Usage
Cyanocobalamin + Folic Acid is a combination of two essential B vitamins used to treat or prevent deficiencies of these vitamins. This medication is prescribed for conditions such as:
- Megaloblastic anemia: A type of anemia characterized by large, immature red blood cells due to impaired DNA synthesis caused by vitamin B12 or folate deficiency.
- Pernicious anemia: Specifically, vitamin B12 deficiency anemia caused by the body’s inability to absorb vitamin B12.
- Dietary deficiencies: Inadequate intake of vitamin B12 or folate due to dietary restrictions (e.g., veganism), malabsorption syndromes, or increased requirements (e.g., pregnancy).
- Prophylaxis during pregnancy: Folic acid is crucial for preventing neural tube defects in developing fetuses.
Pharmacological Classification: Vitamin supplement, Hematopoietic agent.
Mechanism of Action:
- Cyanocobalamin (Vitamin B12): Essential for DNA synthesis, red blood cell maturation, and nerve function. It acts as a coenzyme for several metabolic reactions.
- Folic Acid (Vitamin B9): Essential for DNA and RNA synthesis, cell division, and amino acid metabolism. It plays a vital role in the formation of red blood cells and is crucial during periods of rapid growth, such as pregnancy.
Alternate Names
- Vitamin B12 + Folic Acid
- Cyanocobalamin/Folic Acid
Brand Names: Numerous brand names exist depending on the manufacturer and region.
How It Works
Pharmacodynamics:
- Cyanocobalamin is involved in DNA synthesis, red blood cell maturation, and nerve function.
- Folic acid contributes to DNA and RNA synthesis, cell division, and the metabolism of certain amino acids.
Pharmacokinetics:
- Absorption: Cyanocobalamin is absorbed in the ileum, requiring intrinsic factor for absorption. Folic acid is absorbed primarily in the jejunum.
- Metabolism: Both are metabolized in the liver.
- Elimination: Cyanocobalamin is primarily excreted in bile, with some renal excretion. Folic acid is excreted primarily in the urine.
Mode of Action:
- Cyanocobalamin: Acts as a coenzyme for methionine synthase and methylmalonyl-CoA mutase.
- Folic Acid: Converted to tetrahydrofolic acid, a coenzyme for various metabolic pathways.
Receptor binding, enzyme inhibition, or neurotransmitter modulation:
- Cyanocobalamin: Interacts with intrinsic factor for absorption.
- Folic acid: Converted to various active forms that act as coenzymes.
Elimination pathways:
- Cyanocobalamin: Hepatic (biliary excretion) and renal.
- Folic acid: Primarily renal.
Dosage
Standard Dosage
Adults:
- Vitamin B12 deficiency: 1000 mcg IM or deep SubQ daily for 6-7 days, followed by weekly injections for a month, and then monthly injections.
- Dietary deficiency: Oral supplementation of cyanocobalamin and folic acid can be prescribed.
- Pernicious anemia: 100 mcg IM or deep SubQ monthly.
Children:
- Pediatric dosing is determined by the specific deficiency and the child’s age and weight. Doses are generally lower than adult doses and should be carefully adjusted.
Special Cases:
- Elderly Patients: Standard adult dosing may be appropriate, but attention to renal function is essential.
- Patients with Renal Impairment: Dose adjustments may be required for cyanocobalamin based on renal function.
- Patients with Hepatic Dysfunction: Careful monitoring of liver function is recommended.
- Patients with Comorbid Conditions: Consider interactions with other medications and existing conditions.
Clinical Use Cases Dosage recommendations in these settings may vary and should be determined by the specific clinical scenario and the patient’s condition. The use of Cyanocobalamin + Folic Acid itself is not typically indicated for these situations specifically.
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
- Adjustments are necessary based on renal and hepatic function, other medications, and individual patient responses.
Side Effects
Common Side Effects: Generally, this medication is well-tolerated. Some patients may experience mild gastrointestinal discomfort.
