cyanocobalamin
Cyanocobalamin (Dodex) is an injectable form of vitamin B12 that's used to treat low blood vitamin B12 levels (vitamin B12 deficiency). It can also help restore vitamin B12 levels in adults with anemia due to low vitamin B12. Cyanocobalamin (Dodex) is typically given as an injection through the skin or into the muscle. The dosage can vary and depends on why you need to take cyanocobalamin (Dodex). This medication is available as a lower-cost generic.
What is Cyanocobalamin (Dodex)?
What is Cyanocobalamin (Dodex) used for?
Vitamin B12 deficiency, including with pernicious anemia
Schilling test (vitamin B12 absorption test) - not commonly used
How Cyanocobalamin (Dodex) works
Cyanocobalamin (Dodex) is a form of vitamin B12. Vitamin B12 is important for several processes in your body, including these three major roles:
It promotes red blood cell production to help treat and prevent a condition called pernicious anemia.
It keeps nerve cells healthy so that they work well.
It helps make genetic material (DNA).
Drug Facts
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What are the side effects of Cyanocobalamin (Dodex)?
Common Side Effects
- See Other Side Effects.
Other Side Effects
- Itching
- Diarrhea
- Shortness of breath
Serious Side Effects
- Serious allergic reaction: rash; trouble breathing; swelling of the lips, tongue, or face; vomiting
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Swelling of the ankles, hands, or feet
- Trouble breathing
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
Pros and cons of Cyanocobalamin (Dodex)
Pros
Works well to raise vitamin B12 levels
Typically given once daily to once monthly
Can be used in children
Cons
Needs to be injected under the skin or into the muscle, which can be uncomfortable
Typically lifelong treatment with injections for pernicious anemia
Can cause aluminum toxicity since it contains aluminum
Pharmacist tips for Cyanocobalamin (Dodex)
If your provider says it's okay to give yourself cyanocobalamin (Dodex) at home, make sure you understand how to give yourself the injections properly. If you have any questions, contact your pharmacist or healthcare provider.
If you're giving yourself cyanocobalamin (Dodex) at home, make sure to throw your vials and syringes in a sharps container to prevent needlestick injuries.
Mark your appointments in your calendar to see your provider and get any ordered blood tests drawn (e.g., potassium, vitamin B12, blood count). This will help you and your provider see how well cyanocobalamin (Dodex) is working for you and look for any side effects.
Discuss with your provider how much vitamin B12 you should be getting from your diet or other dietary supplements while taking cyanocobalamin (Dodex).
Vitamin B12 is found in many other multivitamins and supplements. Make sure to read labels carefully on all of the dietary supplements you're taking to see if it contains cyanocobalamin (Dodex).
More on Cyanocobalamin (Dodex) tips
Frequently asked questions about Cyanocobalamin (Dodex)
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What are the risks and warnings for Cyanocobalamin (Dodex)?
Cyanocobalamin (Dodex) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Severe allergic reactions
Severe allergic reactions to cyanocobalamin (Dodex) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (closing of the throat). It's recommended that your provider give you a test dose of cyanocobalamin before starting treatment to determine whether you're at risk of having an allergic reaction to the medication. If you notice difficulty breathing, a choking sensation, swelling around your eyes, swelling of the lips or tongue, dizziness, or nausea after using cyanocobalamin (Dodex), get medical attention right away.
Not recommended for people with Leber’s disease (a rare genetic eye condition)
People with a rare, inherited eye condition called Leber's disease who received vitamin B12 developed severe eye damage. Vitamin B12 products containing cyanocobalamin, including cyanocobalamin (Dodex), isn't recommended in people with Leber's disease. If you have Leber's disease, speak with your provider about alternatives for vitamin B12 supplementation (like hydroxocobalamin).
Toxicity from too much aluminum
Risk factors: History of kidney problems | Babies who were born early (premature)
Cyanocobalamin (Dodex) contains aluminum. Too much cyanocobalamin (Dodex) can cause high blood aluminum levels and can lead to aluminum toxicity. Your provider might order aluminum blood levels while you're taking cyanocobalamin (Dodex), especially if you have kidney problems since you're at higher risk. Contact your provider if you notice any signs or symptoms of aluminum poisoning (e.g., weakness, speech problems, bone pain, seizures).
Risk of serious breathing problem in infants (gasping syndrome)
Risk factors: Newborns | Infants with low birth weight | Pregnant people | Breastfeeding
Certain cyanocobalamin (Dodex) products have a preservative called benzyl alcohol. This preservative can cause a rare, but serious and sometimes life-threatening medical condition called gasping syndrome. This condition is more likely to happen in newborns and infants with low birth weight. If you're pregnant or breastfeeding, talk with your provider before receiving cyanocobalamin (Dodex), since your baby could potentially be exposed to benzyl alcohol in the womb or through your breast milk. Tell your provider if your child experiences any major weight changes while receiving cyanocobalamin (Dodex). Get medical attention right away if your child has symptoms, such as gasping, slowed heart rate, clammy skin, seizures, or weakness in an arm or leg.
