Hydroxocobalamin
Hydroxocobalamin is a synthetic form of vitamin B12 used primarily to treat vitamin B12 deficiency states, including pernicious anemia and other B12-related anemias. It also serves as an antidote for cyanide poisoning, where it binds to cyanide molecules to form non-toxic cyanocobalamin that can be excreted by the body.
Hydroxocobalamin is a vitamin B12 formulation used for treating B12 deficiency and cyanide toxicity.
Key facts at a glance
- ATC
- B03BA03
- RxNorm
- 5514
- Generic
- Hydroxocobalamin
- Class
- atc-b03
- Brands
- Cyanokit
- Availability
- rx
- Lactation
- unknown
- Routes
- —
- Forms
- solution, injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
9 groupspregnancy
first trimesteruse only if clearly needed
reserve for life-threatening cyanide poisoning; avoid routine supplementation
fetal monitoring if used
Use with caution and monitor for adverse effects.
pregnancy
second trimesteruse only if clearly needed
use when benefits outweigh potential fetal risks
fetal monitoring
Use with caution and monitor for adverse effects.
pregnancy
third trimesteruse only if clearly needed
use for acute cyanide poisoning treatment
fetal and maternal monitoring
Use with caution and monitor for adverse effects.
lactation
breastfeedingno adjustment needed
compatible with breastfeeding; vitamin B12 is normally secreted in breast milk
no specific monitoring required
pediatric_age
neonatesweight-based dosing required
use for cyanide poisoning in neonates; limited pediatric data
close monitoring of vital signs and renal function
Use with caution and monitor for adverse effects.
pediatric_age
childrenweight-based dosing
approved for pediatric cyanide poisoning at 70 mg/kg up to 5 grams
monitor blood pressure and renal function
Use with caution and monitor for adverse effects.
geriatric
elderlystandard dosing
standard adult dosing applies; monitor renal function
monitor renal function and blood pressure
renal_impairment
severe renal impairmentuse with caution; no formal dose adjustment
monitor renal function closely; drug is renally excreted
close renal function monitoring
Use with caution and monitor for adverse effects.
hepatic_impairment
severe hepatic impairmentno adjustment needed
not primarily hepatically metabolized; use standard dosing
standard monitoring
Statistics and clinical data
Drug class
Cobalamin derivative used for cyanide poisoning and B12 deficiency
Primary indication
Approved indication for acute cyanide toxicity
FDA approval year
FDA approval for cyanide poisoning indication
Mechanism of action
Molecular mechanism of detoxification
Treatment of vitamin B12 deficiency (pernicious anemia, malabsorption syndromes, nutritional deficiencies) and acute cyanide poisoning. May also be used for preventative supplementation in certain high-risk populations.
Hydroxocobalamin is converted in the body to active cobalamin coenzymes (methylcobalamin and adenosylcobalamin), which are essential for DNA synthesis, red blood cell formation, and neurological function. For cyanide poisoning, it directly binds cyanide ions to form cyanocobalamin for urinary excretion.
May cause temporary reddish discoloration of urine, skin, or mucous membranes. Generally well-tolerated but may cause allergic reactions in rare cases. Administered via intramuscular or intravenous routes depending on the indication. Requires proper diagnosis of underlying deficiency before initiating therapy.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 24, 2026. · Read our editorial policy