Rare but Serious Side Effects: Allergic reactions, such as itching, rash, swelling, or difficulty breathing, are rare but potentially serious.
Long-Term Effects: No significant long-term adverse effects are associated with appropriate cyanocobalamin and folic acid supplementation.
Contraindications
- Hypersensitivity to cyanocobalamin, folic acid, or cobalt.
- Leber’s hereditary optic neuropathy (vitamin B12 can worsen this condition).
Drug Interactions
- Certain medications can interfere with vitamin B12 absorption (e.g., metformin, proton pump inhibitors).
- Anticonvulsants can decrease folate levels.
- Alcohol can interfere with both B12 and folate absorption and metabolism.
Pregnancy and Breastfeeding
- Both cyanocobalamin and folic acid are considered safe during pregnancy and breastfeeding.
- Folic acid supplementation is recommended during pregnancy to prevent neural tube defects.
Drug Profile Summary
- Mechanism of Action: Vitamin B12 is essential for DNA synthesis, RBC maturation, and nerve function. Folic acid is crucial for DNA/RNA synthesis, cell division, and amino acid metabolism.
- Side Effects: Generally well-tolerated. Rare allergic reactions are possible.
- Contraindications: Hypersensitivity, Leber’s hereditary optic neuropathy.
- Drug Interactions: Medications affecting B12 absorption (e.g., metformin, PPIs), anticonvulsants, alcohol.
- Pregnancy & Breastfeeding: Safe and often recommended.
- Dosage: Varies based on indication, age, and route.
- Monitoring Parameters: Hemoglobin, hematocrit, reticulocyte count, vitamin B12 and folate levels.
Popular Combinations
Often combined with other B vitamins in B-complex formulations.
Precautions
- Assess for allergies before administration.
- Monitor for potential drug interactions.
- Ensure adequate intake during pregnancy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cyanocobalamin + Folic Acid?
A: It depends on the indication and patient-specific factors. For vitamin B12 deficiency, 1000 mcg IM or deep SubQ daily for 6-7 days, then weekly for a month, then monthly, is often prescribed. For dietary deficiency, oral supplementation is common. Pernicious anemia requires 100 mcg IM or deep SubQ monthly.
Q2: What are the signs and symptoms of vitamin B12 deficiency?
A: Fatigue, weakness, pale skin, shortness of breath, nerve problems (numbness, tingling), cognitive impairment, and depression.
Q3: Are there any dietary sources of vitamin B12 and folate?
A: Vitamin B12 is primarily found in animal products (meat, poultry, fish, dairy, eggs). Folate is found in leafy green vegetables, legumes, citrus fruits, and fortified grains.
Q4: Can folic acid mask vitamin B12 deficiency?
A: Yes, folic acid can improve the anemia caused by B12 deficiency but will not prevent neurological damage.
Q5: How is pernicious anemia diagnosed?
A: Blood tests (complete blood count, vitamin B12 levels, antibodies against intrinsic factor) and sometimes bone marrow biopsy.
Q6: Are there any specific precautions for pregnant women?
A: Folic acid supplementation (400-800 mcg daily) is recommended during pregnancy to prevent neural tube defects. Adequate B12 intake is also crucial.
Q7: How are vitamin B12 and folate levels monitored?
A: Blood tests can measure serum levels of both vitamins.
Q8: What are the potential side effects of high doses of folic acid?
A: High doses can mask vitamin B12 deficiency and potentially cause gastrointestinal issues in some individuals.
Q9: Can Cyanocobalamin + Folic acid be administered intravenously?
A: Yes, cyanocobalamin can be administered intravenously, intramuscularly, or subcutaneously. Folic acid can also be given intravenously, but typically oral administration is sufficient.
Q10: How long does it take to see improvement after starting Cyanocobalamin + Folic Acid?
A: Improvement in symptoms, such as fatigue and weakness, can be seen within a few days to weeks of starting treatment. Correction of anemia may take longer.
