Neurobion (Cyanocobalamin / Methylcobalamin (Vitamin B12))
Also sold as: Neurobion, Mecobalamin, Methycobal, Cobadex, Vitamin B12 (Cipla)
Pregnancy
Cat A
Lactation
Safe
Schedule
OTC
Forms
Tablet: Methylcobalamin 500 mcg, 1000 mcg, 1500 mcg +3
Indications
- Vitamin B12 deficiency (dietary — vegetarians, vegans; malabsorption — pernicious anaemia, post-gastrectomy, Crohn's, metformin use)
- Megaloblastic/macrocytic anaemia due to B12 deficiency
- Peripheral neuropathy (diabetic neuropathy, deficiency neuropathy)
- Subacute combined degeneration of spinal cord (B12 deficiency — neurological emergency)
- Metformin-induced B12 deficiency (common — monitor all long-term metformin users)
Adult Dosing
B12 deficiency without neurological signs (oral)
Cyanocobalamin 1000–2000 mcg PO once daily (can correct even without intrinsic factor via passive absorption at high doses)
High-dose oral B12 is effective even in pernicious anaemia — passive absorption (1–2% of dose). Monitor levels at 3 months.
Severe B12 deficiency / neurological signs (IM)
1000 mcg IM daily × 7 days → then weekly × 4 weeks → then monthly for life (pernicious anaemia)
IM preferred for pernicious anaemia (intrinsic factor absent — oral unreliable at standard doses)
Diabetic neuropathy (Methylcobalamin)
Methylcobalamin 500–1500 mcg PO or IM daily or 3 times weekly
Ongoing for symptomatic improvement
Metformin-induced deficiency prevention
Cyanocobalamin/Methylcobalamin 500–1000 mcg PO daily (if serum B12 < 200 pg/mL or borderline)
Annual B12 monitoring for all long-term metformin users
Pediatric Dosing
Breastfed infants of vegetarian/vegan mothers need B12 supplementation
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No dose adjustment required — water-soluble, excreted renally |
Hepatic Adjustment
No dose adjustment required
Pregnancy & Lactation
Pregnancy: Category A
Essential in pregnancy — requirement increases to 2.6 mcg/day. Deficiency causes neural tube defects, developmental delays. Vegetarian/vegan pregnant women must supplement B12. Maternal B12 deficiency → neonatal deficiency (especially in breastfed infants).
Lactation: Safe
Safe and important — breastfeeding women need 2.8 mcg/day. Vegetarian/vegan breastfeeding women must supplement to protect infant (breast milk B12 is low in deficient mothers).
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Metformin (long-term) | Reduces B12 absorption (affects ileal receptors) — monitor B12 every 1–2 years in long-term users; supplement if deficient | Moderate |
| PPIs / H2 blockers (long-term) | Reduce B12 absorption (requires acid for release from food) — screen for deficiency in long-term PPI users | Moderate |
| Colchicine, neomycin | Reduce B12 absorption in gut | Minor |
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Side Effects
Common
- Mild nausea (rarely)
- Injection site pain (IM)
- Acneiform rash (cyanocobalamin — rare)
- Red-coloured urine (normal — excess B12 excreted)
Serious / Discontinue If
- Hypokalaemia (IV high-dose B12 — rapid haematopoiesis uses potassium; monitor K+)
- Anaphylaxis (rare — parenteral cyanocobalamin; methylcobalamin lower risk)
Contraindications
- Hypersensitivity to cyanocobalamin or cobalt
- Leber's hereditary optic neuropathy (cyanocobalamin contraindicated; use hydroxocobalamin or methylcobalamin instead)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Neurobion Forte (B1+B6+B12) | Procter & Gamble/Merck | 30 tab ₹85 |
| Methycobal 500mcg | Eisai India | 30 tab ₹185 |
| Cobadex CZS (Mecobalamin 1500mcg + others) | Franco-Indian | 30 cap ₹225 |
| Vitamin B12 Injection 1000mcg | Cipla | Amp ₹18 |
Monitoring Required
- Serum vitamin B12 (baseline; target > 300 pg/mL for neurological protection; > 200 pg/mL for haematological)
- Full blood count (MCV, reticulocytes — response to treatment)
- Serum homocysteine and MMA (methylmalonic acid — sensitive deficiency markers if B12 borderline)
- Neurological assessment (vibration sense, proprioception, power)
- Serum potassium (if IV high-dose repletion)
Patient Counseling Points
- Vegetarians and vegans: most commonly deficient — B12 found only in animal foods; daily supplementation is essential
- Diabetics on metformin: get B12 checked annually — metformin reduces B12 absorption
- Injections vs tablets: for pernicious anaemia (stomach cannot absorb B12), injections are essential lifelong
- Tingling in feet/hands (neuropathy): B12 deficiency is treatable — early treatment prevents permanent nerve damage
- Take with or without food — generally well tolerated
- Urine may turn pink/red — this is harmless, just excess B12 being excreted
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Clinically reviewed by: Dr. Suresh Menon, DM (Endocrinology), Consultant Endocrinologist
Last reviewed: 2026-04-01
References
- ICMR RDA 2020
- Endocrine Society B12 Guidelines
- BNF — Cyanocobalamin
- Diabetes Care — Metformin and B12 Depletion
- Lancet — High-dose Oral B12 (2016)