Vitamin B12

Vitamin B12

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    CaloMist Nasal Spray is no longer available in the United States.

    CaloMist Nasal Spray is used to treat a deficiency of vitamin B12 in people who cannot naturally absorb sufficient amounts the vitamin due to certain health conditions. The nasal spray contains a man-made form of vitamin B12. CaloMist is the brand name of this medication. The generic name is cyanocobalamin. The medication is only available by prescription.

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    Cyanocobalamin, or vitamin B12, is a prescription medication to help replace low vitamin B12 levels. It may be given by mouth, applied to the nasal tissue or as an injection.

    In the body, vitamin B12 helps to make DNA, red blood cells and keeps your nervous system working as it should. Vitamin B12 usually comes from a well-rounded diet that includes fish, meat and dairy products.

    A lack of vitamin B12 could be caused by the following:

    • Not getting enough B12 in your diet (vegans and vegetarians)
    • Having pernicious anemia, which damages your stomach's cells that help absorb vitamin B12.
    • Having an condition of the intestines, like Crohn's disease, ulcerative colitis or celiac disease, or having gastrointestinal surgery may interfere with vitamin B12 absorption.
    • Having bacteria grow abnormally in your stomach.
    • Taking acid reducing drugs (like Prilosec, Prevacid, Zantac or Tagamet) for long periods of time may interfere with vitamin B12 absorption.

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    Possible side effects of cyanocobalamin (also known as vitamin B12) may include diarrhea or mild skin itching. In rare cases, cyanocobalamin may cause allergic reactions, with symptoms including hives, trouble breathing and/or swelling of the face, hands, mouth and throat. Call your doctor at the first sign of these symptoms. Do not take cyanocobalamin supplements or any dietary supplement without consulting your doctor first.
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    If you miss a dose of cyanocobalamin (Vitamin B12), take it as soon as you remember unless it is nearly time for the next dose. Do not double up the dosage, since this could be dangerous and cause unwanted side effects. If you miss your doctor's appointment to get your injection, call the office immediately to reschedule your appointment.

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    If you use the injected form of cyanocobalamin (Vitamin B12) and it is administered to you by a health care professional, it will be stored at the office or clinic. If you use the injected form and administer it to yourself, you will receive vials and syringes (with needles) from the pharmacy. These should be stored at room temperature, away from heat and moisture, away from freezing temperatures, and out of the reach of children and pets.

    The tablet and nasal gel forms of cyanocobalamin should be stored at room temperature away from moisture and heat, so do not store in a bathroom or near ovens or stoves. Do not allow it to freeze. Keep cyanocobalamin nasal gel in the same carton in which you received it from the pharmacist. Keep it where children cannot reach. Discard if the medication has expired.

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    There are several precautions you should be aware of before you begin taking cyanocobalamin (vitamin B12) injection, nasal gel (Nascobal) or tablets. These include:

    • Talk to your doctor if you think you are allergic to cyanocobalamin, any other vitamins or cobalt.
    • Make sure you tell your doctor and pharmacist every nonprescription substance you are taking, including vitamins, aspirin or any dietary supplements, including any prescription drugs you are taking.
    • Make sure you tell your doctor if you are taking the following drugs that may interact: antibiotics such as chloramphenicol, colchicine, folic acid (folate), methotrexate (Rheumatrex, Trexall), para-aminosalicylic acid (Paser) or pyrimethamine (Daraprim).
    • Make sure you tell your doctor if you drink alcohol, if you have had Leber's hereditary optic neuropathy or kidney problems.
    • Make sure you tell your doctor about your plans to get pregnant, if you are currently pregnant or if you are breastfeeding. Cyanocobalamin might cause harm to a developing baby.

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    Cyanocobalamin may be a lifelong treatment, depending on what is causing the B12 deficiency. If you have pernicious anemia, you can expect to take this medicine regularly to avoid permanent medical problems. Your doctor may want to reconsider your dose if you become pregnant, plan to breastfeed or opt for a vegetarian or vegan diet. Tell your doctor about any changes in lifestyle or diet. People with Leber's disease, an inherited vision disorder, should not take cyanocobalamin, as it can damage their optic nerves and potentially cause blindness. Cyanocobalamin may affect people with certain infections, kidney or liver disease, iron or folic acid deficiencies or therapies affecting the bone marrow. Talk to your doctor about these or any other medical conditions you may experience. Certain drugs can interact with cyanocobalamin. These include; antibiotics; methotrexate (Rheumatrex); pyrimethamine (Daraprim); and colchicine. Excessive alcohol consumption within the past two weeks may also cause problems if you are taking cyanocobalamin. Talk to your doctor about all other drugs you are taking, as well as any vitamins, nutritional supplements or over-the-counter medications.

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    Some common side effects for cyanocobalamin (Vitamin B12) include diarrhea or a feeling that your body is swollen. But other side effects can be much more severe. If you or someone you know has any of the following rare side effects, call the doctor right away:

    • Confusion
    • Coughing or wheezing
    • Difficulty breathing or swallowing
    • Dizziness
    • Extreme thirst or tiredness
    • Fast heartbeat
    • Frequent urination
    • Headaches
    • Hives, itching or rash
    • Leg pain
    • Muscle weakness, cramps or pain
    • Pain, warmth, redness, swelling or tenderness in one leg
    • Red skin color, especially on the face
    • Shortness of breath when exercising or lying down
    • Swelling of the arms or legs
    • Unusual bleeding or bruisin

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    It appears that birth control pills that contain higher levels of hormones, particularly estrogen, may be more likely to lower vitamin B12 levels than low-dose pills, but more study is needed. In fact, not all studies indicate that taking birth control pills can reduce your levels of vitamin B12. Talk to your doctor about whether you need to be concerned about your vitamin B12 levels if you take oral contraceptives.
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    There are several medications that can interfere with how well your body absorbs vitamin B12, possibly increasing your risk of vitamin B12 deficiency. Among the drugs that may reduce your body's level of vitamin B12 are medicines used to lower cholesterol, treat ulcers, decrease stomach acid, reduce risk of seizures and treat cancer and diabetes.

    Certain antibiotics (including tetracycline), if taken at the same time as vitamin B12 supplements, may decrease your body's absorption of vitamin B12. The supplement may also decrease your body's absorption of the antibiotic, making it less effective. Taking the antibiotic and the supplement at separate times of the day may lessen these interactions. Talk to your doctor before taking vitamin B12 supplements or any dietary supplement. Always be sure that your doctor is aware of all of the medications and supplements you take.
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