Cyanocobalamin

International non-proprietary name

Cyanocobalamin

Dosage form

Solution for injection 500 μg / ml

Composition

One ampoule (1 ml) contains:

active substance: cyanocobalamin - 500 mcg;

excipients: sodium chloride, water for injection.

Description

Transparent red liquid.

Pharmacotherapeutic group

Stimulants of hematopoiesis. Vitamin B12 and folic acid. Cyanocobalamin and its derivatives. Cyanocobalamin.

ATX code B03BA01

Pharmacological properties

Pharmacokinetics

Communication with plasma proteins - 90%. The maximum concentration (Cmax) after subcutaneous and intramuscular administration is reached after 1 hour. In the blood, vitamin B12 binds to transcobalamins I and II, which transport it to tissues. It is deposited mainly in the liver.

From the liver it is excreted with bile into the intestines and again absorbed into the blood. The half-life (T1 / 2) in the liver is 500 days. It is excreted with normal renal function - 7-10% by the kidneys, about 50% - with feces; with reduced kidney function - 0-7% by the kidneys, 70-100% - with feces. Penetrates through the placental barrier into breast milk.

Pharmacodynamics

Cyanocobalamin (Vitamin B12) has a metabolic, hematopoietic effect. In the body (mainly in the liver) it is converted into methylcobalamin and 5-deoxyadenosylcobalamin. Methylcobalamin is involved in the conversion of homocysteine \u200b\u200bto methionine and S-adenosylmethionine, the key metabolic reactions of pyrimidine and purine bases (and, therefore, DNA and RNA). In case of vitamin deficiency in this reaction, methyltetrahydrofolic acid can replace it, while folate-demanding metabolic reactions are disturbed. 5-deoxyadenosylcobalamin serves as a cofactor in the isomerization of L-methylmalonyl-CoA to succinyl-CoA, an important metabolic reaction of carbohydrates and lipids. Deficiency of vitamin B12 leads to a violation of the proliferation of rapidly dividing cells of hematopoietic tissue and epithelium, as well as to a violation of the formation of the myelin sheath of neurons.

Indications for use

Chronic anemias with cyanocobalamin deficiency (Addison-Birmer disease, alimentary macrocytic anemia)

As part of complex therapy

Polyneuritis, radiculitis, neuralgia (including trigeminal neuralgia), hypotrophy, peripheral nerve injury.

Skin diseases (psoriasis, photodermatosis, dermatitis herpetiformis, atopic dermatitis).

FROM preventive purpose

When prescribing biguanides, paraaminosalicylic acid, ascorbic acid in high doses, pathology of the stomach and intestines with impaired absorption of cyanocobalamin (resection of part of the stomach, small intestine, Crohn's disease, celiac disease, malabsorption syndrome, sprue), malignant formations of the pancreas and intestines

Method of administration and dosage

Subcutaneously

Adults

With Addison-Birmer anemia- 100-200 mcg / day (0.2-0.4 ml) every other day; with funicular myelosis, macrocytic anemias with dysfunction of the nervous system - 400 - 500 μg / day (0.8-1 ml) in the first week - every day, then at intervals between injections up to 5 - 7 days (folic acid is prescribed at the same time); during the period of remission, a maintenance dose of 100 μg / day (0.2 ml) 2 times a month, in the presence of neurological phenomena - 200 - 400 μg (0.4-0.8 ml) 2 - 4 times a month.

With diseases of the central and peripheral nervous system,neurological diseases with pain syndrome are administered in increasing doses Adults - 200 - 500 mcg / day (0.4 -1 ml) before relieving pain

syndrome, then 100 mcg / day for 2 weeks. With traumatic lesions of the peripheral nervous system - 200 - 400 mcg every other day for 40 - 45 days.

INnutritionally or intravenously

To eliminate the deficiency of cyanocobalamin, administer: for treatment - 1 mg (2 ml) daily for 1 - 2 weeks, maintenance dose 1 - 2 mg (2-4 ml) from 1 time per week to 1 time per month; for prophylaxis - 1 mg (2 ml) once a month. The duration of treatment is set individually.

Children

The dosage form of 500 mcg / ml is used in children over the age of 3 years.

Doses and regimen of administration depend on the pathology and range from 30 μg to 100 μg per day.

