Cynomin

Indication
Pernicious anemia, Vitamin B12 deficiency due to low intake from food, Thyrotoxicosis, Hemorrhage, Malignancy, Liver or kidney disease, Gastric bypass surgery, Total or partial gastrectomy, Gluten enteropathy or sprue, Folic acid deficiency, Macrocytic anaemia
Adult Dose
Intramuscular Pernicious or macrocytic anaemia Adult: 250-1000 mcg, given on alternate days for 1-2 wk, then 250 mcg wkly until the blood count returns to normal. Maintenance doses: 1000 mcg, given every mth. Hepatic impairment: Increased requirement in hepatic impairment.

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Renal Dose
Renal impairment: Increased requirement in renal impairment.
Contraindication
Leber’s disease, tobacco amblyopia.
Mode of Action
Vitamin B12 (cyanocobalamin): Required for the maintenance of normal erthropoiesis, nucleprotein and myelin synthesis, cell reproduction and normal growth; Coenzyme; metabolic functions include protein synthesis and carbohydrate metabolism. Plays role in cell replication and hematopoiesis.
Precaution
Intensive treatment of B12-deficient megaloblastic anemia may cause hypokalemia and sudden death Nasal disease; defer use until symptoms resolve Use with caution in patients with Leber optic nerve atrophy Thrombocytosis may occur with treatment of severe vitamin B12 megaloblastic anemia Lactation: Drug distributed in milk; safe to use

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Side Effect
>10% Arthralgia (12%),Dizziness (12%),Headache (12%),Nasopharyngitis (12%) Frequency Not Defined Anaphylaxis,Angioedema,Congestive heart failure,Peripheral vascular disease,Pulmonary edema,Diarrhea,Dyspepsia,Polycythemia vera,Sore throat,Nervousness,Rhinitis,Glossitis,Hypoesthesia

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Pregnancy Category Note
Pregnancy category: A; C (for doses exceeding RDA and for intranasal products) Lactation: Drug distributed in milk; safe to use

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Interaction
Absorption reduced by antibiotics, aminosalicylic acid, anticonvulsants, biguanides, cholestyramine, cimetidine, colchicine, K salts, methyldopa.