Names and pronunciation
(kroe-fel′e-mer) Mytesi
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Drug reference
(kroe-fel′e-mer) Mytesi
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Func. class.: Antidiarrheal Func. class.: Scabicide/pediculicide Func. class.: Vitamin B12, water- soluble vitamin
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Chem. class.: Red sap of Croton lechleri plant
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ACTION: Blocks chloride channel and high-volume water loss in diarrhea ACTION: Needed for adequate nerve functioning, protein and carbohydrate metabolism, normal growth, RBC devel- opment, cell reproduction
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USES: Noninfectious diarrhea in those with HIV/AIDS using antiretrovirals USES: Scabies, lice USES: Vitamin B12 deficiency, pernicious anemia, Vitamin B12 malabsorption syn- drome, Schilling test, increased require- ments with pregnancy, thyrotoxicosis, hemo- lytic anemia, hemorrhage, renal/hepatic disease, nutritional supplementation
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, breastfeed- ing, Black patients, children/adolescents, GI disease, infection, malabsorption syn- drome, pancreatitis CONTRAINDICATIONS: Hyper- sensitivity; raw, inflamed skin CONTRAINDICATIONS: Hyper- sensitivity to this product, cobalt, benzyl alcohol, optic nerve atrophy Precautions: Pregnancy, breastfeeding, children, renal/hepatic disease, folic acid/ iron deficiency anemia, infection
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SIDE EFFECTS CNS: Dizziness, depression GI: Nausea, constipation, abdominal pain, anorexia, flatulence, hemorrhoids INTEG: Acne vulgaris, contact dermatitis MISC: Arthralgia, cough, increased uri- nary frequency SIDE EFFECTS CNS: Flushing, optic nerve atrophy CV: HF, peripheral vascular thrombosis, pulmonary edema GI: Diarrhea INTEG: Itching, rash, pain at injection site META: Hypokalemia SYST: Anaphylactic shock
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INTERACTIONS Increase: serious constipation, bowel obstruction—alosetron (IBS) Increase: constipation—may occur with antimuscarinics, opiate agonists INTERACTIONS Increase: absorption—predniSONE Decrease: absorption—aminoglycosides, anticonvulsants, colchicine, chlorampheni- col, aminosalicylic acid, potassium prep- arations, cimetidine Drug/Herb Decrease: vitamin B12 absorption— goldenseal Drug/Lab Test False positive: intrinsic factor
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TREATMENT OF OVERDOSE: Discontinue product
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DOSAGE AND ROUTES • Adult: PO 125 mg bid DOSAGE AND ROUTES • Adult: TOPICAL After routine bath, apply over the entire body from the chin to the soles; do not apply to the face or head; repeat in 24 hr; patient may take a cleans- ing bath 48 hr after the second dose Treatment of pruritus • Adult: TOPICAL Apply topically by mas- saging gently into affected area until medica- tion is completely absorbed; repeat if needed DOSAGE AND ROUTES cyanocobalamin C • Adult: PO Up to 1000 mcg/day SUB- CUT/IM 30-100 mcg/day × 1 wk, then 100-200 mcg/mo Schilling test • Adult/child: IM 1000 mcg in 1 dose • Child: PO up to 1000 mcg/day SUB- CUT/IM 30-50 mcg/day × 2 wk, then 100 mcg/mo; NASAL 500 mcg weekly hydroxocobalamin • Adult: SUBCUT/IM 30-50 mcg/day × 5-10 days, then 100-200 mcg/mo • Child: SUBCUT/IM 30-50 mcg/day × 5-10 days, then 30-50 mcg/mo
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Available forms: Delayed-release tablets 125 mg Available forms: Lotion, cream 10% (sye-an-oh-koe-bal′a-min) Nascobal, Rubramin PC CytoKit Available forms: Cyanocobalamin: tab- lets 50, 100, 250, 500, 1000, 5000 mcg; extended-release tablets 1000 mcg; loz- enges 100, 250, 500 mcg; nasal 500 mcg/spray; injection 100, 1000 mcg/mL; hydroxocobalamin: injection 1000 mcg/ mL, powder for injection 5 g/vial
