Formulary
Hydroxocobalamin: Indications, Dosing, Side Effects and Interactions
Hydroxocobalamin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Hydroxocobalamin: Indications, Dosing, Side Effects and Interactions
Hydroxocobalamin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis of macrocytic anaemias associated with vitamin B12deficiency**
- **Adult** (By Intramuscular Injection): Prophylaxis of macrocytic anaemias associated with vitamin B 12 deficiency 1 mg every 2-3 months.
**Pernicious anaemia and other macrocytic anaemias without neurological involvement**
- **Adult** (By Intramuscular Injection): Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2-3 months.
**Pernicious anaemia and other macrocytic anaemias with neurological involvement**
- **Adult** (By Intramuscular Injection): Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months.
**Tobacco amblyopia**
- **Adult** (By Intramuscular Injection): Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, then 1 mg every 1-3 months.
**Leber's optic atrophy**
- **Adult** (By Intramuscular Injection): Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, then 1 mg every 1-3 months.
**Poisoning with cyanides**
- **Child** (By Intravenous Infusion): (body-weight 5 kg and above) Initially 70 mg/kg (max. per dose 5 g), to be given over 15 minutes, then 70 mg/kg (max. per dose 5 g) if required, this second dose can be given over 15 minutes-2 hours depending on severity of poisoning and patient stability.
- **Adult** (By Intravenous Infusion): Initially 5 g, to be given over 15 minutes, then 5 g if required, this second dose can be given over 15 minutes-2 hours depending on severity of poisoning and patient stability.
**Macrocytic anaemia without neurological involvement for hydroxocobalamin**
- **Child** (By intramuscular injection): Initially 0.25-1 mg once daily on alternate days for 1-2 weeks, then 0.25 mg once weekly until blood count normal, then 1 mg every 2-3 months.
**Macrocytic anaemia with neurological involvement for hydroxocobalamin**
- **Child** (By intramuscular injection): Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months.
**Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency for hydroxocobalamin**
- **Child** (By intramuscular injection): 1 mg every 2-3 months.
**Leber's optic atrophy for hydroxocobalamin**
- **Child** (By intramuscular injection): Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, then 1 mg every 1-3 months.
**Congenital transcobalamin II deficiency for hydroxocobalamin**
- **Neonate** (By intramuscular injection): 1 mg 3 times a week for 1 year, then reduced to 1 mg once weekly, adjusted as appropriate.
- **Child** (By intramuscular injection): 1 mg 3 times a week for 1 year, then reduced to 1 mg once weekly, adjusted as appropriate.
**Methylmalonic acidaemia and homocystinuria for hydroxocobalamin**
- **Child** (By intramuscular injection): Initially 1 mg daily for 5-7 days, then adjusted according to response to up to 1 mg 1-2 times a week, this is the maintenance dose.
**Methylmalonic acidaemia, maintenance once intramuscular response established for hydroxocobalamin**
- **Child** (By mouth): 5-10 mg 1-2 times a week, some children do not respond to oral route.
**Poisoning with cyanides for Cyanokit**
- **Child (body-weight 5 kg and above)** (By intravenous infusion): Initially 70 mg/kg (max. per dose 5 g), to be given over 15 minutes, then 70 mg/kg (max. per dose 5 g) if required, this second dose can be given over 15 minutes-2 hours depending on severity of poisoning and patient stability.
Cautions
Diagnosis of Vitamin B 12 deficiency should be confirmed before giving hydroxocobalamin
Side effects
General side-effects: Frequency not known Diarrhoea; dizziness; headache; hot flush; nausea; skin reactions; urine discolouration Specific side-effects: Frequency not known With intramuscular use Arrhythmia; chills; drug fever; hypokalaemia; malaise; pain; thrombocytosis; tremor; vomiting With intravenous use Angioedema; dysphagia; extrasystole; gastrointestinal discomfort; memory loss; mucosal discolouration red; peripheral oedema; pleural effusion; rash pustular; red discolouration of plasma; restlessness; swelling; throat complaints
Interactions
**Other interactions (3):**
- Chloramphenicol Parenteral chloramphenicol may attenuate the effect of hydroxocobalamin in anaemia.
- Oral contraceptives The serum concentration of hydroxocobalamin may be lowered.
- Vitamin B 12 assays by microbiological techniques are invalidated by antimetabolites and most antibiotics.
Breast feeding
Present in milk but not known to be harmful.
Medicinal forms
Solution,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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