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Hydroxocobalamin is first line therapy for people with cyanide poisoning. [2] Hydroxocobalamin converts cyanide to the much less toxic cyanocobalamin. Cyanocobalamin is renally cleared. The use of hydroxocobalamin became first line due to its low adverse risk profile, rapid onset of action, and ease of use in the prehospital setting. [16]
It is also not known whether current level of evidence sufficient to recommend this relatively expensive strategy as an alternative to cyanocobalamin or hydroxocobalamin. There is currently insufficient evidence on comparative effectiveness and safety of various B12 vitamers (methylcobalamin, cyancobalamin, hydroxocobalamin, adenosylcobalamin).
Cyanocobalamin is commercially prepared by bacterial fermentation. Fermentation by a variety of microorganisms yields a mixture of methylcobalamin , hydroxocobalamin and adenosylcobalamin . These compounds are converted to cyanocobalamin by addition of potassium cyanide in the presence of sodium nitrite and heat.
Hydroxocobalamin injection is a clear red liquid solution. Treatment should take into account the cause and severity of the condition. [6] Treatment is done by vitamin B 12 supplementation, either by mouth or by injection. [3] Initially in high daily doses, followed by less frequent lower doses, as the condition improves. [3]
Hydroxocobalamin injection usp(1000 mcg/ml) is a clear red liquid solution of hydroxocobalamin which is available in a 30-ml brown glass multidose vial packaged in a paper box. Shown is 500 mcg B-12 (as 1/2 cc) drawn up in a 0.5-cc U-100 27 gauge x 1/2" insulin syringe, as prepared for subcutaneous injection.
Differences in digestion and absorption account for the notable differences in bioavailability between ... Cyanocobalamin, hydroxocobalamin, methylcobalamin ...
Hydroxocobalamin reacts with cyanide to form cyanocobalamin, which can be safely eliminated by the kidneys. This method has the advantage of avoiding the formation of methemoglobin (see below). This antidote kit is sold under the brand name Cyanokit and was approved by the U.S. FDA in 2006. [26]
Adenosylcobalamin (AdoCbl), also known as coenzyme B 12, cobamamide, and dibencozide, is one of the biologically active forms of vitamin B 12. [1]Schematic diagram of the propionate metabolic pathway.