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Administer: • Do not break, crush, or chew • Without regard to meals Administer: PO route • With fruit juice to disguise taste; im- mediately after mixing • With meals if possible for better absorp- tion; large doses should not be used be- cause most is excreted • Protect from light, heat IM route • By IM injection for pernicious anemia for life unless contraindicated Intranasal route • Avoid use within 1 hr of hot fluids, food, no priming needed IV route • IV route not recommended but may be admixed in TPN solution Additive compatibilities: Ascorbic acid, chloramphenicol, hydrocortisone, vita- min B/C Solution compatibilities: Dextrose/Ring- er’s or LR combinations, dextrose/saline combinations, D5W, D10W, 0.45% NaCl, Ringer’s or LR solution Y-site compatibilities: Alfentanil, amikacin, aminophylline, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bretylium, bumetanide, bupre norphine, butorphanol, calcium chloride/ gluconate, ceFAZolin, cefmetazole, cefonicid, cefotaxime, cefoTEtan, cefOXitin, cefTAZi- dime, ceftizoxime, cefTRIAXone, cefuro xime, chloramphenicol, chlorproMAZINE, cimetidine, clindamycin, dexametha sone, digoxin, diphenhydrAMINE, DOBUTamine, DOPamine, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epo- etin alfa, erythromycin, esmolol, famoti- dine, fentaNYL, fluconazole, folic acid, furosemide, ganciclovir, gentamicin, glycopyrrolate, heparin, hydrocorti sone, hydrOXYzine, imipenem-cilastatin, indomethacin, insulin (regular), isoproter- enol hydrochloride, ketorolac, labetalol, lidocaine, magnesium, mannitol, meperi- dine, methoxamine, methyldopate, methyl- PREDNISolone, metoclopramide, metopro- lol, miconazole, midazolam, minocycline, morphine, moxalactam, multiple vitamins injection, nafcillin, nalbuphine, naloxone, netilmicin, nitroglycerin, nitroprusside, nor- epinephrine, ondansetron, oxacillin, oxyto- cin, papaverine, penicillin G potassium/ sodium, pentamidine, pentazocine, PENTo- barbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacillin, polymyxin B, potassium chloride, procain- amide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiN- IDine, raNITIdine, ritodrine, sodium bicarbonate, succinylcholine, SUFentanil, theophylline, thiamine, ticarcillin, ticarcil- lin-clavulanate, tobramycin, tolazoline, trimetaphan, urokinase, vancomycin, vaso- pressin, verapamil, vitamin B complex with C
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Assess: • Stools: volume, color, characteristic, frequency; bowel pattern before protein rebound constipation • Electrolytes (K, Na, Cl), hydration status • Monitor effect in Black patients; may be less effective Assess: • For vitamin B12 deficiency: red, beefy tongue; psychosis; pallor; neuropathy, ataxia, positive Romberg • GI function: diarrhea, constipation • Potassium levels during beginning treat- ment in megaloblastic anemia; q6mo in pernicious anemia; folic acid, plasma vita- min B12 (after 1 wk), reticulocyte counts • Nutritional status: egg yolks, fish, or- gan meats, dairy products, clams, oys- ters: good sources of vitamin B12 • For pulmonary edema, worsening of HF in cardiac patients
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Evaluate: Therapeutic response: decreased diarrhea Evaluate: • Therapeutic response: decreased an- orexia, dyspnea on exertion, palpitations, paresthesias, psychosis, visual disturbances
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CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To avoid OTC products unless directed by prescriber • If drowsiness occurs, not to operate machinery (kroe-tam′-ih-tuhn) Crotan, Eurax (Rx) Patient and caregiver information: • That treatment must continue for life for pernicious anemia • To eat a well-balanced diet • To avoid contact with persons with infection; that infections are common
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PHARMACOKINETICS Gastric intrinsic factor must be present for absorption to occur; stored in liver, kidneys, stomach; 50%-90% excreted in urine; crosses placenta; excreted in breast milk
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• Adult: PO 125 mg bid DOSAGE AND ROUTES
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• Adult: TOPICAL After routine bath, apply over the entire body from the chin to the soles; do not apply to the face or head; repeat in 24 hr; patient may take a cleans- ing bath 48 hr after the second dose Treatment of pruritus
PDF pages 322, 323
• Adult: TOPICAL Apply topically by mas- saging gently into affected area until medica- tion is completely absorbed; repeat if needed DOSAGE AND ROUTES cyanocobalamin C
PDF pages 322, 323
• Adult: PO Up to 1000 mcg/day SUB- CUT/IM 30-100 mcg/day × 1 wk, then 100-200 mcg/mo Schilling test
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• Adult/child: IM 1000 mcg in 1 dose
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• Adult: SUBCUT/IM 30-50 mcg/day × 5-10 days, then 100-200 mcg/mo
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