Hydroxocobalamin in the US

[WiscGuy]

I searched for and responded to a couple of posts regarding this question, but decided a new post under an accurate heading might be a better idea.

I am in the US. I have a prescription for cyanocobalamin that allows me to self inject daily. My GFR test results have been gradually going down and my most recent score was 60. I would like to switch from cyanocobalamin to hydroxocobalamin, but my pharmacist tells me she can get hydroxocobalamin only in 30ml bottles, which if my arithmetic is correct is 30 1000 mcg doses.

My questions:

Does anyone here use 30ml bottles of hydroxocobalamin, and if so, do you experience problems, eg, with sanitary issues?

Are there hydroxocobalamin alternatives in the US to 30 ML bottles of hydroxocobalamin?

Thank you for any information or suggestions.

[Swift20]

Hi WiscGuy

I have only used 10ml bottles but when I was very frequent with my shots I would do half doses, so 20 doses per bottle. My methylcobalamin is from the compounding pharmacy and I never use it for more than 28 days as per my pharmacist. With cyanocobalamin it’s very common to have one bottle for ten months which is ten shots, that is what I did for 10 years as it’s regular practice here and I my doctor did my shots back then with my bottle I would bring with me each time. I never knew other countries didn’t use multi dose bottles until I joined this forum. I’m in Canada and it’s very common here and the US to do this. I prepare my shots very quickly and put my b12 back in a container right away.

Have you asked your pharmacist what works best? My best advice is to do what you are comfortable with. With 30ml bottles you’re going to have a lot of needle holes so I think you would want to be careful with that, but I am not an expert.

[Deejinsc]

I just received my first 30 ml bottle of hydroxocobalamin which took me 9 months to get filled at our local pharmacy. I inject every two weeks. The expiration date is mid 2025 so I am using it and saving the ampoules which have a later expiration date. I keep it in a dark closet and swab with alcohol before and after drawing up. I started with cyanocobalamin this way and never had any problems so don't anticipate any with this.

[Lin602]

Hi WiscGuy,

I'm in AZ and use hydroxocobalamin. I purchase a product from Korea sold out of Texas. It comes as a sealed glass vial (no rubber stopper) in a dose of 5mg/2ml. Once the vial is broken open it must be put into syringes for immediate use or stored in the refrigerator. My dose is 2.5mg per week so I use 1ml and refrigerate the other 1ml for the next week. I prefer weekly dose rather than daily or EOD so that I can travel for a week or long weekend without taking supplies with me. Works great for me. Here is the link for that product. No prescription needed.

nsightaesthetics.com/produc...

I also read on this site about a compounding pharmacy in GA the sells hydroxo by prescription only and will ship with a cold pack. They do not take insurance but you might be able to file a claim after purchase. Their product comes in a 10ml vial with rubber stopper, 10mg/ml. This is a much more concentrated product, might be more suitable for less frequent dosing, not every day or EOD. Here's the link for that company.

mixwithintegrity.com/

I know what a struggle it is to find this product in the US. Good luck to you and let me know if you have any questions about this info.

[mcg-woo]

Hello! I use Actavis 30ml hydroxo. That is the only option available in the US without using a compounding pharmacy. No issues and I have been using it for about 8 years. I wrap mine in foil and refrigerate just to retain as much potency as possible. Toss every 30 days since I don’t inject daily. Actavis hydroxo is labeled for IM use only and cyano is labeled for either SC or IM. Talk to your doctor about this as the rx instructions will need to match the product labeling, I would assume.

Wash your hands, use an alcohol prep to wipe the top of the vial before each use except when you open it the first time-not necessary. If you end up injecting hydroxo IM don’t expect the injection to be as comfortable as cyano either IM or SC. The serum is not as comfortable going in, but I feel like it’s a trade off for a better product. Not sure if I would have the appetite to inject IM daily as 1-2 times a week IM is not fun. Lots of people on this forum inject hydroxo SC with no issue and find it just as effective, just keep in mind the labeling of the Actavis product in the US is for IM only. Best of luck!

[mountmuir27]

As I reside in the USA and can only get prescription Cyano are you 100% certain that was the culprit behind your eGFR drop? Did you re-check - another lab - after drinking more water in the morning prior to labwork to make sure it wasn't simply due to a bit of dehydration? Asking so I can keep an eye on this as well.

