British National Formulary for Children July 2017

HYDROXOCOBALAMIN


Additional information interactions (Hydroxocobalamin).

Cautions

should not be given before diagnosis fully established but see also Drugs used in megaloblastic anaemias (Nutrition and blood); interactions Appendix 1 (hydroxocobalamin)

Breast-feeding

present in milk but not known to be harmful

Side-effects

nausea, headache, dizziness; fever, hypersensitivity reactions (including rash and pruritus); injection-site reactions; hypokalaemia and thrombocytosis during initial treatment; chromaturia

Licensed use

licensed for use in children (age not specified by manufacturers); not licensed for use in inborn errors of metabolism

Indications and dose

Macrocytic anaemia without neurological involvement

  • By intramuscular injection

    Child 1 month–18 years initially 250 micrograms–1 mg 3 times a week for 2 weeks then 250 micrograms once weekly until blood count normal, then 1 mg every 3 months

Macrocytic anaemia with neurological involvement

  • By intramuscular injection

    Child 1 month–18 years initially 1 mg on alternate days until no further improvement, then 1 mg every 2 months

Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency

  • By intramuscular injection

    Child 1 month–18 years 1 mg every 2–3 months

Leber’s optic atrophy

  • By intramuscular injection

    Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, thereafter 1 mg every 1–3 months

Congenital transcobalamin II deficiency

  • By intramuscular injection

    Neonate 1 mg 3 times a week, reduce after 1 year to 1 mg once weekly or as appropriate

    Child 1 month–18 years 1 mg 3 times a week, reduce after 1 year to 1 mg once weekly or as appropriate

Methylmalonic acidaemia and homocystinuria

  • By intramuscular injection

    Child 1 month–18 years initially 1 mg daily for 5–7 days, reduce according to response to maintenance dose of up to 1 mg once or twice weekly

Methylmalonic acidaemia, maintenance once intramuscular response established

  • By mouth

    Child 1 month–18 years 5–10 mg once or twice weekly

    Note

    Some children do not respond to the oral route

Cyanide poisoning

Sub-sections

  • (Non-proprietary) Prescription only medicine

    Injection, hydroxocobalamin 1 mg/mL. Net price 1-mL amp = £2.41

    Brands include Cobalin-H® Not prescribable under National Health Service (NHS), Neo-Cytamen® Not prescribable under National Health Service (NHS)

    Injection, hydroxocobalamin 2.5 mg/mL, 2 mL

    Available from ‘special-order’ manufacturers or specialist importing companies

    Administration For administration by mouth, injection solution may be given orally; it will not have prolonged effect via this route

    Note

    The BP directs that when Vitamin B12 injection is prescribed or demanded hydroxocobalamin injection shall be dispensed or supplied

    Powder available from specialist importing companies