When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to cobalt or any vitamin B-12 injection or supplement.

How to Use This Medicine:
Gel/Jelly, Spray

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• Do not drink hot liquid or eat a hot meal for at least 1 hour before or 1 hour after you use this medicine.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• This medicine is for use only in the nose. Do not get any of it in your eyes or on your skin. If it does get on these areas, rinse it off right away.
• Prime the pump each time you use the medicine. Hold the bottle with the nozzle between 2 fingers and your thumb on the bottom. Pump the bottle until the spray or gel appears, and then pump 2 more times. The medicine is now ready to use.
• Before using the medicine, gently blow your nose to clear the nostrils.
• Wipe the tip of the bottle with a clean tissue and put the cap back on.
• Missed dose: You must use this medicine on a fixed schedule. Call your doctor or pharmacist if you miss a dose.
• Keep the bottle tightly closed when not using it. Store at room temperature, away from heat and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect how cyanocobalamin works. Tell your doctor if you are using any of the following:
  
  • Aminosalicylic acid, colchicine, folic acid, methotrexate, pyrimethamine
  • An antibiotic

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, bone marrow problems, a folic acid or iron deficiency, or Leber disease. Tell your doctor if you drink alcohol regularly or if you are a vegetarian.
• Congestion in your nose can affect how this medicine works. Tell your doctor if you have a runny or stuffy nose, a cold, or allergies.
• Carefully follow your doctor's instructions about diet and oral vitamin supplements.
• Pernicious anemia: You will need to use this medicine for the rest of your life. Talk to your doctor if you have concerns.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Dry mouth, increased thirst, muscle cramps, nausea, vomiting, uneven heartbeat
• Fever, chills, cough, sore throat, body aches
• Unusual bleeding, bruising, or weakness

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088