It is injected subcutaneously at a dose of 1 μg / kg, the maximum daily dose is 100 μg (0.2 ml). With various forms of hypo-aplastic, alimentary anemias in children, the drug is prescribed at the age of 3 to 4 years, 15-50 mcg (0.1 ml), over 4 years old, 50-100 mcg (0.1 ml - 0.2 ml), daily in within 15 days or before the onset of clinical and hematological improvement.

In dystrophic conditions after prolonged illness, subcutaneously 15-30 mcg every other day.

Side effects

Seldom

Excitement, headache, dizziness

Cardialgia, tachycardia

Urticaria, rash, itching, anaphylactic shock, Quincke's edema

Lump and necrosis at the injection site

Frequency unknown

- diarrhea, nausea

Pain at the injection site

Acne, bullous rash, eczema

Edema, sweating, weakness, fever, red coloration of urine (due to the excretion of vitamin B12)

when used in high doses - hypercoagulability, impaired purine metabolism

Contraindications

Hypersensitivity to the active substance (cyanocobalamin)

Thromboembolism, a tendency to form blood clots

Erythremia, erythrocytosis

Pregnancy (there are separate indications about the possible teratogenic effect of B vitamins in high doses), lactation period

Children under 3 years of age (for this dosage form)

Leber's disease, nicotine amblyopia (increases the risk of neurodegenerative damage to the optic nerve)

Exertional angina FC III

Benign and malignant neoplasms (with the exception of cases accompanied by megaloblastic anemia and vitamin B12 deficiency)

Drug interactions

Pharmaceutically incompatible with ascorbic acid, heavy metal salts (inactivation of cyanocobalamin), thiamine bromide, pyridoxine, riboflavin (since the cobalt ion contained in the cyanocobalamin molecule destroys other vitamins).

Aminoglycosides, polymyxin, tetracyclines, salicylates, antiepileptic medicines, colchicine, potassium preparations reduce the absorption of cyanocobalamin.

Cyanocobalamin enhances the development of allergic reactions caused by thiamine.

Chloramphenicol reduces the hematopoietic response.

Cannot be combined with drugs that increase blood clotting.

Cytamen: when used simultaneously with cyanocobalamin, the effect of cytamen is reduced.

Oral contraceptives - reduce the concentration of cyanocobalamin in the blood. Antimetabolites and most antibiotics change the results of microbiological studies of cyanocobalamin.

special instructions

Cyanocobalamin deficiency should be confirmed diagnostically prior to drug administration, as it may mask folic acid deficiency.

During the period of treatment, it is necessary to monitor the parameters of peripheral blood: on the 5-8 day of treatment, the number of reticulocytes and the concentration of iron are determined. The number of erythrocytes, hemoglobin and color indicator must be monitored for 1 month 1-2 times a week, and then 2-4 times a month. Remission is achieved when the number of erythrocytes increases to 4-4.5 million / μl, when the normal size of erythrocytes is reached, aniso- and poikilocytosis disappears, and the number of reticulocytes normalizes after a reticulocytic crisis. After reaching hematological remission, peripheral blood control is carried out at least 1 time in 4-6 months.

With a tendency to develop leuko- and erythrocytosis, the dose of the drug must be reduced or temporarily discontinued with the drug.

Exercise caution in persons prone to thrombosis, with angina pectoris (doses should be reduced, no more than 100 mcg per injection).

In cases of adverse reactions, the use of cyanocobalamin is temporarily stopped or canceled. If necessary, treatment is resumed, starting with small doses - 50 mcg.

Each ampoule of this drug contains 3.5 mg of sodium in the form of salts. This should be taken into account in patients with sodium salt control.

Application in pediatrics

The drug can be used in children over the age of 3 years.

Pregnancy and lactation

There are separate indications about the possible teratogenic effect of B vitamins in high doses, so the use of the drug is not recommended. Cyanocobalamin is excreted in breast milk, therefore it is not recommended to use during lactation or during treatment should be discontinued breast-feeding.

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

Considering the side effects of the drug, care should be taken when driving and work requiring concentration.

Overdose

When using cyanocobalamin in therapeutic doses, no overdose was reported.

