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Folacin (folic acid) when administered as a single agent in doses above 0.1mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations remain progressive. The 2 mgs of cyanocobalamin contained in FOLTX (folacin, cyanocobalamin & pyridoxine) has been shown to provide an adequate amount of cyanocobalamin to address this precaution5. Unmetabolized folic acid has been shown in one study of 105 postmenopausal women (50-75yrs) to have the potential to reduce natural killer cells' cytotoxicity, which may result in an impaired immune response6.

Cyanocobalamin should not be used in those with Leber's optic atrophy. Decreased levels of B12 have been associated with reduced ability to detoxify the cyanide in exposed individuals and cyanocobalamin may increase the risk of irreversible neurological damage from optic atrophy in those affected with the disorder.

Hydroxocobalamin can aid in the detoxification of cyanide. This form of B12 is an acceptable form for B12 supplementation in those with this disorder.

Pregnant women and nursing mothers should only use 12 microgram doses of B12 (cyanocobalamin) from nutritional supplements. Doses higher than this should only be recommended by your physician.

Administration of doses of vitamin B12 greater than 10 micrograms daily may produce a hematological response in those with anemia secondary to folate deficiency.


5 Kuzminski AM, Del Giacco EJ, Allen RH, et al: Effective Treatment of Cobalamin Deficiency with Oral Cobalamin. Blood 1998; 92:1191-1198.

6 Troen AM, Mitchell B, Sorensen B, Wener MH, Johnston A, Wood B, Selhub J, McTierman A, Yasui Y, Oral E, Potter JD, and Ulich CM: Unmetabolized Folic Acid in Plasma is Associated with Reduced Natural Killer Cell Cytoxicity among Postmenopausal Women. Journal of Nutrition 2006 Jan; 136(1): 189-194.

This monograph has been modified to include the generic and brand name in many instances.

Last reviewed on RxList: 6/30/2008


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