Cynomin-H 1000 mcg/ml

Cynomin-H 1000 mcg/ml | INDICATIONS AND USES

Hydroxocobalamin is indicated for the treatment of known or suspected cyanide poisoning.Identifying Patients with Cyanide Poisoning: Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from ... Read moreHydroxocobalamin is indicated for the treatment of known or suspected cyanide poisoning.Identifying Patients with Cyanide Poisoning: Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Hydroxocobalamin should be administered without delay.In some settings, panic symptoms including tachypnea and vomiting may mimic early cyanide poisoning signs. The presence of altered mental status (e.g., confusion and disorientation) and/or mydriasis is suggestive of true cyanide poisoning although these signs can occur with other toxic exposures as well.Smoke Inhalation: Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult. Prior to administration of Hydroxocobalamin, smoke-inhalation victims should be assessed for the following:

Exposure to fire or smoke in an enclosed area
Presence of soot around the mouth, nose or oropharynx
Altered mental status

Although hypotension is highly suggestive of cyanide poisoning, it is only present in a small percentage of cyanide-poisoned smoke inhalation victims. Also indicative of cyanide poisoning is a plasma lactate concentration ≥ 10 mmol/L (a value higher than that typically listed in the table of signs and symptoms of isolated cyanide poisoning because carbon monoxide associated with smoke inhalation also contributes to lactic acidemia). If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.Use with Other Cyanide Antidotes: Caution should be exercised when administering other cyanide antidotes simultaneously with Hydroxocobalamin, as the safety of co-administration has not been established. If a decision is made to administer another cyanide antidote with Hydroxocobalamin, these drugs should not be administered concurrently in the same intravenous line.

Cynomin-H 1000 mcg/ml | PHARMACOLOGY

Vitamin B12 with hydroxyl group complexed to cobalt which can be displaced by cyanide resulting in cyanocobaiamin that is renally excreted.

Cynomin-H 1000 mcg/ml | DOSAGE & ADMINISTRATION

Thirty mcg daily for 5 to 10 days followed by 100 to 200 mcg monthly injected intramuscularly. If the patient is critically ill, or has neurologic disease, an infectious disease or hyperthyroidism, considerably higher doses may be indicated. However, current data indicate that the optimum obtainable neurologic response may be expected with a dosage of vitamin B12 sufficient to produce good hematologic response. Children may be given a total of 1 to 5 mg over a period of 2 or more weeks in doses of 100 mcg, then 30 to 50 mcg every 4 weeks for maintenance.

Cynomin-H 1000 mcg/ml | DRUG INTERACTIONS

history of interaction with ARI Sodium Iodide (II23) 1 -12 MBq (sodium iodide i-123)
ARI Sodium Iodide (1123) 100-750 MBq (sodium iodide i-123) arsenic trioxide
Chloracol (chloramphenicol) chloramphenicol
Chloromycetin (chloramphenicol)
Chloromycetin Sodium Succinate (chloramphenicol)
Hicon (sodium iodide-i-131) lodotope (sodium iodide-i-131) sodium iodide i-123 sodium iodide-i-131 Trisenox (arsenic trioxide)

Cynomin-H 1000 mcg/ml | SIDE EFFECTS

Mild transient diarrhea, itching, transitory exanthema, feeling of swelling of entire body, and anaphylaxis. A few patients may experience pain after injection of hydroxocobalamin.

Cynomin-H 1000 mcg/ml | USE DURING PREGNANCY AND LACTATION

Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Cynomin-H 1000 mcg/ml | PRECAUTIONS & WARNINGS

The validity of diagnostic vitamin B12 or folic acid blood assays could be compromised by medications, and this should be considered before relying on such tests for therapy.Vitamin B12 is not a substitute for folic acid and since it might improve folic acid deficient megaloblastic anemia, indiscriminate use of vitamin B12 could mask the true diagnosis.Hypokalemia and thrombocytosis could occur upon conversion of severe megaloblastic to normal erythropoiesis with B12 therapy. Therefore, serum potassium levels and the platelet count should be monitored carefully during therapy.Vitamin B12 deficiency may suppress the signs of polycythemia vera. Treatment with vitamin B12 may unmask this condition.

Cynomin-H 1000 mcg/ml | THERAPEUTIC CLASS

Antidote preparations, Drugs for Megaloblastic Anemia

Cynomin-H 1000 mcg/ml | STORAGE CONDITIONS

Should be stored in cool and dry place