Symptomsin case of overdose (possible): pulmonary edema, congestive heart failure, peripheral vascular thrombosis, urticaria, less often - anaphylactic shock.

Treatment symptomatic.

Release form and packaging

1 ml in glass ampoules.

10 ampoules, together with a knife or scarifier for opening ampoules, are placed in a cardboard box with a corrugated paper insert.

The box is covered with a label-parcel made of paper for multicolor printing.

Boxes together with instructions for medical use in the state and Russian languages \u200b\u200bare packed in a group package.

The number of instructions for medical use should correspond to the number of packages.

Cyanocobalamin is a drug that allows you to make up for the lack of vitamins in the body and fights all sorts of anemias. It can also help with neuralgia, liver dysfunction.

Release forms

Cyanocobalamin is available in glass ampoules for injection. One package (cardboard) contains 10 ampoules for single use. The volume of one ampoule is 1 ml.

Composition

The composition of the solution for injection includes the following substances:

• Vitamin B12;
• saline injection;
• sodium chloride.

The concentration of the active substance may vary. The main concentration options are 0.02% and 0.05%. That is, the content varies from 200 μg to 500 μg.

Drug action

The substance is used to convert to vitamin B12. When injected, it immediately enters the bloodstream, from where it is transported directly to the cells of various tissues. There, metabolism takes place with the participation of a substance.

Cyanocobalamin is deposited in the liver. After passing through the entire metabolic cycle, it is excreted through the kidneys and the genitourinary system. The elimination period is about 24 hours, the time of the maximum concentration of the drug in the blood is 2 hours after administration.

The medication has the following positive properties:

1. Accelerates tissue regeneration. Activates the healing processes of both external and internal injuries.
2. Increases blood clotting. Allows to stop internal bleeding and compensate for the effects of anemia.
3. Restores the liver. Helps to deal with minor violations of her work.
4. It stabilizes the nervous system, increasing the resistance to stress and endurance of the body during overload.
5. Fights excess cholesterol. Destroys cholesterol plaques, removes excess from the body, improving the state of the circulatory system.
6. Elimination of the consequences of anemia caused by various reasons. Reduces the severity of symptoms, helps to eliminate the disease itself (when used as a component of complex treatment).

Important! When using large dosages, the drug can affect the activity of thromboplasts, increasing it.

Vitamin is necessary for the body, as it is involved in all major processes. It is actively involved in the metabolism of all three types of substances - lipids, carbohydrates and proteins. A timely and sufficient supply of the vitamin allows the production of red blood cells to be activated and enhances their characteristics, such as tolerance to hemolysis.

Indications for use

The substance is primarily aimed at combating anemia of various types. It can be caused by both blood loss and vitamin deficiencies.

Variants of anemia, in the fight against which the drug is considered effective:

• iron deficiency;
• caused by a lack of vitamin B12 (Addison-Birmer);
• aplastic;
• posthemorrhagic;
• adverse reactions to certain medications such as hormonal oral contraceptives, etc.

Thanks to such an action as stimulating the production of red blood cells, the substance allows you to fight all types of anemias. However, it is important to note that only in the case of Addison-Birmer disease will it help to eliminate both the root cause of the disease and its symptoms. In the case of diagnosing other types of anemia, it is necessary to use additional drugs, which, together with Cyanocobalamin, will form a single complex of therapy.

Also, the drug is used for the following problems:

• dermatitis of various kinds, such as allergic dermatitis, atopic and so on;
• dysfunction of the renal system;
• radiation sickness;
• persistent migraines;
• decreased immunity and prolonged course of infectious diseases;
• neoplasms, both benign and malignant.

The vitamin substance can also be used in some other conditions. Positive reviews are left by patients who used the medication for compensation:

• down's disease;
• nephrosis and necrosis of the liver;
• cirrhosis of liver tissue;
• chronic hepatitis;
• alcoholism;
• cerebral palsy in children;
• sclerosis of an atrophic nature;
• fever lasting more than 1 to 2 weeks;
• injuries and disorders of nerves in the peripheral regions;
• muscle wasting;
• neurological disorders.

Contraindications

Patients who suffer from vitamin deficiency and benign or malignant tumors should take the drug with caution. The substance, when administered in excess, can cause a reverse reaction and lead not to a therapeutic effect, but only to worsen the course of the disease.

