Hydroxocobalamin

Dosage Forms & Strengths

lyophilized powder for reconstitution

• 5g/vial

injection solution

• 1000mcg/mL (30mL)

Cyanide Poisoning

Drug of choice in continental Europe/Australia

70 mg/kg (usually 5 g) IV infusion over 15 minutes; additional 5 g IV may be given depending on severity of poisoning and clinical response 

Not to exceed a cumulative dose of 10 g

Vitamin B12 Deficiency

Initial: 30 mcg IM qDay for 5-10 days

Maintenance: 100-200 mcg IM qmonth; may administer higher dose if critically ill or hyperthyroidism or neurologic or infectious disease present

Dosage Forms & Strengths

lyophilized powder for reconstitution

• 5g/vial

injection solution

• 1000mcg/mL (30mL)

Cyanide Poisoning (Off-label)

70 mg/kg (usually 5 g) IV infusion over 15 minutes; additional dose of 35 mg/kg IV may be given depending on severity of poisoning and clinical response

Vitamin B12 Deficiency

Initial: 100 mcg IM qDay for > 2 weeks (1-5 mg total dose)

Maintenance: 30-50 mcg IM qmonth

IV Preparation

Reconstitute lyophilized powder with 200 mL 0.9% NaCl; resulting concentration is 25 mg/mL

Hydroxocobalamin may be found in some form under the following brand names:

• Calafol Rx

• Cyanokit

• Folpace Rx

• Hydro-Cobex

• Hydroxy-Cobal

Vitamin B12 is essential to growth, cell reproduction, hematopoiesis, nucleoprotein and myelin synthesis.

Fifty percent of the administered dose of Hydroxocobalamin disappears from the injection site in 2.5 hours. Hydroxocobalamin is bound to plasma proteins and stored in the liver. It is excreted in the bile and undergoes some enterohepatic recycling. Within 72 hours after injection of 500 to 1000 mcg of Hydroxocobalamin, 16 to 66 percent of the injected dose may appear in the urine. The major portion is excreted within the first 24 hours.

• Cyanokit

• Antidote
• Vitamin, Water Soluble

IM injection: Treatment of pernicious anemia; treatment of vitamin B12 deficiency due to dietary deficiencies or malabsorption diseases, inadequate secretion of intrinsic factor, competition for vitamin B12 by intestinal parasites/bacteria, or inadequate utilization of B12 (eg, during neoplastic treatment)

IV infusion (Cyanokit): Treatment of cyanide poisoning (known or suspected)

IM: Hypersensitivity to hydroxocobalamin or any component of the formulation

IV (Cyanokit®): There are no contraindications listed in the manufacturer’s labeling.

No dosage adjustments provided in manufacturer's labeling (has not been studied).

No dosage adjustments provided in manufacturer's labeling (has not been studied).