Generic Name and Formulations:
Cyanocobalamin 1000mcg, salcaprozate sodium 100mg; tabs.
Dietary management of patients with Vit. B12 deficiency that cannot be managed by a modification of the normal diet alone (eg, pernicious anemia, malabsorption of Vit. B12, others).
Take on empty stomach (at least 1hr before a meal) with water. ≥18yrs: initially 1 tab daily; may adjust up to max 2 tabs daily.
<18yrs: not established.
Sensitivity to cobalt. Hereditary optic nerve atrophy (Leber's disease).
Confirm diagnosis. Risk of hypokalemia and sudden death in severe megaloblastic anemia. Infection, uremia, and iron or folic acid deficiency may reduce response. May unmask polycythemia vera. Obtain hematocrit, reticulocyte count, Vit. B12, folate, iron levels prior to treatment. May need supplemental folate. Reevaluate if low levels of Vit. B12 persist despite treatment. 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.
Antibiotics, methotrexate, pyrimethamine may interfere with lab tests. Colchicine, para-aminosalicylic acid, chronic heavy alcohol use may impair Vit. B12 absorption; may need to adjust dose. Reduced response with bone marrow suppressants (eg, chloramphenicol).
Pulmonary edema, CHF, peripheral vascular thrombosis, polycythemia vera, mild transient diarrhea, itching, transitory exanthema, body swelling, possible anaphylactic shock and death.
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