Depo-Cobolin Disease Interactions

Hypokalemia (resulting in death) has occurred during vitamin B12 therapy as a result of increased red blood cell requirements during hematopoiesis. Clinical monitoring and correction of potassium levels prior to and during vitamin B12 therapy is necessary.

The use of cyanocobalamin is contraindicated in patients with Leber's disease (hereditary optic nerve atrophy). Cyanocobalamin has induced severe and rapid optic nerve atrophy in patient's with early Leber's disease.

Absorption of vitamin B12 is decreased in malabsorption syndromes and in pernicious anemia without coadministration of intrinsic factor (IF). Cyanocobalamin is rapidly absorbed following IM or subcutaneous injections. Hydroxocobalamin (cyanocobalamin analog) functions the same a cyanocobalamin, but has induced antibody formation to the hydroxocobalamin-transcobalamin II complex. The use of cyanocobalamin may be preferred in patients with these conditions.

Cyanocobalamin products contain aluminum that may be toxic and may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and other solutions which also contain aluminum. Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum greater than 4-5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Caution and monitoring are recommended.