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cyanocobalamin (generic name)

a vitamin b complex - treats Imerslund-Grasbeck disease, Cardiovascular disease/hyperhomocysteinemia, Fatigue, Angioplasty, Stroke, Alzheimer's...
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Alternate Title

Cobalamin, Cyanocobalamin

Category

Herbs & Supplements

Synonyms

B-12, B Complex, B Complex Vitamin, bedumil, cobalamin, cobalamins, cobamin, cyanocobalamin, cyanocobalaminum, cycobemin, hydroxocobalamin, hydroxocobalaminum, hydroxocobemine, idrossocobalamina, methylcobalamin, vitadurin, vitamin B-12.

Background

Vitamin B12 is an essential water-soluble vitamin that is commonly found in a variety of foods such as fish, shellfish, meat, and dairy products. Vitamin B12 is frequently used in combination with other B vitamins in a vitamin B complex formulation. It helps maintain healthy nerve cells and red blood cells and is also needed to make DNA, the genetic material in all cells. Vitamin B12 is bound to the protein in food. Hydrochloric acid in the stomach releases B12 from protein during digestion. Once released, B12 combines with a substance called intrinsic factor (IF) before it is absorbed into the bloodstream.

The human body stores several years' worth of vitamin B12, so nutritional deficiency of this vitamin is extremely rare. Elderly are the most at risk. However, deficiency can result from being unable to use vitamin B12. Inability to absorb vitamin B12 from the intestinal tract can be caused by a disease known as pernicious anemia. Additionally, strict vegetarians or vegans who are not taking in proper amounts of B12 are also prone to a deficiency state.

A day's supply of vitamin B12 can be obtained by eating 1 chicken breast plus 1 hard-boiled egg plus 1 cup plain low-fat yogurt, or 1 cup milk plus 1 cup raisin bran.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Megaloblastic anemia - due to vitamin B12 deficiency: Vitamin B12 deficiency is a cause of megaloblastic anemia. In this type of anemia, red blood cells are larger than normal and the ratio of nucleus size to cell cytoplasm is increased. There are other potential causes of megaloblastic anemia, including folate deficiency or various inborn metabolic disorders. If the cause is B12 deficiency, then treatment with B12 is the standard approach. Patients with anemia should be evaluated by a physician in order to diagnose and address the underlying cause.
Grade: A

Pernicious anemia: Pernicious anemia (blood abnormality) is a form of anemia that occurs when there is an absence of intrinsic factor, a substance normally present in the stomach. Vitamin B12 binds with intrinsic factor before it is absorbed and used by the body. An absence of intrinsic factor prevents normal absorption of B12 and may result in pernicious anemia. Pernicious anemia treatment is usually lifelong; supplemental vitamin B12 given intramuscularly, intranasally, or by mouth.
Grade: A

Vitamin B12 deficiency: Studies have shown that a deficiency of vitamin B12 can lead to abnormal neurologic and psychiatric symptoms. These symptoms may include: ataxia (shaky movements and unsteady gait), muscle weakness, spasticity, incontinence, hypotension (low blood pressure), vision problems, dementia, psychoses, and mood disturbances. Researchers report that these symptoms may occur when vitamin B12 levels are just slightly lower than normal and are considerably above the levels normally associated with anemia. People at risk for vitamin B12 deficiency include strict vegetarians, elderly people, breastfed infants, and people with increased vitamin B12 requirements associated with pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, liver or kidney disease. Administering vitamin B12 orally, intramuscularly, or intranasally is effective for preventing and treating dietary vitamin B12 deficiency.
Grade: A

Alzheimer's disease: Some patients diagnosed with Alzheimer's disease have been found to have abnormally low vitamin B12 levels in their blood. However, vitamin B12 deficiency itself often causes disorientation and confusion and thus mimics some of the prominent symptoms of Alzheimer's disease. Well-designed clinical trials are needed before a strong recommendation can be made.
Grade: C

Angioplasty: Some evidence suggests that folic acid plus vitamin B12 and pyridoxine daily can decrease the rate of restenosis in patients treated with balloon angioplasty. But this combination does not seem to be as effective for reducing restenosis in patients after coronary stenting. Due to the lack of evidence of benefit and potential for harm, this combination of vitamins should not be recommended for patients receiving coronary stents.
Grade: C

Breast cancer: Researchers at Johns Hopkins University report that women with breast cancer tend to have lower vitamin B12 levels in their blood serum than do women without breast cancer. In a subsequent review of these findings, it was hypothesized that vitamin B12 deficiency may lead to breast cancer because it could result in less folate being available to ensure proper DNA replication and repair. Higher dietary folate intake is associated with a reduced risk of breast cancer. The risk may be further reduced in women who also consume high amounts of dietary vitamin B12 in combination with dietary pyridoxine (vitamin B6) and methionine. However, there is no evidence that dietary vitamin B12 alone reduces the risk of breast cancer.
Grade: C

Cardiovascular disease/hyperhomocysteinemia: Hyperhomocysteinemia (high homocysteine levels in the blood) is a risk factor for coronary, cerebral, and peripheral atherosclerosis, recurrent thromboembolism, deep vein thrombosis, myocardial infarction (heart attack), and ischemic stroke. Elevated homocysteine levels may be a marker instead of a cause of vascular disease. However, it is not clear if lowering homocysteine levels results in reduced cardiovascular morbidity and mortality. Folic acid, pyridoxine (vitamin B6), and vitamin B12 supplementation can reduce total homocysteine levels; however, this reduction does not seem to help with secondary prevention of death or cardiovascular events such as stroke or myocardial infarction in people with prior stroke. More evidence is needed to fully explain the association of total homocysteine levels with vascular risk and the potential use of vitamin supplementation.
Grade: C

