Cyanocobalamin Uses, Benefits, Dosages, & Side Effects

Cyanocobalamin is a form of the B-complex vitamin commonly called vitamin B12.

In humans, cobalamin (B12) is integral for producing blood cells and platelets in bone marrow through a process called hematopoiesis.

It is also crucial for proper growth, cellular reproduction and for nucleoprotein and myelin synthesis.

Cyanocobalamin also functions together with pyridoxine (vitamin B6) and folic acid (vitamin B9) to maintain healthy nerves and to synthesize genetic material like RNA (ribonucleic acid) and DNA (deoxyribonucleic acid).

This vitamin also helps the body to regulate homocysteine; an amino acid homologue that might contribute to heart disease in high levels. [1, 2, 3]

This article reviews what scientists have learned about cyanocobalamin. Its constituents, mechanisms, uses, dosages, benefits, safety, side effects and interactions will be covered.

Cyanocobalamin

Vitamin B12

Energy

Brain Health

B12 Deficiency

How It Works:

• Supports normal growth and energy levels
• Helps maintain healthy nerve cells
• Essential for red blood cell formation

Dosage:

Between 50 - 6,000 mcg per day

Safety:

Rated Likely Safe

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What is Cyanocobalamin?

Cyanocobalamin contains cobalt (Co) as its central metal ion. Its molecular formula is C63H88CoN14O14P. [2]

Cyanocobalamin is water-soluble; meaning it dissolves in water, but not in lipids (fats). As such, it is not stored inside the body and must be constantly resupplied. [2]

The University of Maryland Medical Center (UMM) states that the body cannot produce its own vitamin B12; making it an essential nutrient

Vitamin B12 is found in some foods naturally and added to other foods. It is also available as a dietary supplement, and as a prescription medication. [2]

The National Institutes of Health (NIH) states, “Vitamin B12 exists in several forms and contains the mineral cobalt, so compounds with vitamin B12 activity are collectively called ‘cobalamins’.” [3]

The two forms of B12 that are metabolically-active in humans are called methylcobalamin (methyl-B12) and 5-deoxyadenosylcobalamin. [3]

Vitamin B12 is the most chemically-complex of all vitamins. According to PubChem, “Cyanocobalamin’s structure is based on a corrin ring, which, although similar to the porphyrin ring found in heme, chlorophyll, and cytochrome, has two of the pyrrole rings directly bonded.” [4]

Cyanocobalamin occurs naturally as dark-red crystals, or crystalline powder. It is odorless and tasteless. [4]

Uses for Cyanocobalamin

The Natural Medicines Comprehensive Database (NMCD) states that people take cyanocobalamin supplements for many purposes.

It is used orally (by mouth), topically (applied externally), intranasally (via the nose), intramuscularly (injected into muscle), intravenously (injected into blood vein) and subcutaneously (injected under skin). [5]

Some uses for oral cyanocobalamin supplementation include: [5]

• Protection against the toxins and allergens from tobacco smoke;
• ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease);
• Hyperhomocysteinemia (high serum cholesterol);
• Preventing and treating vitamin B12 deficiency;
• Hypertriglyceridemia (high serum triglycerides);
• AMD (age-related macular degeneration);
• IBD (inflammatory bowel disease);
• Improving cognitive function;
• Treating pernicious anemia;
• MS (multiple sclerosis);
• Boosting immunity;
• Increasing energy;
• Elevating mood;

There are dozens of other uses for this dietary supplement – including treatment for heart disease, male infertility, diabetes, memory loss, osteoporosis, various psychiatric disorders, AIDS and chronic diarrhea. [5]

Cyanocobalamin is also used orally for treating respiratory tract infections, liver and kidney disease, periodontal disease, hemorrhage, canker sores and tinnitus. [5]

Vitamin B12 is also taken by mouth its purported ability to reduce the risk of lung, colorectal, breast, cervical, prostate and other types of cancer. [5] However, research studies conducted so far have not demonstrated a benefits for cancer prevention.

Topically, cyanocobalamin is administered commonly along with avocado oil, for treating eczema (atopic dermatitis) and psoriasis. [5]

Vitamin B12 is administered intranasally for correcting vitamin B12 deficiency, and pernicious anemia. [5]

Some doctors administer cyanocobalamin parenterally for: [5]

• Preventing and treating vitamin B12 deficiency and associated myelopathy;
• Treating pernicious anemia (inability to produce healthy blood cells);
• Tremor associated with shaky-leg syndrome (orthostatic tremor);
• CFS (chronic fatigue syndrome);
• Liver and kidney disease;
• Diabetic neuropathy;
• Hepatitis C;

There are many other uses for cyanocobalamin not listed above. Seek medical advice about any intended use you may have in mind for this dietary supplement.

