March 29, 2017
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CaloMist Nasal Spray

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CaloMist Nasal Spray

CaloMist Nasal Spray Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

Last reviewed on RxList 5/26/2016

CaloMist Nasal Spray (cyanocobalamin) is a synthetic form of vitamin B12 used to treat vitamin B12 deficiency in people with pernicious anemia and other conditions. The brand name CaloMist Nasal Spray is discontinued, but generic versions may be available. Common side effects of CaloMist Nasal Spray (cyanocobalamin) includeL:

The recommended initial dose of CaloMist Nasal Spray is one spray in each nostril once daily (25 mcg per nostril, total daily dose 50 mcg). CaloMist Nasal Spray may interact with antibiotics, methotrexate, pyrimethamine, colchicine, or alcohol. Tell your doctor all medications and supplements you use. It is unknown if CaloMist Nasal Spray can harm a fetus. Tell your doctor if you are pregnant or plan to become pregnant during treatment. This drug passes into breast milk, but it is unknown if it could harm a nursing baby. Consult your doctor before breastfeeding.

Our CaloMist Nasal Spray (cyanocobalamin) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is Prescribing information?

The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.

CaloMist Nasal Spray FDA Prescribing Information: Side Effects
(Adverse Reactions)


Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The data described below and in Table 1 reflect exposure in 25 subjects (age range 27-82 years; 17 women; 21 Caucasians) with vitamin B12 deficiency (12 with pernicious anemia, 4 secondary to gastrointestinal surgery, 9 with unknown cause) who received CaloMist Nasal Spray 50 mcg daily for 8 weeks in an uncontrolled clinical trial. Prior to enrollment, all subjects were required to have normal vitamin B12 levels with intramuscular vitamin BI2 injections. One patient who completed the study developed epistaxis on Day 12 of dosing and was noted to have irritation of the right nasal septum at study end. This patient had pre-existing allergic rhinitis and required a doubling of the CaloMist Nasal Spray dose during the last week of the study because of declining vitamin B12 concentrations.

Table 1. Potentially related adverse reactions reported during 8 weeks of treatment with CaloMist Nasal Spray in an uncontrolled clinical trial.

Preferred Term CaloMist Nasal Spray (cyanocobalamin)
n (%)
Arthralgia 3 (12%)
Dizziness 3 (12%)
Headache 3 (12%)
Nasopharyngitis 3 (12%)
Rhinorrhea 3 (12%)
Bronchitis 2 (8%)
Nasal Discomfort 2 (8%)
Pain 2 (8%)
Rash 2 (8%)
Asthma 1 (4%)
Back Pain 1 (4%)
Cough 1 (4%)
Epistaxis 1 (4%)
Hypersomnia 1 (4%)
Influenza Like Illness 1 (4%)
Malaise 1 (4%)
Pharyngolaryngeal Pain 1 (4%)
Postnasal Drip 1 (4%)
Procedural Pain 1 (4%)
Pyrexia 1 (4%)
Scab 1 (4%)
Sinus Headache 1 (4%)
Sinusitis 1 (4%)
Tooth Abscess 1 (4%)

Experience with Parenteral Vitamin B12

The following adverse reactions have been reported with parenteral vitamin B12:

Generalized: Anaphylactic shock and death

Cardiovascular: Pulmonary edema and congestive heart failure early in treatment Peripheral vascular thrombosis

Hematological : Polycythemia vera

Gastrointestinal: Mild transient diarrhea Dermatological: Itching; transitory exanthema

Postmarketing Experience

The following adverse reactions have been identified during postapproval use of cyanocobalamin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Angioedema and angioedema-like reactions [See WARNINGS and PRECAUTIONS]

Read the entire FDA prescribing information for CaloMist Nasal Spray (Cyanocobalamin)

Report Problems to the Food and Drug Administration


You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

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