It is strictly forbidden to use the substance for the following diseases:

• erythremia;
• serious violations of the production of red blood cells;
• allergy, individual intolerance to the components of the composition (primarily to sodium chloride).

Side effects

The most common side effect of the drug is allergic reactions. They are especially pronounced in hypersensitive patients and people who are taking vitamin B1 concomitantly. The main variation of allergy is urticaria, cases of more serious reactions (anaphylactic shock, laryngeal edema, etc.) are very rare.

Due to the fact that the drug affects circulatory system and causes changes in pressure, patients may develop headaches, dizziness, and migraines. With a strong reaction, occasional fainting is likely.

Patients with irregular heart rhythms or with a hereditary tendency to them may notice short-term bouts of tachycardia or cardialgia. People with a high sensitivity of the nervous system, mild mental excitability noted within 12 hours after taking the drug such side symptoms, like increased irritability and irritability.

If the maximum dosage is violated, metabolic processes in the body may be disrupted. There is no need to treat these disorders: it is enough to temporarily stop taking the vitamin and consult a doctor.

Dosage and duration of administration

The course of therapy, its duration and the dosage of the drug differ depending on which disease the substance is prescribed to treat. Treatment options:

1. Elimination of symptoms of cerebral palsy, fever, vitamin deficiency anemia and in children. The dosage is 30-50 mcg per day, that is, a quarter of an ampoule of 0.02%.
2. Anemia with neuralgic symptoms. 500 mcg per injection. The number of injections is prescribed individually, usually 1 injection per day. At first, during the week, injections are given regularly. After 7 days, the drug is administered less frequently: once a week until the symptoms of the disease are eliminated.
3. Liver dysfunction (cirrhosis, hepatitis). Either 100 mcg every two days, or 30 to 60 mcg daily.
4. Nerve disorders in the periphery (dysfunction as a result of traumatic effects). Up to 400 mcg for 45 days. Injections are given every other day. The minimum dosage is 200 mcg.
5. Sclerosis. First, the drug is prescribed every other day at a dosage of 15 mcg, then the dosage is gradually increased to 250 mcg every other day.

The dosage should be prescribed by a specialist. If you have given clear instructions, you should not break them. It is possible to reduce the dosage or stop taking the drug only if symptoms of allergy or deterioration in health are observed as a result of taking the medication.

Important! Prescribing repeated courses of the drug is likely, but after a break of at least 2 weeks. A repeated course should be prescribed only by a doctor.

Injection methods

The drug is absorbed by any method of administration of the solution. You can resort to one of the following options:

• intramuscular injection;
• subcutaneous administration;
• introduction into the spinal canal;
• injection under the skin.

The most effective options, when the drug is absorbed best, are injections into the spinal canal or into muscle tissue. However, the injection into the spinal canal is accompanied by painful sensations. This injection method is used only in medical institutions, if necessary, to quickly deliver the vitamin to the body.

Cyanocobalamin - instructions for use (injections):

• treat the area where the injection will be made with an antiseptic;
• make an injection using the chosen method using a disposable syringe with a volume of 1 ml;
• pinch the injection site for 2 minutes with a cotton swab, if there is poor blood clotting.

Oral intake

Cyanocobalamin can be taken orally in combination with folic acid (oral tablets are available). This form of release has several advantages:

• ease of use;
• the possibility of prescribing to patients with hemophilia;
• availability for patients with allergies to the components of the injection solution.

However, oral tablets also have a significant drawback - they are poorly absorbed by the intestines, and the active substance is almost not accumulated by the body. To get the required dose of the drug, it is necessary to use overdosages.

In case of impaired absorption and assimilation of substances, the vitamin may not be absorbed at all through the digestive system.

Use during pregnancy and breastfeeding

Taking the drug during pregnancy is strictly prohibited. It can lead to the development of side reactions, increased toxicosis. The use of high dosages increases the risk of miscarriage.

It is not recommended to use the remedy when planning a pregnancy, because there is a great chance that conception has already occurred. In the first trimester, the effect of the substance is especially noticeable and can lead to delays in the formation of the fetus.

