Hydroxocobalamin
CYANOKIT
What it isHydroxylated vitamin B12 that binds cyanide as cyanocobalamin; cyanide poisoning and B12 deficiency.
Why this oneIt detoxifies cyanide without inducing methemoglobinemia, favoring it in smoke inhalation where nitrites can impair oxygen delivery.
What limits itDeep-red discoloration of skin, urine, and plasma interferes with colorimetric laboratory tests and some dialysis equipment.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Vitamin B12 deficiency | adult | 30 mcg IM daily x5-10 days | 100-200 mcg IM monthly | |
| Vitamin B12 deficiency | pediatric | 100 mcg IM (total 1-5 mg over >=2 weeks) | 30-50 mcg IM q4wk (maintenance) | |
| Schilling test (flushing dose) | adult | 1000 mcg IM |
Renal Undefined
Hepatic Undefined
Instructions
- Administer intramuscularly only (oral not dependable)
- Protect from light; inspect for particulate matter/discoloration before use
- Monitor serum potassium closely first 48 h; supplement if needed
- Addisonian pernicious anemia requires lifelong parenteral therapy
Available strengths
- inj 1 mg/mL
Cautions
- Hypokalemia possible on correction of megaloblastic anemia - monitor potassium
- Hypersensitivity/anaphylaxis reported
Adverse reactions
- Mild transient diarrhea
- Itching, transitory exanthema
- Feeling of body swelling
- Anaphylaxis
- Injection-site pain
Pregnancy Category C; use only if clearly needed
Lactation Undefined
Cost
Hydroxocobalamin (CYANOKIT)
What pharmacies pay · NADAC 9/30/26
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 1 mg/mL | inj | per unit | $0.81/mL | not offered |
NO BOXED WARNINGS
Principal riskIt turns fluids red and blocks colorimetric assays
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityRenal injury, hypertension and extensive laboratory interference