From the Guidelines
Hydroxocobalamin should be administered 1 mg intramuscularly on alternate days until there is no further improvement in patients with vitamin B12 deficiency and possible neurological involvement, and 1 mg intramuscularly three times a week for 2 weeks in those without neurological involvement, followed by maintenance treatment with 1 mg intramuscularly every 2-3 months for life. The use of hydroxocobalamin is crucial in treating vitamin B12 deficiency, which can lead to megaloblastic, macrocytic anemia, and neurological symptoms if left untreated 1. It is essential to treat vitamin B12 deficiency immediately, especially in cases with possible neurological involvement, to prevent further complications. According to the British Obesity and Metabolic Surgery Society guidelines, hydroxocobalamin is the preferred treatment for vitamin B12 deficiency, and its administration should be tailored to the individual patient's needs, with or without neurological involvement 1. Some key points to consider when using hydroxocobalamin include:
- The importance of urgent specialist advice from a neurologist and haematologist in cases with possible neurological involvement
- The need to exclude folic acid deficiency before initiating treatment with hydroxocobalamin
- The potential for folic acid deficiency to mask severe vitamin B12 depletion
- The recommended dosing regimen for hydroxocobalamin, which varies depending on the presence or absence of neurological involvement 1. In clinical practice, it is crucial to prioritize the treatment of vitamin B12 deficiency to prevent morbidity, mortality, and impaired quality of life, and hydroxocobalamin is a safe and effective treatment option when used appropriately 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Vitamin B12 is essential to growth, cell reproduction, hematopoiesis, nucleoprotein and myelin synthesis. The use of Hydroxocobalamin (Vitamin B12) is for:
- Growth
- Cell reproduction
- Hematopoiesis (production of blood cells)
- Nucleoprotein synthesis
- Myelin synthesis 2
From the Research
Uses of Hydroxocobalamin (Vitamin B12)
- Hydroxocobalamin is used as an antidote for cyanide poisoning, particularly in cases of smoke inhalation 3, 4, 5, 6.
- It is effective in treating acute cyanide poisoning caused by ingestion of cyanide salts 4.
- Hydroxocobalamin has been used in the prehospital setting to treat suspected cyanide poisoning in patients with smoke inhalation 5.
- It is also used to treat vitamin B12 deficiency, with some studies suggesting that a combination of methylcobalamin and adenosylcobalamin or hydroxocobalamin is effective in rectifying the deficiency 7.
Administration and Dosage
- Hydroxocobalamin can be administered intravenously, with a typical dose of 5g (maximum 15g) for adults with suspected cyanide poisoning 5.
- The appropriate weight-adjusted dose for pediatric patients is significantly lower than the standard adult dose, and excessive administration can lead to side effects such as chromaturia and erythroderma 3.
Side Effects and Safety
- Common side effects of hydroxocobalamin include chromaturia, pink or red skin discoloration, hypertension, erythema, and increased blood pressure 3, 5.
- Hydroxocobalamin is generally well-tolerated, with no serious adverse events attributed to its use in the treatment of cyanide poisoning 4, 5.
- Transient alterations in renal and hepatic function have been observed in patients receiving high-dose hydroxocobalamin, but these are consistent with the critical condition of the patients and mild anemia consistent with progressive hemodilution 5.