The use of the drug during breastfeeding is also prohibited. If, due to medical indications, the use of the substance is extremely necessary, you need to temporarily stop breastfeeding and transfer the baby to artificial nutrition. Breastfeeding can be resumed only with the permission of the pediatrician: only a specialist knows when the active substance will be excreted from the blood and breast milk.

In extreme cases, use during pregnancy is possible, but only if:

• benefit exceeds possible harm for a child;
• dosages will be reduced as for a child (15-30 mcg).

Interaction with other drugs

The drug cannot be administered simultaneously with many other vitamins and nutrients, namely:

• with ascorbic acid;
• with B vitamins (1 and 6);
• riboflavin.

It is generally not recommended to mix the contents of the ampoule with other drugs. If simultaneously assigned vitamin complexes with a different content, injections should be given in other places (for example, one injection in the thigh, another in the shoulder). If you have any doubts about the compatibility of drugs, you should consult a specialist.

A metabolic disorder of a substance is possible when using the following drugs:

• medicines for epileptic seizures;
• colchicine medicines;
• salicital.

The absorption of the drug is also disturbed by the salts of heavy metals, which can enter the body together with multivitamin complexes or as part of injections.

If, in parallel with the medication, drugs are used that increase blood clotting, the latter will have to be abandoned or the dosage reduced, because Zinocobalamin also increases coagulability. The double action of drugs can lead to stagnation in the circulatory system, oxygen starvation of tissues, and the formation of blood clots.

If B1 drugs are used, then side effectsassociated with their use, increase: urticaria, dizziness, etc. Therefore, it is recommended to take complexes of these substances in different time, preferably at intervals of 2-3 weeks.

Drug analogs

If, for a number of reasons, Cyanocobalamin injection solution does not suit you, you can choose one of the analogs:

• Medivitan;
• Cyanocobalamin Vial;
• Bufus;
• Darnitsa.

Most of the drugs are available in the form of tablets for oral administration. They should not be taken if there is a history of allergic reactions to folic acid. However, the oral form of release is suitable for those who, for various reasons, cannot constantly resort to injections (inconvenience of use, blood diseases, hemophilia). However, it is important to consider that oral administration is less effective than intravenous or intramuscular administration.

Price

The cost of the drug starts from 18 rubles (ampoules with 200 mcg) or 24 rubles (0.5 mg). It is more profitable to purchase ampoules in online stores and social pharmacies. The substance is available in all retail and chain pharmacies and does not need to be ordered in advance.

Shelf life and storage conditions

The drug is stored for 2 years, subject to the storage rules. Optimal storage conditions - temperature up to 25 degrees, dry, dark place (ampoules inside the box).

In case of a change in the color of the solution (it should be transparent), the appearance of a precipitate, formations, if chips are found on the glass of the ampoule or holes in its lid, the drug should be discarded.

Outcome

Cyanocobalamin is a useful vitamin preparation, but it should not be taken as a preventive measure, without a doctor's recommendation. If you need to replenish the balance of vitamins at home, you should use multivitamin complexes.

Vitamin B12 is an essential element in human functioning. It is synthesized in the large intestine, but is not able to be independently absorbed, since absorption occurs in the small intestine. Cyanocobalamin enters the body with animal food. The liver and kidneys are especially rich. B12 plays an important role in red blood cell formation, cartilage and nerve cell regeneration. Anemia associated with B12 deficiency often occurs in vegetarians who refuse animal products. In such cases, doctors use vitamin B12 shots to maintain balance in the body.

Indications for the use of vitamin B12 in ampoules

The difference in prices is small. The cost of the drug is quite inexpensive, it is affordable for any segment of the population.

Vitamin B12, available in the form of a solution for injection, is widely used in medical practice. It has proven effective in various diseases... A high degree of assimilation by the body, a minimum of side effects make it convenient for use. There are various opinions regarding the painfulness of injections with B12, but more often the opinion is that they are not painful.

If you have any experience with cyanocobalamin, please share your information.

Watch the video about the role of vitamin B12 in the body:

Cyanocobalamin INN

Description of the active substance

Cyanocobalamin INN.

