Megaloblastic anaemia
Drug Safety Update
December 2023: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions
NICE Guidance
NG239: Vitamin B12 deficiency in over 16s: diagnosis and management, March 2024
NG201: Antenatal care, August 2021
CG156: Fertility problems: assessment and treatment, September 2017
Folic acid: 400micrograms daily should be recommended for all women attempting to conceive and continued until the 12th week of pregnancy to reduce the risk of a neural tube defect. Women at high risk, (women with epilepsy and those with a previous affected pregnancy), should take 5mg from preconception until 12 weeks. Pregaday® is a combined iron and folic acid preparation but only contains 350micrograms of folic acid.
When offering oral vitamin B12 replacement in pregnancy or during breastfeeding, consider a dosage of at least 1 mg a day. Otherwise please see KMICB position statement here for local recommendations.
Cyanocobalamin 1mg tablets for use in pregnancy as an alternative to IM hydroxocobalamin injections.
Cyanocobalamin injection is not used therapeutically, hydroxocobalamin provides better replacement as it is retained in the body longer than cyanocobalamin. However, it may be used for the Schilling test.
Pregaday is available to purchase OTC.
| Pack |
|---|
| 90 tablet (9 x 10 tablets) |
| Pack |
|---|
| 1000 tablet |
| 28 tablet (2 x 14 tablets) |
| Pack |
|---|
| 150 ml |
| Pack |
|---|
| 150 ml |
Cyanocobalamin tablets are not recommended for prescribing. Please see K&M ICB Position Statement here.
Cyanocobalamin 1mg tablets for use in pregnancy as an alternative to IM hydroxocobalamin injections.
| Pack |
|---|
| 1 tablet |
| 60 tablet |
| 28 tablet |
| 100 tablet |
| 90 tablet |
| 50 tablet |
| 30 tablet |
This is not used therapeutically hydroxocobalamin provides better replacement as it is retained in the body longer than cyanocobalamin. This may be used for the Schilling test.
| Pack |
|---|
| 5 ampoule |
- On Formulary Preferred
- On Formulary Second Line
- On Formulary Third Line
- Specialist Initiation
- Secondary Care Only
- Not Approved for Formulary