Cynomin H

• Addisonian pernicious anaemia
• Other macrocytic anaemias associated with vitamin B12 deficiency
• Nutritional deficiencies
• Schilling test (vitamin B12 absorption and deficiency states)

Adult Dose (Intramuscular):

• Addisonian pernicious anaemia (without neurological involvement): Initial: 250-1,000 mcg on alternate days (1-2 weeks), then 250 mcg weekly; Maintenance: 1,000 mcg monthly
• Addisonian pernicious anaemia (with neurological complications): Initial: 1,000 mcg on alternate days; Maintenance: 1,000 mcg monthly
• Prophylaxis: 250-1,000 mcg monthly
• Nutritional deficiencies: 30 mcg daily for 5-10 days, then 100-200 mcg monthly

Child Dose (Intramuscular):

• 1-5 mg over 2 or more weeks in doses of 100 mcg, then 30-50 mcg every 4 weeks for maintenance

Schilling test: 1,000 mcg intramuscular injection

Common Side Effects:

• Allergy
• Flushing (warmth in face, ears, neck and trunk)
• Anaphylactic reaction
• Dark colored urine
• Erythema (skin redness)

Occasional: Itching exanthema, chills, fever, nausea, dizziness, anaphylactic shock (rare), acneiform and bullous eruptions (rare)

Use in Pregnancy: May be unsafe; animal studies have shown harmful effects; should not be used for treatment of megaloblastic anaemia of pregnancy.

Precautions:

• Regularly monitor serum potassium levels and platelet count during therapy (to avoid hypokalemia and thrombocytosis)
• Tell doctor if pregnant, planning to become pregnant or breastfeeding
• Should not be given without first confirming the diagnosis if possible
• Regular blood examination is advisable
• If megaloblastic anaemia fails to respond, investigate folate metabolism
• Cardiac arrhythmias secondary to hypokalemia reported during initial therapy; monitor plasma potassium