Close monitoring needed for people with severe pernicious anemia
If you have severe pernicious anemia, your provider might monitor you more closely. Treating severe pernicious anemia with vitamin B12 can cause low potassium and high platelet levels. These conditions can be serious and life-threatening. Your provider will track your potassium and platelet levels through bloodwork during treatment with cyanocobalamin (Dodex). Don't use any other vitamin B12 supplement while taking cyanocobalamin (Dodex) unless your provider specifically instructs you to. Contact your provider if you notice headache, confusion, shortness of breath, heart palpitations (chest pounding), muscle weakness or cramps, or unusual bleeding. These can be symptoms of electrolyte or platelet problems.
Potential to hide anemia due to low folic acid
Risk factors: Taking more than 10 mcg of vitamin B12 daily
Taking vitamin B12 can sometimes mask anemia due to low folic acid levels). This means that vitamin B12 might help raise your red blood cell count without affecting your folic acid (folate) levels (so your folic acid levels will still be low). Your provider might check your folic acid levels through bloodwork to make sure you receive appropriate treatment for all your nutrient deficiencies.
Cyanocobalamin (Dodex) dosage forms
Typical dosing for Cyanocobalamin (Dodex)
Pernicious anemia (low red blood cell count due to low vitamin B12): The typical dose is 100 mcg injected into the muscle or under the skin once daily for 6 or 7 days. If your vitamin B12 levels improve, 100 mcg can be given on alternating days for 7 doses, then every 3 to 4 days for another 2 to 3 weeks. Then, you'll receive 100 mcg of cyanocobalamin (Dodex) once monthly lifelong.
Low vitamin B12 levels that aren't due to gut problems: People who can't take the cyanocobalamin by mouth (for whatever reason) can receive cyanocobalamin (Dodex) for a short amount of time. Your provider will decide the dose based on how low your vitamin B12 levels are. You'll probably switch to the oral version of cyanobalamin for long-term treatment.
Schilling test (vitamin B12 absorption test): The typical dose is 1,000 mcg injected into the muscle after taking an oral cyanocobalamin dose (taken by mouth).
More on Cyanocobalamin (Dodex) dosage forms
How much does Cyanocobalamin (Dodex) cost?
Cyanocobalamin (Dodex) contraindications
Allergy to cobalt or vitamin B12
What are alternatives to Cyanocobalamin (Dodex)?
Vitamin B12 deficiency, including with pernicious anemia
Schilling test (vitamin B12 absorption test) - not commonly used
To maintain normal vitamin B12 levels in adults with pernicious anemia (low red blood cell count due to low vitamin B12) after receiving cyanocobalamin injection
To treat and prevent vitamin B12 deficiency in adults
Vitamin B12 deficiency (low vitamin B12 levels)
Schilling test (vitamin B12 absorption test)
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References
Best studies we foundAllen, L. H. (2012). Vitamin B-12. Advances in Nutrition.
Calderón-Ospina, C. A., et al. (2020). B Vitamins in the nervous system: Current knowledge of the biochemical modes of action and synergies of thiamine, pyridoxine, and cobalamin. Central Nervous System Neuroscience & Therapeutics.
Hikma Pharmaceuticals USA Inc. (2023). Cyanocobalamin injection [package insert]. DailyMed.
MedGen. (n.d.). Gasping syndrome. National Library of Medicine.
MedlinePlus. (2022). Folate-deficiency anemia.
MedlinePlus. (2022). Pernicious anemia.
MedlinePlus. (2022). Schilling test.
National Heart, Lung, and Blood Institute. (2022). Thrombocythemia and thrombocytosis.
National Institutes of Health, Office of Dietary Supplements. (2023). Vitamin B12: Fact sheet for consumers.
National Organization for Rare Disorders. (2008). Anemia, pernicious.
Rahimzadeh, M. R., et al. (2022). Aluminum poisoning with emphasis on its mechanism and treatment of intoxication. Emergency Medicine International.
Ramphul, K., et al. (2023). Schilling test. StatPearls.
Shemesh, A., et al. (2022). Leber hereditary optic neuropathy (LHON).
Vaqar, S., et al. (2023). Pernicious anemia. StatPearls.
Vasavada, A., et al. (2023). Cyanocobalamin. StatPearls.
Zagouri, F., et al. (2020). Supportive medication in cancer during pregnancy. Biomed Central Pregnancy and Childbirth.
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