How does Cyanocobalamin Work inside the Body?

UMM states that cyanocobalamin works along with folic acid (vitamin B9) to help iron to be better utilized and to make new blood cells. [2]

These two B-complex vitamins also work synergistically to produce a chemical, called SAMe (S-adenosylmethionine) that is involved in regulating mood and immunity. [2]

PubChem reports, “Cyanocobalamin is a cobalt-containing coordination compound generated by intestinal microbes, and a natural water-soluble vitamin of the B-complex family that must combine with Intrinsic Factor and calcium ions for absorption by the intestine.” [4]

Like other B-complex vitamins, vitamin B12 is used to help metabolize carbohydrates, proteins and fats. It also helps to facilitate choline and folic acid synthesis. [4]

According to RXList, cyanocobalamin: [1]

• Reaches peak plasma levels about 1 hour after intramuscular injection;
• Is rapidly absorbed from intramuscular/subcutaneous sites of injection;
• Is transported via specific B12 binding proteins;
• Is majorly excreted via urine within 8 hours;
• Is stored primarily inside the liver;

Although cyanocobalamin is the most commonly-used form of vitamin B12, hydroxycobalamin is said to be equally effective. [1]

Cyanocobalamin can be utilized as an enzymatic cofactor in the body to produce methionine synthase, which is then used to reduce plasma homocysteine levels. [6]

Examine.com states, “Vitamin B12 is also important in the process of methylation or methyl donation, a process where a small chemical group known as a methyl group is donated from one molecule to another to support metabolic function.” [6]

NMCD expands, “Methionine synthase catalyzes the conversion of homocysteine to methionine. Methionine is required for the formation of S-adenosylmethionine, a universal methyl donor for almost 100 different substrates, including DNA, RNA, hormones, proteins, and lipids.” [5]

Cyanocobalamin Health Benefits

NMCD rates natural medicines on their efficacies in specific health conditions, based unbiasedly on evidence from research. Natural medicines can be rated as effective, likely effective, possibly effective, possibly ineffective, likely ineffective or insufficient reliable evidence to rate.

Cyanocobalamin is rated as effective for preventing and reversing vitamin B12 deficiency. [5] This will be reviewed in more detail below.

Vitamin B12 is also rated effective for treating a rare inherited condition called Imerslund-Grasbeck disease. It is marked by vitamin B12 deficiency that results in megaloblastic anemia (poor red blood cell production because of inhibited DNA synthesis). [5]

NMCD states, “Administering vitamin B12 intramuscularly in the form of hydroxocobalamin 1 mg daily for 10 days followed by monthly injections for the remainder of a patient’s life is effective for treating familial selective vitamin B12 malabsorption (Imerslund-Grasbeck disease).” [5]

Hyperhomocysteinemia:

Oral use of cobalamin and folic acid, and sometimes pyridoxine, is able to decrease serum levels of homocysteine.

Used alone, 0.5-5 mg/day folic acid reduces serum homocysteine by about 25%. Adding 0.5 mg/day vitamin B12 further reduces these levels by 7% on average. [5]

NMCD states, “Vitamin B12 in combination with folic acid and other vitamins also seems to significantly reduce homocysteine levels in patients with end-stage renal disease (ESRD) , as well as reduce the risk of cardiovascular events and mortality risk.” [5]

More research is needed to understand if and how cyanocobalamin reduces homocysteine in other groups, or how that might help to reduce risks for developing adverse cardiovascular conditions.

AMD:

Cyanocobalamin is rated possibly effective for age-related macular degeneration, and postherpetic neuralgia.

One large-scale human study showed that taking 1000 mcg (micrograms) cyanocobalamin, along with 50 mg folic acid and 2.5 mg pyridoxine, significantly reduces the risk for women developing age-related macular degeneration.

NMCD reports, “Women 40 years and older with a history of cardiovascular disease or at least three risk factors for cardiovascular disease who take this combination for an average of 7.3 years have a 34% reduced risk of developing AMD and a 41% reduced risk of visually significant AMD compared to placebo.” [5]

However, the effects of using cyanocobalamin without pyridoxine and folic acid for AMD are not clear. More research is needed.