[WiscGuy in reply to mountmuir27]

I don't know what is behind my eGFR drop. Sally Pacholoc addressed this issue in the recorded interview that was recently posted, perhaps by Technoid. For some reason I am unable to paste in the link here. In the article, "Vitamin B12", by Bruce Wolffenbuttel et al., BMJ 2023, cyanocobalamin is contraindicated for people with kidney disease. The abstract of the article referenced is available without charge; the article itself is behind a paywall. Apparently, according to Sally P., the thought is that for people who have frequent injections, the kidneys break down and excrete the cyanide, and that is difficult to do. Sally lives in the US, and said she uses the 30ml vials of hydroxocobalamin. As with many issues pertaining to B12, research is thin.

I got the URL for the Sally Pacholoc interview to paste in. The discussion I mentioned is at 32:20.

m.youtube.com/watch?v=gHxU3...(Not working as expected?)

[Technoid in reply to WiscGuy]

Do you supplement Creatine WiscGuy ? That can cause eGFR to seem lower than it actually is due to elevated creatinine.

ref : kidney.org/kidney-topics/cr...

[WiscGuy in reply to Technoid]

Thank you for your post. In May, I cut way back on supplements, hoping that kidney function (after reading your comment, I will think of it as "kidney function as reflected in eGFR results") would improve. One that I cut was creatine because I came across an article that mentioned the correlation between creatine and indicated kidney function. I am continuing multivitamin, vitamin B complex, vitamin D, omega-3, acetyl L- Carnitine, whey protein, and B12 injections. I also take two types of eye drops (Dorzolamide twice a day, and Latanoprost once per day). I have not yet retested eGFR.

[WiscGuy in reply to Technoid]

Thank you especially for your comment, "That can cause eGFR to seem lower than it actually is due to elevated creatinine." I was unaware of this. And thank you for the link.

[WIZARD6787]

I made an error when switching between forms and used a vial that had not expired but had been used for a while and developed bacteria in the vial.

This causes some minor infection which resolved in a few days.

Someone on the forum lead me to the CDC recommend that a vial be discarded after 30 days from first use.

That recommendation is for clinical use which is much more hazardous due to exposure to people that are ill.

In my state compounding companies only sell prefilled syringes which if insurance covers it that is pretty sweet.

Good on your doctor for prescribing enough to inject daily.

I did a trial of both hydroxocobalamin and Cyanocobalamin and for me at the time they were equivalent. I kept the dose and frequency the same for that trial.

I also made the error long ago of thinking only in terms of milliliters and did not account for different concentrations.

I through trials found that B12 in a higher amount per ml more effective than a lower consideration. Reasons unknown.

[helvella in reply to WIZARD6787]

I suspect I might have been the one who identified the CDC recommendation. (I know I have posted that but cannot know if you saw it in my posting.) And, as that person, I feel I have to point out that is not quite what they say.

Once a multi-dose vial is opened (e.g., needle-punctured) the vial should be dated and discarded within 28 days unless the manufacturer states another date for that opened vial. The beyond-use-date should never exceed the manufacturer's original expiration date.

cdc.gov/injection-safety/hc...

The advice is NOT confined to clinical use. It applies to ALL use in any circumstances.

If used for multiple patients, there are additional requirements.

Although posted on the CDC site, that advice is from the USP.

I'd feel terrible if someone became ill because I had not referred back to the CDC/USP advice. I'd hope everyone who self-injects, and especially those who use multi-dose vials, would have a look at the linked website and read carefully.

[WIZARD6787 in reply to helvella]

I miss-wrote. By Bad. I was not clear that I was stating my personal method after reading the CDC recommendations.

Thanks for picking it up and pointing it out.

[Casurvior]

i used to take hydroxocobalamin in 30 m bottles, I kept in refrigerator and ALWAYS used sterile needles. Never had any issues.

[Elijahhawk]

Hello, WiscGuy,

First off, do you happen to live in Wisconsin for if you do, I'm just south of you in Iowa.

I've used the 30ml vials of Hydroxo as I can't find an American source for individual ampules. As has already been said, the manufacture recommendation is that it not be used past 28 days regardless of a person refrigerating or not. And as already been mentioned, a slight swipe with a little isopropyl alcohol to the rubber covering. I've had no problems other than throwing away a lot of B12 that I won't be using that month!

The best to you

[WiscGuy in reply to Elijahhawk]

Yes, I live in Wisconsin. Thank you for sharing your experience with hydroxocobalamin.