Cyanocobalamin (Nasal)

Cyanocobalamin is a synthetic form of vitamin B-12 used in the treatment and prevention of vitamin B-12 deficiency.


Cyanocobalamin contains vitamin B-12 and a cyanide molecule. While many may recognize the name cyanide as a poison, the amount contained in cyanocobalamin is too small to be toxic.

Cyanocobalamin helps to resolve symptoms of vitamin B-12 deficiency, which often include depression and fatigue. Cyanocobalamin nasal gel can help to restore a reduced red blood cell count and can be an effective treatment for pernicious anemia, which is a condition where vitamin B-12 is not absorbed in the intestine. Because it is absorbed in the nose, it can be an effective alternative route for when the patient cannot absorb it in the intestine.

Symptoms of pernicious anemia include paler-than-normal or yellowed skin. If left untreated, pernicious anemia can result in irreversible damage to the spinal cord. A doctor may also prescribe cyanocobalamin to treat the sensation of pins and needles or difficulties with mobility caused by nerve damage (neuropathy) from a vitamin B-12 deficiency. Visual neuropathy is yet another condition that can be reversed with cyanocobalamin. Visual neuropathy can affect visual accommodation, which is the patient's ability to adjust their focus from something that is near to something that is further away or vice versa.

Factors that can result in a vitamin B-12 deficiency include excessive alcohol consumption and smoking.

Some studies suggest that a high level of an amino acid called homocysteine is an indicator that an individual is at a higher risk of developing heart disease. A doctor may administer vitamin B-12 in the form of cyanocobalamin to lower a patient's homocysteine levels. There is presently no evidence that a high level of homocysteine actually causes heart disease.

Animal products are the best sources of vitamin B-12, which means that vegans are at a higher risk of deficiency. Age is another factor in vitamin B-12 deficiency, young people are rarely deficient in it, but older people often are as a result of decreased stomach acid or because of unhealthy diets.

Conditions treated include

  • style="font-weight: 400;">Pernicious anemia
  • Atrophic gastritis
  • Crohn's disease
  • 400;">Celiac disease
  • Intestinal parasites
  • 400;">Grave's disease

Type of Medicine

  • Vitamin

Side Effects

There are very few side effects from cyanocobalamin. Side effects that a few patients may encounter include a dip their potassium level called hypokalemia. This occurs for patients with anemia. The dip in potassium levels is the result of the body making new blood cells. Other side effects include muscle cramping, weakness, and an irregular heartbeat. Some patients may experience diarrhea, while others may get the sensation that their entire body is swollen.

A few patients report extreme thirst and frequent urination as a result of cyanocobalamin. In many cases, the milder cyanocobalamin side effects will go away quickly with no need for the patient to seek medical attention. Over time, their body may adjust to cyanocobalamin.

Serious allergic reactions to cyanocobalamin are rare, but patients should seek medical attention if they have symptoms of such a reaction. Typical symptoms of an allergic reaction include itching or a rash. Allergic reactions tend to show up immediately after the medication has been administered. In addition to itching, some patients may also experience difficulty breathing, a stuffed or a runny nose. Other symptoms of an allergic reaction include facial swelling as well as swelling of the throat, tongue or lips.


Patients should take cyanocobalamin nasal gel exactly as prescribed by their doctor. Directions will be printed on the prescription label.

A patient's vitamin B-12 requirements may change if they adopt a vegan diet, are pregnant or if they start breastfeeding. Patients should inform their doctor about any dietary changes or other health matters.

The nasal gel is administered only after patients have received the subcutaneous form and are in remission.

The adult and pediatric dose of cyanocobalamin nasal gel is 500 mcg into the nostrils once weekly. Cyanocobalamin nasal gel is to be administered within an hour of meals (before or after) and is applied to the inside of the patient's nose. Patients should try to take the gel on the same day each week to ensure that they remember to take it.

In order to ensure that cyanocobalamin nasal gel is beneficial, the patient will be required to have their blood tested every three to six months.

If a patient misses a dose, they should not panic as it takes a little time before the body will become deficient in the vitamin; they should never try to double up in order to make up for a missed dose. However, they should try to take it as soon as possible. If it is almost time for their next dose, they should only take one dose.

It is important that patients take cyanocobalamin nasal gel according to their doctor's prescription, not less or more of the drug. If there is anything in the instructions that they do not understand, they should ask their doctor or their pharmacist to explain it to them.