Pharmachologic effect:

Vitamin B12, has a metabolic, hematopoietic effect. In the body (mainly in the liver) it turns into a coenzyme form - adenosylcobalamin, or cobamamide, which is an active form of vitamin B12 and is part of numerous enzymes, incl. in the composition of reductase, which reduces folic acid to tetrahydrofolic acid. Possesses high biological activity. Cobamamide is involved in the transfer of methyl and other one-carbon fragments, therefore it is necessary for the formation of deoxyribose and DNA, creatine, methionine - a donor of methyl groups, in the synthesis of a lipotropic factor - choline, for the conversion of methylmalonic acid into succinic acid, which is part of myelin, for the utilization of propionic acid. It is necessary for normal blood formation - it promotes the maturation of red blood cells. Promotes the accumulation of compounds containing sulfhydryl groups in erythrocytes, which increases their tolerance to hemolysis. It activates the blood coagulation system, in high doses causes an increase in thromboplastic activity and prothrombin activity. Reduces blood cholesterol levels. Has a beneficial effect on the function of the liver and nervous system. Increases the tissue's ability to regenerate.

Indications:

Chronic anemias, occurring with a deficiency of vitamin B12 (Addison-Birmer disease, alimentary macrocytic anemia), as part of the complex therapy of anemias (including iron deficiency, posthemorrhagic, aplastic, anemias caused by toxic substances and / or drugs). Chronic hepatitis, liver cirrhosis, liver failure. Polyneuritis, radiculitis, neuralgia (including trigeminal neuralgia), funicular myelosis, peripheral nerve injuries, amyotrophic lateral sclerosis, cerebral palsy, Down's disease. Skin diseases (psoriasis, photodermatosis, dermatitis herpetiformis, neurodermatitis). For prophylactic purposes - when prescribing biguanides, PASK, ascorbic acid in high doses, pathology of the stomach and intestines with impaired absorption of vitamin B12 (resection of a part of the stomach, small intestine, Crohn's disease, celiac disease, malabsorption syndrome, sprue), radiation sickness.

Contraindications:

Hypersensitivity, thromboembolism, erythremia, erythrocytosis, pregnancy (there are separate indications of the possible teratogenic effect of B vitamins in high doses), lactation period. With caution - angina pectoris.

Dosing regimen:

Inside, s / c, i / m, i / v and intralumbar. S / c, with Addison-Birmer anemia - 100-200 mcg / day every other day; with funicular myelosis, macrocytic anemias with dysfunction of the nervous system - 400-500 μg / day in the first week - daily, then at intervals between injections up to 5-7 days (folic acid is prescribed at the same time); during the period of remission, the maintenance dose is 100 mcg / day 2 times a month, in the presence of neurological phenomena - 200-400 mcg 2-4 times a month. For acute posthemorrhagic and iron deficiency anemia - 30-100 mcg 2-3 times a week; with aplastic anemia - 100 mcg before the onset of clinical and hematological improvement. For disorders of the nervous system - 200-400 mcg 2-4 times a month. In diseases of the central nervous system and peripheral nervous system - 200-500 mcg every other day for 2 weeks. For injuries of the peripheral nervous system - 200-400 mcg every other day for 40-45 days. With hepatitis and liver cirrhosis - 30-60 mcg / day or 100 mcg every other day for 25-40 days. With radiation sickness - 60-100 mcg daily for 20-30 days. With funicular myelosis, amyotrophic lateral sclerosis - endolumbar, 15-30 mcg with a gradual increase in the dose to 200-250 mcg per injection. To eliminate vitamin B12 deficiency, inject i / m or i / v, 1 mg daily for 1-2 weeks; for prophylaxis - 1 mg once a month i / m or i / v. For children early age for alimentary anemia and premature babies - s / c, 30 mcg per day daily for 15 days. With dystrophies in young children, Down's disease and infantile cerebral palsy - sc, 15-30 mcg every other day.

Side effects:

Allergic reactions, mental agitation, cardialgia, tachycardia. When used in high doses - hypercoagulation, impaired purine metabolism.

Special instructions:

During the period of treatment, it is necessary to monitor the parameters of peripheral blood: on the 5-8 day of treatment, the content of reticulocytes and the concentration of iron are determined. The number of erythrocytes, Hb and the color indicator must be monitored for 1 month 1-2 times a week, and then 2-4 times a month. Remission is achieved with an increase in the number of erythrocytes up to 4,000,000-4500,000 / μl, when the normal size of erythrocytes is reached, the disappearance of aniso- and poikilocytosis, and the normalization of the reticulocyte content after reticulocytic crisis. After reaching hematological remission, peripheral blood control is carried out at least 1 time in 4-6 months.

