The Medical Letter on Drugs and Therapeutics
In Brief: Vitamin B12 Nasal Spray
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A nasal spray formulation of cyanocobalamin (Nascobal – Questcor) has been approved by the FDA for maintenance treatment of vitamin B12 deficiency. Nascobal is already available as an intranasal gel. Vitamin B12 deficiency, diagnosed by elevated serum concentrations of methylmalonic acid with or without elevated serum homocysteine and low serum B12 concentrations (<200 pg/mL), is common in older patients.1

Since intestinal absorption of B12 may be impaired, the usual maintenance treatment of deficiency is intramuscular injection of the vitamin in doses of 1 mg every 4 weeks (after more frequent doses have restored serum concentrations to normal levels). However, in patients with atrophic gastritis and even in those with pernicious anemia, some oral cyanocobalamin (about 1%) is absorbed by diffusion.2 A randomized, controlled ... more      

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Title: In Brief: Vitamin B12 Nasal Spray
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