrected and are deemed no longer at risk for vitamin B12 deficiency, discontinue nasal spray administration safety and effectiveness of continued long-term use in these individuals not established in patients with pernicious anemia, continue appropriate vitamin B12 treatment indefinitely. If serum levels of B12 decline after one month of treatment, consider increasing dose assess serum B12 level one month after each dose adjustment if serum B12 levels are persistently low, consider alternative therapy (eg, intramuscular or subcutaneous vitamin B12 therapy). The effectiveness of nasal spray in patients with active symptoms of nasal congestion, allergic rhinitis or upper respiratory infection has not been determined treatment with nasal spray should be deferred until symptoms subsided. In patients with correctible or temporary causes of vitamin B12 deficiency, the benefit of continued longterm use of nasal spray following adequate correction of vitamin B12 deficiency and underlying disease has not been established. 
Nasal spray should not be used for the vitamin B12 absorption test (Schilling test). Nasal dose: 500 mcg once weekly Limitations of use Initial: 30 mcg IM once daily for 5-10 days Nasal spray: 500 mcg (1 spray in 1 nostril) weekly if patient is taking hot meals, spray should be administered 1 hour before or after meal B12 Deficiency Manufacturer recommendation: 100 mcg IM/SC once daily for 6-7 days, then every other day for 7 doses, then every 3-4 days for 2-3 weeks, then monthlyĪlternative parenteral dosing: 1000 mcg IM/SC once daily for 7 days, then weekly for 1 month, then monthly Dietary supplement: 50-6,000 mcg/day Pernicious Anemia
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