Hydroxocobalamin

Vitamin B12 Deficiency: As a form of vitamin B12, hydroxocobalamin acts as a cofactor for two important enzymes: methylmalonyl-CoA mutase and methionine synthase [1]. These enzymes are crucial for DNA synthesis, fatty acid metabolism, and amino acid metabolism [5]. By replenishing vitamin B12 levels, hydroxocobalamin helps correct the metabolic abnormalities caused by its deficiency [1].
Cyanide Poisoning: Hydroxocobalamin binds to cyanide ions in the body, forming cyanocobalamin (vitamin B12a), which is then excreted in the urine [6]. This effectively removes cyanide from the body, preventing it from causing harm [6].

Hypersensitivity: Avoid use in patients with known hypersensitivity to hydroxocobalamin or cobalt [7].
Allergies: Patients with allergies to cobalt should not use hydroxocobalamin [8].
Precautions:
Renal Impairment: Monitor renal function, as hydroxocobalamin can cause acute renal failure and oxalate crystals in the urine [9].
Blood Pressure: It can cause substantial increases in blood pressure. Monitor blood pressure during treatment [9].
Concurrent Conditions: Conditions like concurrent infection, uraemia, or deficiencies in folic acid or iron may impair the therapeutic response [7].

30mL

Hydroxocobalamin dosage and administration [3]
Hydroxocobalamin dosage and administration can vary depending on the condition being treated. Here are some general guidelines:
For Vitamin B12 Deficiency:
Initial Dose: 30 mcg intramuscularly (IM) daily for 5 to 10 days [3]
Maintenance Dose: 100 to 200 mcg IM monthly [3]
For Cyanide Poisoning:
Initial Dose: 5 grams intravenously (IV) over 15 minutes. A second 5-gram dose may be given depending on the severity of poisoning and clinical response [3].
Maximum Dose: 10 grams.
Special Populations:
Pediatric Patients: Dosage is typically adjusted based on weight. For example, 70 mg/kg (up to 5 grams) over 30 minutes as a single infusion [4].
It's important to follow the specific instructions provided by a healthcare professional, as they can tailor the dosage to individual needs and conditions [4].

Hydroxocobalamin has a few known drug interactions, although they are generally not severe [10]. Here are some notable ones:
Moderate Interactions:
Arsenic Trioxide: Hydroxocobalamin may reduce the effectiveness of arsenic trioxide.
Chloramphenicol: There may be an increased risk of bone marrow suppression when used together.
Dimethyl Fumarate: Hydroxocobalamin might reduce the effectiveness of dimethyl fumarate.
Diroximel Fumarate: Similar to dimethyl fumarate, hydroxocobalamin may reduce its effectiveness.
Monomethyl Fumarate: This medication may also have reduced effectiveness when taken with hydroxocobalamin.
Sodium Iodide (I-123 and I-131): Hydroxocobalamin can interfere with the effectiveness of these iodides.
Disease Interactions [3]:
Hypokalemia: Hydroxocobalamin can exacerbate low potassium levels, so monitoring and correction of potassium levels are necessary [3].
Leber's Disease: Use of hydroxocobalamin is contraindicated in patients with Leber's hereditary optic neuropathy as it can accelerate optic nerve atrophy [3].
Malabsorption Syndromes: Absorption of vitamin B12 can be decreased in patients with malabsorption syndromes [3].

Hydroxocobalamin can cause a range of side effects, which can vary in severity. Here are some common and serious side effects:
Common Side Effects [10]:
Nausea
Headache
Acne-like skin rash
Redness or irritation at the injection site
Red coloring of the urine (which may last 2 to 5 weeks)
Pain or swelling at the injection site
Serious Side Effects (rare) [8]
Allergic reactions: Hives, difficulty breathing, swelling of the face, lips, tongue, or throat.
Irregular heartbeats or palpitations [8]
Severe shortness of breath, wheezing, or cough with foamy mucus [3]
Chest pain [3]
Severe high blood pressure (severe headache, blurred vision, buzzing in ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure) [3]
Bright red blood in stools [3]
If you experience any of these serious side effects, it's important to seek medical attention immediately.

Pregnancy and Lactation: Use with caution in pregnant and breastfeeding women [7].
Pediatric Use: Dosage adjustments are necessary for children [10].

hydroxocobalamin should be stored properly to maintain its effectiveness and safety. Here are some general guidelines:
Temperature: Store at a temperature below 25°C (77°F). Avoid freezing [11].
Light Sensitivity: Protect from light, as vitamin B12 is sensitive to light [3].
Humidity: Keep in a dry place to prevent moisture absorption [11].