Anemias:
Indications for: NASCOBAL
Maintenance treatment in patients with pernicious anemia who are in remission after intramuscular Vit. B12 therapy and who have no nervous system involvement. Treatment of dietary, drug-induced, or malabsorption-related Vit. B12 deficiency not due to pernicious anemia. Prevention of Vit. B12 deficiency in patients with Vit. B12 requirements in excess of normal.
Adult Dosage:
Give at least 1hr before or after hot foods or liquids. Initially 1 spray (500mcg) in one nostril once weekly. Monitor response; may increase dose if serum B12 levels decline after 1 month. If levels persistently low, consider alternative formulations. Defer dose if nasal congestion, allergic rhinitis, or upper respiratory infections occur.
Children Dosage:
Not established.
NASCOBAL Contraindications:
Cobalt hypersensitivity.
NASCOBAL Warnings/Precautions:
Obtain hematocrit, reticulocyte count, Vit. B12, folate, and iron levels prior to initiation. May need supplemental folate or iron. Monitor B12 blood levels and peripheral blood count 1 month after initiation, 1 month after each dose adjustment, and regularly at 3–6 month intervals. Do not use for Schilling Test. Leber's optic atrophy: not recommended; consider alternatives. Suspected cyanocobalamin hypersensitivity: consider intradermal test dose of parenteral Vit. B12 prior to initiation. May mask previously unrecognized folate deficiency. Risk of hypokalemia and sudden death in severe megablastic anemia; monitor serum potassium, platelet count during therapy. May unmask polycythemia vera. Pregnancy.
NASCOBAL Interactions:
May be antagonized by chloramphenicol (when used for treating anemia); monitor and consider alternatives if needed.
Adverse Reactions:
Infection, headache, glossitis, paresthesia, asthenia, nausea, rhinitis; anaphylaxis.
Generic Drug Availability:
NO
How Supplied:
Single-use nasal spray (0.125mL)—4
