| Drug ID: | D384 |
| Drug Name: | Vitamin B12 |
| Synonyms: |
Cyanocob(III)alamin; Cyanocobalamin; Vitamin B12; Vitamin B12 complex; Vitamin B12 NOS
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| Type: | Supplement |
| DrugBank ID: |
DB00115
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| DrugBank Description: |
Cyanocobalamin (commonly known as Vitamin B12) is a highly complex, essential vitamin, owing its name to the fact that it contains the mineral, cobalt. This vitamin is produced naturally by bacteria , and is necessary for DNA synthesis and cellular energy production. Vitamin B12 has many forms, including the cyano-, methyl-, deoxyadenosyl- and hydroxy-cobalamin forms. The _cyano_ form, is the most widely used form in supplements and prescription drugs , . Several pharmaceutical forms of cyanocobalamin have been developed, including the tablet, injection, and nasal spray forms , , . This drug was initially approved by the FDA in 1942 .
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| PubChem ID: |
5311498
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| CasNo: |
68-19-9
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| Repositioning for NAFLD: |
Yes
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| SMILES: |
[CH-](#N)[Co+3]1234N5=C6[C@H]([C@@]([C@@]5([C@@H]5[N-]1C(=C(C1=N3C(=CC3=N2C(=C6C)[C@]([C@@H]3CCC(=O)N)(CC(=O)N)C)C([C@@H]1CCC(=O)N)(C)C)C)[C@]([C@H]5CC(=O)N)(C)CCC(=O)NC[C@H](OP(=O)(O[C@H]1C([C@@H](N2C=N4c3c2cc(c(c3)C)C)O[C@@H]1CO)O)[O-])C)C)(CC(=O)N)C)CCC(=O)N
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| InChiKey: |
--
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| Molecular Weight: |
-666.0
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| DrugBank Targets: |
Methionine synthase cofactor; Methylmalonyl-CoA mutase, mitochondrial cofactor; Methionine synthase reductase cofactor; Methylmalonic aciduria type A protein, mitochondrial binder; Methylmalonic aciduria and homocystinuria type C protein cofactor; Methyle
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| DrugBank MoA: |
Vitamin B12 serves as a cofactor for _methionine synthase_ and _L-methylmalonyl-CoA mutase_ enzymes. Methionine synthase is essential for the synthesis of purines and pyrimidines that form DNA. L-methylmalonyl-CoA mutase converts L-methylmalonyl-CoA to _succinyl-CoA_ in the degradation of propionate , an important reaction required for both fat and protein metabolism. It is a lack of vitamin B12 cofactor in the above reaction and the resulting accumulation of methylmalonyl CoA that is believed to be responsible for the neurological manifestations of B12 deficiency . Succinyl-CoA is also necessary for the synthesis of hemoglobin .
In tissues, vitamin B12 is required for the synthesis of _methionine_ from homocysteine. Methionine is required for the formation of S-adenosylmethionine, a methyl donor for nearly 100 substrates, comprised of DNA, RNA, hormones, proteins, as well as lipids . Without vitamin B12, tetrahydrofolate cannot be regenerated from 5-methyltetrahydrofolate, and this can lead to functional folate deficiency , .
This reaction is dependent on methylcobalamin (vitamin B12) as a co-factor and is also dependent on folate, in which the methyl group of methyltetrahydrofolate is transferred to homocysteine to form _methionine_ and _tetrahydrofolate_. Vitamin B12 incorporates into circulating folic acid into growing red blood cells; retaining the folate in these cells . A deficiency of vitamin B12 and the interruption of this reaction leads to the development of megaloblastic anemia.
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| DrugBank Pharmacology: |
**General effects**
Cyanocobalamin corrects vitamin B12 deficiency and improves the symptoms and laboratory abnormalities associated with pernicious anemia (megaloblastic indices, gastrointestinal lesions, and neurologic damage). This drug aids in growth, cell reproduction, hematopoiesis, nucleoprotein, and myelin synthesis. It also plays an important role in fat metabolism, carbohydrate metabolism, as well as protein synthesis. Cells that undergo rapid division (for example, epithelial cells, bone marrow, and myeloid cells) have a high demand for vitamin B12 .
**Parenteral cyanocobalamin effects**
The parenteral administration of vitamin B12 rapidly and completely reverses the megaloblastic anemia and gastrointestinal symptoms of vitamin B12 deficiency. Rapid parenteral administration of vitamin B12 in deficiency related neurological damage prevents the progression of this condition .
**Nasal spray effects**
In 24 vitamin B12 deficient patients who were already stabilized on intramuscular (IM) vitamin B12 therapy, single daily doses of intranasal cyanocobalamin for 8 weeks lead to serum vitamin B12 concentrations that were within the target therapeutic range (>200 ng/L) .
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| DrugBank Indication: |
**Nasal spray**
The cyanocobalamin nasal spray is indicated for the maintenance of vitamin B12 concentrations after normalization with intramuscular vitamin B12 therapy in patients with deficiency of this vitamin who have no nervous system involvement .
Note: CaloMist , the nasal spray form, has not been evaluated for the treatment of newly diagnosed vitamin B12 deficiency.
**Injection forms (subcutaneous, intramuscular)**
These forms are indicated for vitamin B12 deficiencies due to various causes, with or without neurologic manifestations . Vitamin B12 deficiency is frequently caused by malabsorption, which is often associated with the following conditions :
Addisonian (pernicious) anemia
Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacterial overgrowth, total or partial gastrectomy
Fish tapeworm infestation
Malignancy of the pancreas or bowel
Folic acid deficiency
**Oral forms**
Vitamin B12 supplements are widely available and indicated in patients who require supplementation for various reasons. Dose requirements for vitamin B12 which are higher than normal (caused by pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be achieved with oral supplementation . Oral products of vitamin B12 are not recommended in patients with malabsorption, as these forms are primarily absorbed in the gastrointestinal tract .
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| Targets: |
MTHFR cofactor
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| Therapeutic Category: |
--
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| Clinical Trial Progress: |
Phase 3 on-going (IRCT20120718010333N5)
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| Latest Progress: |
Under clinical trials
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