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Cyanocobalamin (Vitamin B-12) (Into the nose)

Cyanocobalamin (sye-an-oh-koe-BAL-a-min)

Treats vitamin B12 deficiency and pernicious anemia.

Brand Name(s):


There may be other brand names for this medicine.

When This Medicine Should Not Be Used:

This medicine is not right for everyone. Do not use it if you had an allergic reaction to cobalt or any vitamin B12 injection or supplement.

How to Use This Medicine:

Gel/Jelly, Spray

  • Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
  • Do not drink hot liquids or eat a hot meal for at least 1 hour before or 1 hour after you use this medicine.
  • This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
  • This medicine contains only 1 spray. Use each nasal spray device only one time. You do not need to prime it before using.
  • Before using the medicine, gently blow your nose to clear the nostrils.
  • Hold the nasal spray device with your thumb on the bottom and your pointer finger and middle finger on either side of the nozzle.
  • Close 1 nostril with your other index finger, then insert the nozzle into the open nostril about half an inch or as far as it feels comfortable. Tilt your head slightly forward.
  • Breathe in gently through your nose, close your mouth, and at the same time press the plunger firmly upwards with your thumb.
  • Remove the nozzle from your nostril. At the same time, keep your head straight for 10 to 20 seconds while gently breathing in through your nose and breathing out through your mouth.
  • Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
  • Missed dose: You must use this medicine on a fixed schedule. Call your doctor or pharmacist if you miss a dose.
  • Keep the bottle tightly closed when not using it. Store at room temperature, away from heat and direct light. Keep the medicine in its original container until you are ready to use it.

Drugs and Foods to Avoid:

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Some medicines can affect how cyanocobalamin works. Tell your doctor if you are also using chloramphenicol to treat anemia.

Warnings While Using This Medicine:

  • Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, bone marrow problems, a folic acid or iron deficiency, or Leber disease. Tell your doctor if you drink alcohol regularly or if you are a vegetarian.
  • Congestion in your nose can affect how this medicine works. Tell your doctor if you have a runny or stuffy nose, a cold, or allergies.
  • Carefully follow your doctor's instructions about diet and oral vitamin supplements.
  • Pernicious anemia: You will need to use this medicine for the rest of your life. Talk to your doctor if you have concerns.
  • Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
  • Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Dry mouth, increased thirst, muscle cramps, nausea, vomiting, uneven heartbeat
  • Fever, chills, cough, sore throat, body aches
  • Unusual bleeding, bruising, or weakness

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Last Updated: 5/1/2020

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