Generic Name and Formulations:
Cyanocobalamin 500mcg/spray; soln for nasal spray; contains benzalkonium chloride.
Indications for NASCOBAL:
Maintenance of normal hematologic status in pernicious anemia patients who are in remission after intramuscular Vit. B12 therapy and who have no nervous system involvement. Supplementation for other Vit. B12 deficiencies.
Hematological parameters must be within normal range before beginning therapy. Allow at least 1hr before or after hot foods or liquids. Initial dose: One spray (500mcg) in one nostril once weekly. Monitor response, may increase dose if serum B12 levels decline.
Confirm diagnosis. May need supplemental folate. Risk of hypokalemia or sudden death in severe megablastic anemia. Leber's disease. Defer dose if nasal congestion, rhinitis, or upper respiratory infections occur. Reevaluate if low levels of Vit. B12 persist despite treatment. Do not use for Schilling Test. Infection, uremia, and iron or folic acid deficiency may reduce response. Increased risk of stomach carcinoma in those with pernicious anemia; perform tests when indicated. May unmask polycythemia vera. Monitor B12 blood levels 1 month after starting therapy, 1 month after any dose increase, and regularly at 3–6 month intervals. Monitor serum potassium, platelet counts. Pregnancy (Cat.C).
Antibiotics, methotrexate, pyrimethamine may interfere with lab tests. Colchicine, chronic heavy alcohol use may impair Vit. B12 absorption. Reduced response with bone marrow suppressants (eg, chloramphenicol).
Headache, nausea, rhinitis.
Single-use nasal spray (0.125mL)—4
Endocrinology Advisor Articles
- Soluble Klotho Levels Predictive of Kidney Failure in Type 2 Diabetes
- HbA1c Levels Predictive of Liraglutide Treatment Response in T2D
- Clinicians May Be Overtreating Older Patients With Diabetes
- Comorbid and Pharmacologic Factors Increase Risk for Gastrointestinal Disorders in Diabetes
- Obesity Risk in Infants Born to Women With Diabetes
- Diabetes May Decrease Ability to Feel Acid Regurgitation
- Autism Does Not Affect Metabolic Control in Type 1 Diabetes
- Hormonal Contraceptives May Adversely Affect Psychological Health in Adolescent Girls
- Obesity Can Negatively Effect Liver in Children as Young as 8
- Recommendations Developed on Gender Equity in Medicine