Multigen

Cyanocobalamin is a prescription medication used to used to treat and prevent a lack of vitamin B12.

Cyanocobalamin belongs to a group of drugs called vitamins. These help to supply vitamin B12.

This medication is available in an injectable form to be given directly into the muscle (IM) or under the skin by a healthcare professional.

Common side effects of cyanocobalamin include diarrhea and feeling as if your entire body is swollen.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• antibiotics such as chloramphenicol (Chloromycetin, Mychel-S)
• colchicine (Colcrys)
• folic acid
• methotrexate (Rheumatrex, Trexall)
• para-aminosalicylic acid (Paser)
• pyrimethamine (Daraprim)

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

This is not a complete list of cyanocobalamin drug interactions. Ask your doctor or pharmacist for more information.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Cyanocobalamin falls into category C.There are no well-controlled studies that have been done in pregnant women. Cyanocobalamin should be used during pregnancy only if the possible benefit outweighs the possible risk to the unborn baby.

However, vitamin B12 is an essential vitamin and requirements are increased during pregnancy. Amounts of vitamin B12 that are recommended by the Food and Nutrition Board, National Academy of Science-National Research Council for pregnant women (4 mcg daily) should be consumed during pregnancy.

Take Cyanocobalamin exactly as prescribed.

This medication is available in an injectable form to be given directly into the muscle (IM) or under the skin by a healthcare professional.

Patients with pernicious anemia will require monthly injections of vitamin B12 for the remainder of their lives.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of cyanocobalamin at the same time.

Use Multigen as ordered by your doctor. Read all information given to you. Follow all instructions closely.

• This medicine works better if you take it on an empty stomach. You may take this medicine with food if it causes an upset stomach. Some foods like eggs, whole grain breads, cereal, dairy products, coffee, and tea may make Multigen not work as well. If this medicine causes an upset stomach, talk with your doctor about the best way to take Multigen with food.
• This medicine prevents many other drugs from getting into the body. If you take other drugs, check with your doctor or pharmacist to see if you need to take them at some other time than this medicine.

What do I do if I miss a dose?

• Take a missed dose as soon as you think about it.
• If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
• Do not take 2 doses at the same time or extra doses.

• If your symptoms or health problems do not get better or if they become worse, call your doctor.
• Do not share your drugs with others and do not take anyone else's drugs.
• Keep a list of all your drugs (prescription, natural products, vitamins, OTC) with you. Give this list to your doctor.
• Talk with the doctor before starting any new drug, including prescription or OTC, natural products, or vitamins.
• Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about Multigen (iron, succinic acid, vitamin C, vitamin B12, & desiccated stomach substance), please talk with your doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about Multigen. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using Multigen.

Review Date: October 4, 2017

Applies to multivitamin with iron: oral capsule, oral miscellaneous, oral solution reconstituted, oral tablet, oral tablet extended release

Other dosage forms:

• oral powder, oral tablet chewable
• oral capsule, oral elixir, oral liquid, oral miscellaneous, oral solution, oral tablet
• oral liquid, oral solution, oral suspension

Applies to multivitamin with iron: injectable solution, oral capsule, oral capsule extended release, oral liquid, oral powder for reconstitution, oral tablet, oral tablet chewable, oral tablet extended release

Gastrointestinal

Gastrointestinal side effects associated with oral iron therapy have included nausea, constipation, anorexia, heartburn, vomiting, and diarrhea. These effects are generally dose-related. In addition, stools may appear darker in color in patients taking products containing iron. Iron oral preparations may rarely cause Hemoccult-positive stools, patients with positive tests generally require further work-up.[Ref]

Other

Stained teeth have primarily occurred following ingestion of iron liquid preparation.

Iron overload (i.e., hemosiderosis) has been reported in patients genetically predisposed, or have underlying disorders, that augment the absorption of iron. It has also occurred following administration of excessive parenteral iron therapy, combination of oral and parenteral iron, or in patients with hemoglobinopathies that were erroneously diagnosed as iron deficiency anemia. Hemosiderosis is treated with repeated phlebotomy or long-term administration of deferoxamine. The liver is particularly susceptible to toxicity in iron-overload states.[Ref]

Other side effects associated with oral iron products have included stained teeth and iron overload (hemosiderosis). Secondary hemochromatosis due to prolonged iron ingestion has been reported rarely.[Ref]

Metabolic

Metabolic side effects associated with iron have included decreased absorption of thyroxine (T4).[Ref]

Some side effects of Multigen may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.