Postherpetic Neuralgia:

In patients with subacute postherpetic neuralgia, 1000 mcg subcutaneous injections of methylcobalamin, 6 times weekly for 4 weeks, significantly reduced pain, relative to subcutaneous lidocaine or oral cyanocobalamin. [5]

NMCD states, “Additional clinical research shows that this same dose and duration of subcutaneous vitamin B12 significantly reduces pain and analgesic requirements compared to baseline in patients with postherpetic pain and itching.” [5]

More research is needed to fully understand how cyanocobalamin affects postherpetic neuralgia symptoms.

NMCD rates vitamin B12 possibly ineffective for reducing the risk of developing cancer. In elderly and middle-aged patients with cardiovascular disease, using vitamins B12, B6 and B9 together did not reduce cancer risks after a median usage span of 4.7 years. [5]

NMCD states, “Additional clinical research shows that taking vitamin B12 500 mcg, folic acid 2 mg, and vitamin B6 25 mg daily for around 3.4 years does not reduce the risk of cancer in patients recovering from stroke or transient ischemic attack.” [5]

NMCD also rates Vitamin B12 possibly ineffective for: [5]

• Circadian rhythm sleep disorders;
• Cognitive function;
• Fractures;
• Stoke;

There are a number of other conditions for which Vitamin B12 has been studied, but not extensively enough to make a determination about effectiveness. NMCD states that there is insufficient reliable evidence to rate its efficacy in the following conditions: [5]

Alzheimer’s disease, angioplasty, atherosclerosis (“clogged” arteries), eczema breast cancer, canker sores, cervical cancer, colorectal cancer, diabetic neuropathy, diarrhea, fatigue, hepatitis C, hypertriglyceridemia, lower respiratory tract infection, lung cancer, peripheral neuropathy, psoriasis, schizophrenia, shaky leg syndrome, and venous thromboembolism.

Seek medical advice if you are thinking about using a cyanocobalamin supplement for the prevention or treatment of any medical condition. The FDA has not approved the use of cyanocobalamin as a medicine for the treatment of any of the conditions listed above.

Cyanocobalamin Deficiency

Vitamin B12 deficiency in young, healthy non-vegan or vegetarian individuals with a standard American diet is rare.

However, it is not uncommon for elderly individuals to be mildly deficient in this essential nutrient. Low levels could be caused by a poor diet, or by a lack of stomach acids needed to absorb this vitamin. [2]

UMM states that other groups at higher risk for vitamin B12 deficiency include vegans, vegetarians, those with nutrient absorption disorders, those with Helicobacter pylori, infections, those with AIDS and those with diabetes mellitus. [2]

Some of the most common symptoms of cyanocobalamin deficiency include fatigue, shortness of breath, diarrhea, nervousness, numbness, and tingling in the toes and fingers. [2]

Severe cyanocobalamin deficiency can cause nerve damage. [2]

According to RXList, individuals with pernicious anemia or other conditions that can affect the absorption of vitamin B12 from the gastrointestinal tract may need to use forms of this supplement that do not rely on oral administration. [1]

Previously, this meant that people with low B12 levels would need to get intramuscular injections with cyanocobalamin once a month to maintain sufficient levels.

However, the injections were considered to be very painful and required regular visits to a doctor’s office, making them inconvenient and not cost effective. As a result, other alternatives for administering vitamin B12 were developed.

One popular example is sublingual drops or tablets. These products are placed under the tongue where they are absorbed through the mucosal membrane directly into the bloodstream.

Furthermore, according to NMCD, oral cyanocobalamin dietary supplements can be used to treat vitamin B12 deficiency in patients with pernicious anemia or malabsorption disorders.

Clinical research shows that oral treatments given in sufficiently high dosages can improve the vitamin B12 status of patients and that intramuscular injections are not necessary.

