CYANOCOBALAMIN
(Vitamin B12)Standard Prescription
cyanocobalamin__mcg IM/SC daily x __ days
cyanocobalamin__mcg IM/SC__(weekly/monthly)
cyanocobalamin__mcg IM/SC__(weekly/monthly)
Dosages
Treatment of B12 Deficiency:
Children:
Parenteral (preferred):
Initial: 1000 mcg IM/SC daily for 2-7 days then 100 mcg IM/SC weekly x 1 month (if severe anemia, start with 0.2 mcg/kg/dose IM/SC daily x 2 days then continue with above regimen)
Maintenance: 100 mcg IM/SC once monthly
Oral (alternative): 1000 mcg PO daily
Adult:
Oral (preferred):
-Pernicious anemia/malabsorption: 1000 mcg PO daily
-For other causes: 250 mcg PO daily
Parenteral (For those with significant neurological symptoms):
1000 mcg IM/SC daily x 1-5 days, then 1000 mcg IM weekly x 1-4 weeks, then 1000 mcg IM every 1-2 months or 1000-2000 mcg PO daily
Supplement for all ages on vegan diet:
5-10 mcg PO daily
Children:
Parenteral (preferred):
Initial: 1000 mcg IM/SC daily for 2-7 days then 100 mcg IM/SC weekly x 1 month (if severe anemia, start with 0.2 mcg/kg/dose IM/SC daily x 2 days then continue with above regimen)
Maintenance: 100 mcg IM/SC once monthly
Oral (alternative): 1000 mcg PO daily
Adult:
Oral (preferred):
-Pernicious anemia/malabsorption: 1000 mcg PO daily
-For other causes: 250 mcg PO daily
Parenteral (For those with significant neurological symptoms):
1000 mcg IM/SC daily x 1-5 days, then 1000 mcg IM weekly x 1-4 weeks, then 1000 mcg IM every 1-2 months or 1000-2000 mcg PO daily
Supplement for all ages on vegan diet:
5-10 mcg PO daily
Mechanism of Action
Vitamin B12, Nutritional supplement
Forms Supplied
injection: 100 mcg/mL, 1000 mcg/mL
tablet: 1000 mcg
Comments
Patients with pernicious anemia require life-long therapy.
Patients with malabsorption require treatment until underlying condition or diet is corrected.
May cause hypokalemia, hypersensitivity, pruritis and vascular thrombosis.
IV route not recommended because of a more rapid elimination.
Limited evidence for PO route in children – may use in less severe deficiencies/maintenance.
Contraindicated in Leber’s disease (hereditary optic nerve atrophy).
Folic acid supplementation may also be required.
Patients with malabsorption require treatment until underlying condition or diet is corrected.
May cause hypokalemia, hypersensitivity, pruritis and vascular thrombosis.
IV route not recommended because of a more rapid elimination.
Limited evidence for PO route in children – may use in less severe deficiencies/maintenance.
Contraindicated in Leber’s disease (hereditary optic nerve atrophy).
Folic acid supplementation may also be required.
References
44, 289, 290, 291, 292
Last Edited
2025-04-27 01:54:34