Fatigue: There is some evidence that intramuscular injections of vitamin B12 given twice per week might improve the general well-being and happiness of patients complaining of tiredness or fatigue. However, fatigue has many potential causes. Well-designed clinical trials are needed before a recommendation can be made.
Grade: C

High cholesterol: Some evidence suggests that vitamin B12 in combination with fish oil might be superior to fish oil alone when used daily to reduce total serum cholesterol and triglycerides. Well-designed clinical trials of vitamin B12 supplementation alone are needed before a conclusion can be drawn.
Grade: C

Imerslund-Grasbeck disease: Administering vitamin B12 intramuscularly seems to be effective for treating familial selective vitamin B12 malabsorption (Imerslund-Grasbeck disease). Further research is needed to confirm these results.
Grade: C

Shaky-leg syndrome: Preliminary clinical reports show that cyanocobalamin may help relieve tremor associated with shaky-leg syndrome. Further research is needed to confirm these results.
Grade: C

Sickle cell disease: One study suggests that a practical daily combination may include folic acid, vitamin B12, and vitamin B6. This combination may be a simple and relatively inexpensive way to reduce these patients' inherently high risk of endothelial damage. Further research is needed to confirm these results.
Grade: C

Circadian rhythm sleep disorders: Taking vitamin B12 orally, in methylcobalamin form, does not seem to be effective for treating delayed sleep phase syndrome. Supplemental methylcobalamin, with or without bright light therapy, does not seem to help people with primary circadian rhythm sleep disorders.
Grade: D

Lung cancer: Preliminary evidence suggests that there is no relationship between vitamin B12 status and lung cancer.
Grade: D

Stroke: In people with a history of stroke, neither high dose vitamin B12 combinations containing pyridoxine, vitamin B12, and folic acid nor low dose combinations containing pyridoxine, vitamin B12, and folic acid seem to affect risk of recurring stroke.
Grade: D

Leber's disease: Vitamin B12 is contraindicated in early Leber's disease, which is a hereditary optic nerve atrophy.
Grade: F

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Aging, AIDS, allergies, amyotrophic lateral sclerosis, asthma, autism, chronic fatigue syndrome, cognitive function, depression, depressive disorder (major), diabetes, diabetic peripheral neuropathy, energy level enhancement, growth disorders (failure to thrive), hemorrhage, immunosuppression, improving concentration, inflammatory bowel disease, kidney disease, liver disease, male infertility, malignant tumors, memory loss, mood (elevate), mouth and throat inflammation (atrophic glossitis), multiple sclerosis, myoclonic disorders (spinal myoclonus), neural tube defects, osteoporosis, periodontal disease, poisoning (cyanide), protection from tobacco smoke, psychiatric disorders, seborrheic dermatitis, seizure disorders (West syndrome), tendonitis, thrombosis, thyrotoxicosis / thyroid storm (adjunct iodides), tinnitus, tremor, vitiligo.

Dosing

Adults (over 18 years old)

Recommended dietary allowances (RDAs) are 2.4 micrograms per day for adults and adolescents aged 14 years and older, 2.6 micrograms per day for adult and adolescent pregnant females, and 2.8 micrograms per day for adult and adolescent lactating females. Because 10-30% of older people do not absorb food-bound vitamin B12 efficiently, those over 50 years of age should meet the RDA by eating foods fortified with B12 or by taking a vitamin B12 supplement. Supplementation of 25-100 micrograms per day has been used to maintain vitamin B12 levels in older people. A doctor and pharmacist should be consulted for use in other indications. Vitamin B12 has been taken by mouth and given by intramuscular (IM) injection by healthcare professionals. One clinical trial tested patients' acceptance of intranasal vitamin B12 replacement therapy (500 micrograms per week).

Children (under 18 years old)

Recommended dietary allowances (RDAs) have not been established for all pediatric age groups; therefore Adequate Intake (AI) levels have been used instead. The RDA and AI of vitamin B12 are: infants 0-6 months, 0.4 micrograms (AI); infants 7-12 months, 0.5 micrograms (AI); children 1-3 years, 0.9 micrograms; children 4-8 years, 1.2 micrograms; and children 9-13 years, 1.8 micrograms.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Vitamin B12 supplements should be avoided in people sensitive or allergic to cobalamin, cobalt, or any other product ingredients.

Side Effects and Warnings

Caution should be used in patients undergoing angioplasty since an intravenous loading dose of folic acid, vitamin B6, and vitamin B12 followed by oral administration taken daily after coronary stenting might actually increase restenosis rates. Due to the potential for harm, this combination of vitamins should not be recommended for patients receiving coronary stents.

Itching, rash, transitory exanthema, and urticaria have been reported. Vitamin B12 and pyridoxine has been associated with cases of rosacea fulminans, characterized by intense erythema with nodules, papules, and pustules. Symptoms may persist for up to four months after the supplement is stopped, and may require treatment with systemic corticosteroids and topical therapy.

Diarrhea has been reported.

Peripheral vascular thrombosis has been reported. Treatment of vitamin B12 deficiency can unmask polycythemia vera, which is characterized by an increase in blood volume and the number of red blood cells. The correction of megaloblastic anemia with vitamin B12 can result in fatal hypokalemia and gout in susceptible individuals, and it can obscure folate deficiency in megaloblastic anemia. Caution is warranted.

Vitamin B12 is contraindicated in early Leber's disease, which is hereditary optic nerve atrophy. Vitamin B12 can cause severe and swift optic atrophy.

Pregnancy and Breastfeeding

Vitamin B12 is likely safe when used orally in amounts that do not exceed the recommended dietary allowance (RDA).

There is insufficient reliable information available about the safety of larger amounts of vitamin B12 during pregnancy.

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