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Initial: 5 g as single infusion may repeat a second 5 g dose depending on the severity of poisoning and clinical response. Dosage and Administration Dosing: AdultĬyanide poisoning: IV: Note: If cyanide poisoning is suspected, antidotal therapy must be given immediately. IV (Cyanokit): There are no contraindications listed in the manufacturer's labeling. IM: Hypersensitivity to hydroxocobalamin or any component of the formulation

IV infusion (Cyanokit): Treatment of cyanide poisoning (known or suspected) Use: Off Labelĭata from multiple case reports and a case series suggest that use of hydroxocobalamin may be beneficial in the treatment of vasoplegic syndrome and may be used as an alternative to or in patients who are refractory to methylene blue, in patients with glucose-6-phosphate dehydrogenase deficiency, or risk factors for serotonin syndrome during cardiac surgery Cai 2017, Roderique 2014, Shah 2018 or liver transplantation An 2018, Boettcher 2017, Woehlck 2016.

IM injection: Treatment of pernicious anemia treatment of vitamin B 12 deficiency due to dietary deficiencies or malabsorption diseases, inadequate secretion of intrinsic factor, competition for vitamin B 12 by intestinal parasites/bacteria, or inadequate utilization of B 12 (eg, during neoplastic treatment) When normalized for body weight, men and women revealed no major pharmacokinetic differences. Significant forms various cobalamin-(III) complexes Use in Specific Populations Special Populations: Gender Urine (50% to 60% within initial 72 hours) Half-Life Elimination V dss:Free cobalamins-(III): 280.7 to 349.5 L Total cobalamins-(III): 21.8 to 25.6 L Metabolism Pharmacokinetics/Pharmacodynamics Distribution

In the presence of cyanide, each hydroxocobalamin molecule can bind one cyanide ion by displacing it for the hydroxo ligand linked to the trivalent cobalt ion, forming cyanocobalamin, which is then excreted in the urine. Cyanocobalamin acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis, used in cell replication and hematopoiesis. Hydroxocobalamin (vitamin B 12a) is a precursor to cyanocobalamin (vitamin B 12).