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Nascobal Generic Name & Formulations
Legal Class
Rx
General Description
Cyanocobalamin 500mcg/spray; soln for nasal spray; contains benzalkonium chloride.
How Supplied
Single-use nasal spray (0.125mL)—4
Manufacturer
Generic Availability
NO
Nascobal Indications
Indications
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.
Nascobal Dosage and Administration
Adult
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
Not established.
Nascobal Contraindications
Contraindications
Cobalt hypersensitivity.
Nascobal Boxed Warnings
Not Applicable
Nascobal Warnings/Precautions
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 Pharmacokinetics
See Literature
Nascobal Interactions
Interactions
May be antagonized by chloramphenicol (when used for treating anemia); monitor and consider alternatives if needed.
Nascobal Adverse Reactions
Adverse Reactions
Infection, headache, glossitis, paresthesia, asthenia, nausea, rhinitis; anaphylaxis.
Nascobal Clinical Trials
See Literature
Nascobal Note
Not Applicable
Nascobal Patient Counseling
See Literature