Drug Interactions

Certain medicines should not ever be used together; however, sometimes, a doctor will prescribe two drugs together even though they can interact. If this is the case, the doctor may want to adjust the dose or take certain precautions. Patients should inform their healthcare providers about the drugs they are taking, including both prescription and over-the-counter medications.

The drugs that interact with cyanocobalamin in the body are typically those that reduce levels of vitamin B-12. Patients should inform their doctor if they are taking any of the following:

  • Phenytoin
  • Phenobarbital
  • Primidone
  • Methotrexate
  • Colchicine
  • Colestipol
  • Cholestyramine
  • Colesevelam
  • Cimetidine
  • Famotidine
  • Ranitidine
  • Metformin
  • Esomeprazole
  • Lansoprazole
  • Omeprazole
  • Rabeprazole
  • Tetracycline

Cyanocobalamin should not be administered at the same time as tetracycline due to the latter drug's potential to affect its absorption. In general, antibiotics have the tendency to lower vitamin B-12 levels in the body if used for a long time.

The list above is not complete. Patients should ask their doctor for more information on drug interactions when taking cyanocobalamin.


In addition to telling them about their allergies and drug use, patients should also tell their doctor about any other conditions that may be exacerbated by their use of cyanocobalamin. They should not use cyanocobalamin if they have an allergy to cobalt since it contains cobalt. Similarly, premature infants with benzyl alcohol hypersensitivity may have an allergic reaction since benzyl alcohol is used as a preservative in the majority of cyanocobalamin injection formulations. Benzyl alcohol can cause Ĺ“Gasping Syndrome in infants. Gasping Syndrome can be fatal. Patients with Leber's disease (hereditary optic nerve atrophy) may see the condition worsen if their cyanocobalamin levels are already high.

Aluminum toxicity can occur in some cases as cyanocobalamin does contain aluminum. Aluminum toxicity is most likely to occur in cases where the patient's kidney function is impaired.

Patients who are breastfeeding should note that cyanocobalamin is distributed into breast milk, which means that infants may be exposed to the drug. Doses administered to older patients should also be selected with caution as older patients are at greater risk of decreased liver, kidney or heart function. They are also more likely to be receiving other drug therapy and may have other health conditions.

If an allergy is suspected, the doctor should administer an intradermal test to check for hypersensitivity. This is important since there have been cases of anaphylactic shock and death resulting from cyanocobalamin use.

Other conditions that a patient should inform their physician about include:

  • 400;">Polycythemia vera
  • 400;">Iron deficiency anemia
  • Bone marrow suppression
  • Infection (including respiratory infection)
  • 400;">Renal Failure
  • Uremia
  • Rhinorrhea
  • Pregnancy

It is unlikely that an overdose will occur, if the medication is administered in a medical setting or if the patient follows their doctor's prescription carefully; however, if one is suspected, patients should seek emergency medical attention immediately.

Unless their doctor tells them otherwise, the patient should continue with their normal diet.


Patients should exercise caution when storing cyanocobalamin nasal gel. As with all medications, care should be taken to keep cyanocobalamin away from children and animals. Examples of ideal locations for storage include a medicine cabinet with a lock or a high shelf in a closet.

Cyanocobalamin nasal gel should be protected from extreme heat and cold; ideally, it should be stored at room temperature. It should also be protected from both light and moisture as well. It should not be kept in the kitchen or in the bathroom. Patients should discard their cyanocobalamin if it becomes cloudy or discoloured. They should also discard any unused cyanocobalamin after its expiration date. The medication should be disposed of in a way that children and animals will not be able to find them.


Cyanocobalamin nasal gel is generally safe, but as with many medications, it can be risky if patients are not mindful of the contraindications. It is designed to treat vitamin B-12 deficiency as a result of various health conditions, but how well a patient responds to it can be influenced by their health as well as other medications that they may be taking. The list of conditions and drugs with which it can interact with it is long. It is therefore important that doctors have as much information as possible about a patient's medical history and their lifestyle.

When stored and administered correctly, cyanocobalamin nasal gel can be an effective treatment for vitamin B-12 deficiency and help to maintain the health of red blood cells as well as the health of the patient's nervous system. It may provide relief from a range of symptoms caused by Crohn's and celiac disease in addition to providing protection from serious illnesses like heart disease. In order to achieve the best possible results, the patient will have to be forthcoming with their doctor while also following their instructions carefully.