![]() Mild: IM: 1,000 mcg once weekly (usual dose) or up to 3 times weekly, until deficiency is corrected, then follow with a maintenance dose of 1,000 mcg every other month longer intervals (eg, every 3 months) for maintenance dosing may also be used (Devalia 2014 Schrier 2019). Vitamin B 12 deficiency: Note: Oral cobalamin (eg, cyanocobalamin) may be used for less severe deficiencies and/or maintenance therapy (Devalia 2014). IV: 5 to 10 g over 10 to 15 minutes (An 20 Ortoleva 2019 Roderique 2014 Shah 2018).Ĭontinuous IV infusion: Initial: IV bolus 125 to 250 mg, followed by continuous IV infusion rate of 250 to 500 mg/hour (Boettcher 2017 Woehlck 2016). Dosing is not standardized refer to institutional protocols. Vasoplegic syndrome (off-label use): Note: Consider in patients who are refractory to methylene blue or as an alternative to methylene blue in patients who are at risk of serotonin syndrome or have glucose-6-phosphate dehydrogenase deficiency (Ortoleva 2019). Initial: 5 g as single infusion may repeat a second 5 g dose depending on the severity of poisoning and clinical response. Dosing: AdultĬyanide poisoning: IV: Note: If cyanide poisoning is suspected, antidotal therapy must be given immediately. IV (Cyanokit): There are no contraindications listed in the manufacturer's labeling. IM: Hypersensitivity to hydroxocobalamin or any component of the formulation IV infusion (Cyanokit): Treatment of cyanide poisoning (known or suspected) Off Label Uses Vasoplegic syndromeĭata from multiple case reports and a case series suggest that use of hydroxocobalamin may be beneficial in the treatment of vasoplegic syndrome and may be used as an alternative to or in patients who are refractory to methylene blue, in patients with glucose-6-phosphate dehydrogenase deficiency, or risk factors for serotonin syndrome during cardiac surgery, , or liver transplantation. IM injection: Treatment of pernicious anemia treatment of vitamin B 12 deficiency due to dietary deficiencies or malabsorption diseases, inadequate secretion of intrinsic factor, competition for vitamin B 12 by intestinal parasites/bacteria, or inadequate utilization of B 12 (eg, during neoplastic treatment) When normalized for body weight, men and women revealed no major pharmacokinetic differences. Significant forms various cobalamin-(III) complexes Special Populations: Gender Urine (50% to 60% within initial 72 hours) Half-Life Elimination ![]() V dss: Free cobalamins-(III): 280.7 to 349.5 L Total cobalamins-(III): 21.8 to 25.6 L Metabolism In the presence of cyanide, each hydroxocobalamin molecule can bind one cyanide ion by displacing it for the hydroxo ligand linked to the trivalent cobalt ion, forming cyanocobalamin, which is then excreted in the urine. ![]() Cyanocobalamin acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis, used in cell replication and hematopoiesis. ![]() Hydroxocobalamin (vitamin B 12a) is a precursor to cyanocobalamin (vitamin B 12). If needed, a second dose (half of the initial dose) may be administered.Detailed Hydroxocobalamin dosage information Brand Names: U.S. Sodium thiosulfate should be given IV immediately following sodium nitrite administration at a dose of 12.5 g.If needed, a second dose of up to half the previous dose may be given, as long as methemoglobin levels are kept below 35-40%. A single dose of sodium nitrite is typically enough to raise methemoglobin levels to 20% in an adult. Once the IV line is in place, amyl nitrite should be discontinued and 10 mL of 3% sodium nitrite (300mg) should be infused IV at a rate of 2.5 - 5.0 mL/min (2-4 mins).Reapply until sodium nitrite can be administered (IV must be in place). Amyl nitrite should be given in alternate intervals of 15 sec followed by 15 sec rest, using a new ampule every 3 minutes. Break and ampule of amyl nitrite in a handkerchief and hold it in front of the patients mouth/nose.1 Tourniquet & Instructions for Treatment.12 Ampules Amyl Nitrite Inhalants (0.3 mL).2 Vials Sodium Thiosulfate Injection (12.5 g in 50mL of water).2 Ampules Sodium Nitrite Injection (300 mg in10mL of water).
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