Interaction:

Pharmaceutically incompatible with ascorbic acid, heavy metal salts (inactivation of cyanocobalamin), thiamine bromide, pyridoxine, riboflavin (since the cobalt ion contained in the cyanocobalamin molecule destroys other vitamins). Aminoglycosides, salicylates, anticonvulsants, colchicine, potassium preparations reduce absorption. It enhances the development of allergic reactions caused by thiamine. Chloramphenicol reduces the hematopoietic response.

Dosage Form: & nbspInjection. Composition:

Composition of the medicinal product (per 1 ml):

Active substance : cyanocobalamin - 200 mcg or 500 mcg.

Excipients: sodium chloride - 9.0 mg; water for injection - up to 1 ml.

Description: Transparent liquid from light pink to bright pink, color (dosage 200 μg / ml) or clear liquid from light red to bright red (dosage 500 μg / ml). Pharmacotherapeutic group:Vitamin. ATX: & nbsp

B.03.B.A.01 Cyanocobalamin

Pharmacodynamics:Vitamin B12 has metabolic and hematopoietic effects. In the body (mainly in the liver) it turns into a coenzyme form - adenosylcobalamin, or cobamamide, which is an active form of vitamin B12 and is part of numerous enzymes, including in the composition of reductase, which reduces folic acid intetrahydrofolic. Possesses high biological activity.

Cobamamide is involved in the transfer of methyl and other one-carbon fragments, therefore it is necessary for the formation of deoxyribose and DNA, creatine, methionine - a donor of methyl groups, in the synthesis of a lipotropic factor - choline, for the conversion of methylmalonic acid into succinic acid, which is part of myelin, for the utilization of propionic acid ...

It is necessary for normal blood formation - it promotes the maturation of red blood cells.

Promotes the accumulation in erythrocytes of compounds containingsulfhydryl groups, which increases their tolerance to hemolysis.

Activates the blood coagulation system, in high doses causesincreased thromboplastic activity and prothrombin activity.

Reduces blood cholesterol levels. Has a beneficial effect onfunctions of the liver and nervous system. Increases the ability of tissues toregeneration.

The daily requirement for vitamin B12: for adult men - 1-2 mg; forelderly people -1.2-1.4 mg; for women - 1-2 mg (in pregnant women -more by 0.5 mg, in nursing - by 0.6 mg); for children - depending on age - 0.3-1.4 mg.

Pharmacokinetics:

In the blood, vitamin B12 binds to transcobalamins I and II, which transport it to tissues. It is deposited mainly in the liver.

The connection with proteins in plasma is 90%. The maximum concentration after subcutaneous and intramuscular administration is after 1 hour. They penetrate the placental barrier, breast milk.

It is excreted from the liver with bile into the intestines and blood is again absorbed.

The half-life in the liver is 500 days.

It is excreted with normal renal function -7-10% by the kidneys, about 50% - with feces; with a decrease in kidney function - 0-7% by the kidneys, 70-100% - with feces.

Indications:

Conditions accompanied by vitamin B12 deficiency:

chronic anemia, occurring with a deficiency of vitamin B12 (Addison-Birmer disease, alimentary macrocytic anemia), as part of the complex therapy of anemias (including iron deficiency, posthemorrhagic, aplastic, anemias caused by toxic substances and / or drugs).

In the complex therapy: chronic hepatitis, liver cirrhosis, liver failure, alcoholism.

In neurology: polyneuritis, radiculitis, hypotrophy, neuralgia (incl.

trigeminal neuralgia), funicular myelosis, disease of the peripheral nervous system of traumatic genesis, amyotrophic lateral sclerosis, cerebral palsy, Down's disease.

In dermatology: psoriasis, photodermatosis, dermatitis herpetiformis, atopic dermatitis.

For prophylactic purposes: when prescribing biguanides, paraaminosalicylic acid, ascorbic acid in high doses, pathology of the stomach and intestines with impaired absorption of vitamin B12 (resection of part of the stomach, small intestine, Crohn's disease, celiac disease, malbsorption syndrome, sprue), enteritis, diarrhea, malignant formations of the pancreas and intestines, radiation sickness.