NMCD states that oral, intramuscular and intranasal administration of cyanocobalamin are all acceptable methods for reversing vitamin B12 deficiency. Ask your doctor which is best for you. [5]

Cyanocobalamin Dosage

The Linus Pauling Institute (LPI) reports the following RDAs (recommended daily allowances) for cyanocobalamin: [7]

• infants 0-6 months: 0.4 mcg/day (AI);
• Infants 7-12 months: 0.5 mcg/day (AI);
• Children 1-3 years: 0.9 mcg/day;
• Children 4-8: 1.2 mcg/day;
• Children 9-13 years: 1.8 mcg/day;
• Adolescents 14-18 years: 2.4 mcg/day;
• Adults 19-50 years: 2.4 mcg/day;
• Pregnancy all ages: 2.6 mcg/day;
• Breastfeeding all ages; 2.8 mcg/day;

Adults over 50 years of age are also advised to get 2.4 mcg/day cyanocobalamin. However, in this age group, it is recommended that, “Vitamin B12 intake should be from supplements or fortified foods due to the age-related increase in food-bound malabsorption.” [7]

Cyanocobalamin Foods

According to RXList, “Vitamin B12 is not present in foods of plant origin, but is abundant in foods of animal origin. In people with normal absorption, deficiencies have been reported only in strict vegetarians who consume no products of animal origin (including no milk products or eggs).” [1]

Some of the best sources of cyanocobalamin are clams, beef liver, fish, meat, poultry, eggs and dairy products. B12 may also be found in fortified foods – like breakfast cereals, for instance. This vitamin is not normally found in plants. [1]

The average human diet provides between 5-15 mcg/day cyanocobalamin. This is a protein-bound form that can be absorbed with normal digestion patterns. [1]

NIH lists the following foods with their respective amounts of cobalamin provided per serving:

• 3 oz cooked sockeye salmon: 4.8 mcg;
• 3 oz cooked rainbow trout: 5.4 mcg;
• 3 ounces cooked clam: 84.2 mcg;
• 3 oz cooked beef liver: 70.7 mcg;
• 1 large hard boiled egg: 0.6 mcg;
• 3 oz beef top sirloin: 1.4 mcg;
• 1 oz Swiss cheese: 0.9 mcg;
• 1 cup low-fat milk: 1.2 mcg;
• 3 oz cooked tuna: 2.5 mcg;

Cyanocobalamin Supplements

NIH states, “In dietary supplements, vitamin B12 is usually present as cyanocobalamin, a form that the body readily converts to the active forms 5-deoxyadenosylcobalamin and methylcobalamin.”

NMCD reports that there are more than 9000 (nine thousand) different dietary supplements available that contain cyanocobalamin.

Vitamin B12 supplements come in a wide variety of forms. Some examples include:

• Multivitamins – Tablets or Liquid Drops
• Chewable and Gummy Vitamins for Children
• B-Complex Vitamin Supplements
• Single Ingredient Tablets or Capsules
• Intranasal Sprays
• Sublingual Fast-Dissolve Strips or Tablets
• Soft gels
• Lozenges
• Powdered Packets

According to NIH, only about 1/50th of cyanocobalamin from oral supplements gets absorbed in healthy people. That means in order to get the recommended 2.4 mcg/day recommended for adults, you would have to take an oral supplement providing about 120 mcg.

Ask your doctor if you should take a cyanocobalamin supplement and which dosages is best for you.

Cyanocobalamin Safety and Side Effects

NMCD states that B12 supplements are likely safe when used at appropriate dosages and taken orally, topically, intravenously, intramuscularly, or intranasally.

Cyanocobalamin supplements are regarded as safe, even if taken in large dosages.

B-complex vitamins are often taken together in the form of B-100 or B-50 supplements.

UMM states, “Vitamin B12 is considered safe and nontoxic, however taking any one of the B vitamins for a long period of time can result in an imbalance of other important B vitamins. Taking folic acid at high doses can hide a vitamin B12 deficiency.”

Seek medical advice about the safety of using a cyanocobalamin supplement in your case.

Cyanocobalamin Interactions

UMM reports that cyanocobalamin supplements might interact with various types of medications, including:

• H2 blockers like cimetidine (Tagamet), famotidine (Pepcid AC) and ranitidine (Zantac);
• Antiseizure drugs like phenytoin (Dilantin), phenobarbital,and primidone (Mysoline);
• Bile acid sequestrants like colestipol (Colestid) and cholestyramine (Questran);
• Proton pump inhibitors like lansoprazole (Prevacid) and omeprazole (Prilosec);
• Chemotherapy drugs, particularly methotrexate;
• A drug uses for treating gout called colchicine;
• Metformin and other antidiabetes medications;
• Tetracycline antibiotics;

Discontinue using dietary supplements at least two weeks before elective surgeries to reduce the risk of possible complications.

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