Monograph Details
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Hematology
> Anemias
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NASCOBAL |
| Manufacturer |
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Questcor Pharmaceuticals |
| Legal Classification |
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Rx
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| Generic Name |
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Cyanocobalamin 500micrograms/0.1mL; intranasal gel. |
| Indications |
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Maintenance of hematologic remission after intramuscular Vit. B12 therapy when Vit. B12 supplementation is needed. |
| Children |
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Not recommended. |
| Adults |
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Hematological parameters must be within normal range before beginning therapy. Allow at least 1 hour before or after hot foods or liquids. Initial dose: One spray (500micrograms) in one nostril once per week. Monitor response, may increase dose if serum B12 levels decline. Adjust dose in increments of 500micrograms. |
| Precautions |
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Confirm diagnosis. May need supplemental folate. Leber's disease. Defer dose if nasal congestion, rhinitis, or upper respiratory infections occur. Reevaluate if low levels of Vit. B12 persist despite treatment. Do not use for Schilling Test. Infection, uremia, bone marrow suppressants, and iron or folic acid deficiency may reduce response. May unmask polycythemia vera. Monitor B12 blood levels 1 month after starting therapy, 1 month after any dose increase, and regularly at 3–6 month intervals. Monitor serum potassium, platelet counts. Pregnancy (Cat.C). |
| Interactions |
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Antibiotics, methotrexate, pyrimethamine may interfere with lab tests. Colchicine, chronic heavy alcohol use may impair Vit. B12 absorption. |
| Adverse Reactions |
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Headache, nausea, rhinitis. |
| How Supplied |
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Intranasal gel soln (2.3mL)—1 (8 doses) |
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