Contraindications:Hypersensitivity, thromboembolism, erythremia, erythrocytosis, pregnancy, lactation. Carefully:Angina pectoris, benign and malignant neoplasms, accompanied by megaloblastic anemia and vitamin B12 deficiency, a tendency to form blood clots. Pregnancy and lactation:The use of the drug is contraindicated for. pregnancy (there are separate indications about the possible teratogenic effect of B vitamins in high doses) and during breastfeeding. Method of administration and dosage:

The drug is applied subcutaneously, intramuscularly, intravenously and intralumbar.

Subcutaneously: with Addison-Birmer anemia - 100-200 mcg / day every other day; with funicular myelosis, macrocytic anemias with dysfunction of the nervous system - 400-500 μg / day in the first week - every day, then with an interval between injections up to 5-7 days (folic acid is prescribed at the same time); during the period of remission, the maintenance dose is 100 mcg / day 2 times a month, and for disorders of the nervous system, 200-400 mcg 2-4 times a month.

In acute posthemorrhagic and iron deficiency anemia - 30-100 mcg 2-3 times a week; with aplastic anemia - 100 mcg, before the onset of clinical and hematological improvement. In case of violation of the nervous system - 200-400 mcg 2-4 times a month.

In diseases of the central nervous system and peripheral nervous system, 200-500 mcg every other day for 2 weeks.

In diseases of the peripheral nervous system of traumatic genesis - 200-400 mcg every other day for 40-45 days.

With hepatitis and cirrhosis of the liver - 30-60 mcg / day or 100 mcg every other day for 25-40 days;

With radiation sickness - 60-100 mcg daily for 20-30 days. With funicular myelosis, amyotrophic lateral sclerosis - intralumbar, 15-30 mcg with a gradual increase in the dose to 200-250 mcg per injection.

To eliminate vitamin B12 deficiency, it is administered intramuscularly or intravenously, 1 mg daily for 1-2 weeks.

For young children with alimentary anemia and premature infants - subcutaneously 30 mcg per day daily for 15 days. With dystrophies in young children, Down's disease and infantile cerebral palsy - subcutaneously, 15-30 mcg every other day.

Side effects:

With increased sensitivity to cyanocobalamin, allergic reactions, headache, dizziness, nervous excitement, pain in the heart, tachycardia, diarrhea may occur.

When used in high doses - hypercoagulation, impaired purine metabolism.

Interaction:

Pharmaceutically incompatible with ascorbic acid, heavy metal salts (inactivation of cyanocobalamin), thiamine bromide, pyridoxine, riboflavin (since the cobalt ion contained in the cyanocobalamin molecule destroys other vitamins). Cannot be combined with drugs that increase blood clotting. Aminoglycosides, salicylates, antiepileptic drugs, potassium preparations reduce absorption.

The risk of developed allergic reactions caused by thiamine.

Chloramphenicol reduces the hematopoietic response.

Special instructions:

Vitamin B12 deficiency should be confirmed diagnostically before prescribing the drug, as it may mask folic acid deficiency.

During the period of treatment, it is necessary to monitor the parameters of peripheral blood: on the 5-8th day of treatment, the number of reticulocytes and the concentration of iron are determined. The number of erythrocytes, hemoglobin and the color indicator must be monitored for 1 month 1 - 2 times a week, and then 2 - 4 times a month. Remission is achieved when the number of erythrocytes increases to 4-4.5 million / μg, when the normal size of erythrocytes is reached, aniso- and poikilocytosis disappears, and the reticulocyte content normalizes after reticulocytic crisis. After reaching hematological remission, peripheral blood control is carried out at least 1 time in 4-6 months.

Exercise caution in persons prone to thrombosis, angina pectoris (in smaller doses up to 0.1 mg per injection). Take for a long time for pernicious anemia, upcoming operations on the gastrointestinal tract. When used in recommended doses in the elderly, there were no adverse reactions other than those listed above.

Impact on the ability to drive vehicles. Wed and fur .:The drug does not negative impact on the ability to drive a car and / or other mechanisms.