CaloMist: Adult Dosing

Dosage forms: 25 mcg/spray

vitamin B12 deficiency, adjunct tx

1 spray/nostril qd

Info: for maintenance after normalization w/ IM vitamin B12 in pts w/o nervous system involvement; may incr. to 1 spray/nostril bid in pts w/ inadequate response; separate admin. from other nasal drugs by 3h

renal dosing

see below

renal impairment: caution advised, consider incr. dose freq and/or amt

hepatic dosing

see below

hepatic impairment: caution advised, consider incr. dose freq and/or amt

CaloMist: Peds Dosing

This information is currently unavailable or not applicable for this drug.

CaloMist: Contraindications/Cautions

• hypersens. to drug/class/compon.
• hypersens. to cobalt
• hereditary optic atrophy
• caution if myelosuppression
• caution if uremia
• caution if infection
• caution if iron deficiency
• caution if folate deficiency
• caution if polycythemia
• caution if nasal pathology, significant
• caution if rhinitis/URI symptoms
• caution if other nasal drug use
• caution if impaired renal fxn
• caution if impaired hepatic fxn

CaloMist: Drug Interactions

Monitor/Modify Tx

• chloramphenicol

• omeprazole

Caution Advised

• colchicine

CaloMist: Adverse Reactions

Serious Reactions

• hypokalemia
• thrombocytosis
• angioedema

Common Reactions

• rhinorrhea
• nasopharyngitis
• arthralgia
• dizziness
• headache
• nasal irritation
• pain
• bronchitis
• rash

CaloMist: Safety Monitoring

Pregnancy: C

Lactation: Safe

Monitoring Parameters: K; Plt

CaloMist: Pharmacology

Metabolism: liver; CYP450: unknown

Excretion: bile; urine (excess unchanged drug); Half-life: 6 days; Info: 90% stored in liver

Class: Vitamins/Nutritionals

Mechanism Of Action
essential component and participant in physiologic systems and reactions

CaloMist: Manufacturer/Pricing

Manufacturer: Fleming and Company DEA/FDA: Rx

CaloMist: Patient Education

• Generic Name: cyanocobalamin (nasal)

• Pronounced: sye AN oh koe BAL a min

• Brand Names: CaloMist, Nascobal

What is the most important information I should know about nasal cyanocobalamin?

You should not use this medication if you are allergic to cobalt, or if you have Leber's disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber's disease.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Use all of your medications as directed.

Avoid eating or drinking hot foods or liquids within 1 hour before or after using the nasal form of this medication.

Tell your doctor if you develop nasal congestion, a cold, or allergies. The nasal spray may not work as well if you are congested.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.

What is nasal cyanocobalamin?

Cyanocobalamin is a man-made form of vitamin B12. Vitamin B12 is important for growth, cell reproduction, blood formation, and protein and tissue synthesis.

Cyanocobalamin is used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions.

Cyanocobalamin may also be used for other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before using nasal cyanocobalamin?

You should not use this medication if you are allergic to cobalt, or if you have Leber's disease. Cyanocobalamin can lead to optic nerve damage (and possibly blindness) in people with Leber's disease.

Before using cyanocobalamin, tell your doctor if you have:

• any type of infection;
• iron or folic acid deficiency;
• kidney or liver disease; or
• if you are receiving any medication or treatment that affects bone marrow.

Tell your doctor if you develop nasal congestion, a cold, or allergies. Nasal cyanocobalamin may not work as well if your nose is congested.

FDA pregnancy category C. It is not known whether this medication can harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Cyanocobalamin passes into breast milk, but it is not known whether cyanocobalamin could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use nasal cyanocobalamin?

Use this medication exactly as prescribed by your doctor. Do not use it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Your dose needs may change if you become pregnant, if you breast-feed, or if you eat a vegetarian diet. Tell your doctor about any changes in your diet or medical condition.

To use nasal cyanocobalamin.

• Gently blow your nose to clear any mucus.
• Prime the nasal gel pump before your first use and whenever it has been longer than 2 days between uses. Pump the gel unit several times until a gel droplet appears at the tip, then pump 2 more times.
• Prime the nasal spray before your first use by pumping the spray a few times until a fine mist appears. Prime the pump 1 time before each use thereafter.
• Insert the tip of the nasal pump about half an inch into your nostril, pointing it toward the back of the nose.
• Gently press your other nostril closed with your finger, and tilt your head forward. Pump and sniff gently at the same time. Return your head to an upright position.
• Remove the pump from your nose. Rub your nostril gently for a few seconds.
• Clean the tip of the spray or gel pump with a clean tissue and recap.

To be sure this medication is helping your condition, your blood will need to be tested every 3 to 6 months. This will help your doctor determine the correct dose and how long to treat you with cyanocobalamin. Do not miss any scheduled appointments.

To treat pernicious anemia, you will have to use this medication on a regular basis for the rest of your life. Not using the medication can lead to irreversible nerve damage in your spinal cord.

Pernicious anemia is also treated with folic acid to help maintain red blood cells. However, folic acid will not treat Vitamin B12 deficiency and will not prevent possible damage to the spinal cord. Use all of your medications as directed.

Store this medication at room temperature away from moisture, heat, and light. Keep the nasal gel in the prescription vial when not in use. Store the nasal spray upright.

What happens if I miss a dose?

Use the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to use the medicine and skip the missed dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of cyanocobalamin is not likely to cause life-threatening symptoms.

What should I avoid while using nasal cyanocobalamin?

Do not drink hot liquid or eat hot food within 1 hour before or after you use nasal cyanocobalamin.

Avoid drinking large amounts of alcohol while you are being treated with cyanocobalamin.

Avoid using any other nasal medications that your doctor has not recommended or prescribed.

What are the possible side effects of nasal cyanocobalamin?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• chest pain;
• feeling short of breath, even with mild exertion;
• swelling, rapid weight gain; or
• unusual warmth, redness, or pain in an arm or leg.

Less serious side effects may include:

• headache, dizziness, weakness;
• nausea, upset stomach, diarrhea;
• numbness or tingling;
• runny nose, sneezing, sore throat, swollen tongue;
• fever;
• joint pain; or
• itching or rash.

This list is not complete and other side effects may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect nasal cyanocobalamin?

Before using cyanocobalamin, tell your doctor if you are taking any of the following medications:

• antibiotics;
• methotrexate (Rheumatrex);
• pyrimethamine (Daraprim);
• colchicine; or
• if you drank a lot of alcohol within the past 2 weeks.

This list is not complete and there may be other drugs that can interact with cyanocobalamin. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about nasal cyanocobalamin.

---

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

CaloMist: Pill Pictures

This information is currently unavailable or not applicable for this drug.