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Generic name: cyanocobalamin (nasal)
Drug class: Vitamins

Medically reviewed by  A Ras MD.

What is Nascobal?

Nascobal is a prescription medicine that is used to help with anemia. It is used to treat or prevent low vitamin B12. Nascobal may be given to you for other reasons. Talk to your doctor.


Cyanocobalamin is a synthetic form of vitamin B12 with equivalent vitamin B12 activity. The chemical name is 5,6-dimethyl-benzimidazolyl cyanocobamide. The cobalt content is 4.35%. The molecular formula is C63H88CoN14O14P, which corresponds to a molecular weight of 1355.38 and the following structural formula:

chemical structure

Cyanocobalamin occurs as dark red crystals or orthorhombic needles or crystalline red powder. It is very hygroscopic in the anhydrous form, and sparingly to moderately soluble in water (1:80). Its pharmacologic activity is destroyed by heavy metals (iron) and strong oxidizing or reducing agents (vitamin C), but not by autoclaving for short periods of time (15-20 minutes) at 121°C. The vitamin B12 coenzymes are very unstable in light.

Before taking Nascobal, tell your doctor:

  • If you are allergic to Nascobal; any part of this medicine; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
  • If you have an eye problem called Leber’s optic atrophy.
  • If you have any of these health problems: Nasal allergies, stuffy nose, or signs of a common cold.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take Nascobal with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take Nascobal?

  • Tell all of your health care providers that you take Nascobal. This includes your doctors, nurses, pharmacists, and dentists.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • Talk with your doctor before you drink alcohol.
  • Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.

How is Nascobal taken?

Use Nascobal as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • Keep taking Nascobal as you have been told by your doctor or other health care provider, even if you feel well.
  • Do not take Nascobal by mouth. Use in your nose only. Keep out of your mouth and eyes (may burn).
  • Blow your nose before use.
  • Do not use for at least 1 hour before or 1 hour after eating or drinking hot foods or liquids.

What do I do if I miss a dose?

  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.

What are the side effects of Nascobal that I need to call my doctor about immediately?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of low potassium levels like muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal.
  • Swelling, warmth, numbness, change of color, or pain in a leg or arm.
  • Shortness of breath, a big weight gain, or swelling in the arms or legs.
  • Change in balance.
  • A burning, numbness, or tingling feeling that is not normal.
  • Change in eyesight.

What are some other side effects of Nascobal?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

  • Dizziness.
  • Headache.
  • Feeling tired or weak.
  • Feeling nervous and excitable.
  • Upset stomach or throwing up.
  • Diarrhea.
  • Signs of a common cold.
  • Runny nose.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

If overdose is suspected:

If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

How to use Nascobal

 Step 1. Blow your nose gently to clear both nostrils.

Step 2. Hold Nascobal with your thumb on the bottom and your index (pointer) finger and middle finger on either side of the nozzle (see Figure A).


(Figure A)

Step 3. Gently close 1 side of your nose (nostril) with your other index finger. Insert the nozzle into the open nostril about half an inch or as far as it feels comfortable and tilt your head slightly forward (see Figure B).  Do not press the plunger yet.

(Figure B)


Step 4. Breathe in gently through your nose, close your mouth, and at the same time press the plunger firmly upwards with your thumb.

Step 5. Remove the nozzle from your nostril.  At the same time, keep your head straight for 10 to 20 seconds while gently breathing in through your nose and breathing out through your mouth.





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