hydroxocobalamin (vit B12) / Generic mfg. - LARVOL DELTA

Evaluation of the Use of Hydroxocobalamin at a Large Academic Institution (SCCM 2026) - "Hydroxocobalamin was frequently used outside the indications of use at this institution, primarily as a last-line agent in refractory shock. While associated with reduced norepinephrine equivalents from 0.2 mcg/kg/min to 0.16 mcg/kg/min at 3 hours, its use did not improve mortality outcomes. These findings underscore the need for stricter adherence to institutional guidelines and EMR improvements to determine indications."

Clinical • Cardiovascular • Hypertension

ABCs of Vasoplegia (SCCM 2026) - "This session will evaluate the pathophysiology associated with vasodilatory shock along with the pharmaceutical proprieties of each drug. Side effects, timing and frequency of dosing, and cost will be discussed in the this pro/con debate.Learning Objectives: • Discuss pathophysiology that causes vasopressor-resistant vasodilatory shock • Explain the mechanisms of methylene blue and hydroxocobalamin in the treatment of vasodilatory shock • Discuss side effects, cost, and appropriate dosing of methylene blue and hydroxocobalamin Learning Objectives: • Discuss pathophysiology that causes vasopressor-resistant vasodilatory shock • Explain the mechanisms of methylene blue and hydroxocobalamin in the treatment of vasodilatory shock • Discuss side effects, cost, and appropriate dosing of methylene blue and hydroxocobalamin"

Cardiovascular

Color Theory in Shock: Sequential Hydroxocobalamin and Methylene Blue in Vasoplegia (SCCM 2026) - "In this case series of patients who received sequential methylene blue and hydroxocobalamin for vasoplegia, there was no difference in vasopressor requirements or mean arterial pressure at 30, 60 and 180 minutes."

Cardiovascular • Hepatology

Predictors of Response to Corticosteroids in Vasoplegic Shock Following Cardiopulmonary Bypass (SCCM 2026) - "Patients were excluded if there was documentation of chronic steroid use in the last 6 months or acute steroid therapy at a duration of 2 weeks or longer within 4 weeks of encounter, underwent solid organ transplantation, or received methylene blue or hydroxocobalamin post-CPB.A univariate analysis comparing responders to non-responders to corticosteroid therapy was performed utilizing baseline population, ICU LOS and mortality, hospital LOS and mortality, and hemodynamic outcomes (vasopressor requirements, MAP, SVR). Hydrocortisone demonstrated varied clinical response when used for VS secondary to CPB. Receipt of etomidate within 48 hours prior to HCT initiation for treatment of VS was associated with nonresponse."

Cardiovascular • Solid Organ Transplantation

IMPACT OF METHYLENE BLUE VERSUS HYDROXOCOBALAMIN ON PULMONARY ARTERY PRESSURES AND RIGHT VENTRICULAR FUNCTION IN THE TREATMENT OF POST-OPERATIVE VASOPLEGIA (ACC 2026) - "To be reported upon study completion."

Cardiovascular

Shrimp: A Study on Hydroxocobalamin Given to Healthy Individual to Monitor Symptoms (clinicaltrials.gov) - P1 | N=10 | Completed | Sponsor: Brigham and Women's Hospital

New P1 trial

Survival After Massive Potassium Cyanide Ingestion Without Antidote in a Tertiary Care Setting. (PubMed, Cureus) - "Survival after massive oral ingestion is rare, and published cases almost always involve the use of specific antidotes such as hydroxocobalamin or sodium nitrite with sodium thiosulfate...He subsequently developed marked hepatocellular injury (peak aspartate aminotransferase: 490.5 IU/L and alanine aminotransferase: 1069.4 IU/L) with preserved bilirubin and coagulation profile, for which N-acetylcysteine infusion and hepatoprotective agents were administered, with excellent response...This case demonstrates that survival is possible after apparently massive potassium cyanide ingestion, even without antidote availability, when clinicians rapidly recognize the diagnosis and provide meticulous supportive care. It also highlights critical gaps in antidote access and underscores the need for integrated psychiatric follow-up and tighter control of online cyanide sales, particularly in low-resource settings."

Journal • Bipolar Disorder • Borderline Personality Disorder • Cardiovascular • CNS Disorders • Diabetes • Hepatology • Hypotension • Metabolic Disorders • Personality Disorder • Psychiatry

A two-center comparison of the efficacy of methylene blue and hydroxocobalamin for the treatment of refractory shock. (PubMed, Perfusion) - "The methylene blue group had a higher in-hospital mortality rate (78% vs 59%, OR 2.4 [95% CI 1.2-5.1]) and shorter median time to death (18 hours vs 106 hours, p = 0.003). However, among patients alive at discharge, there was no statistically significant difference between methylene blue and hydroxocobalamin in time to discontinuation of vasopressors (90 hours vs 129 hours), ICU length of stay (19 days vs 33 days), hospital length of stay (33 days vs 54 days), or vasopressor-free days at 28 days (18 days vs 14 days).ConclusionAmong patients with refractory shock, methylene blue and hydroxocobalamin were associated with significant reductions in vasopressor doses over 24 hours; however, no significant difference was observed between the two agents."

Journal • Infectious Disease • Septic Shock

Metabolic Enzyme MeHNL11 Regulates MeCAS1b Transcription for Cyanide Reutilization in Response to Nitrate Deficiency in Cassava. (PubMed, Plant Biotechnol J) - "The exogenous application of the cyanide antidote hydroxocobalamin (COB) inhibited cyanide assimilation by MeCAS1b, leading to exacerbated N deficiency symptoms, such as leaf yellowing and a significant reduction in the contents of NH4 + and free amino acids (AA) in cassava seedlings under low-N conditions (LN). Our research demonstrates that the MeHNL11-MeCAS1b module plays a pivotal role in CG recycling, offering new insights into the underlying mechanisms governing cassava's exceptional tolerance to low N stress."

Journal • Infertility

Intravenous Hydroxocobalamin for Cyanide Poisoning From Smoke Inhalation: A Comprehensive Scoping Review. (PubMed, J Am Coll Emerg Physicians Open) - "This review underscores critical gaps and highlights variability in the real-world use of hydroxocobalamin for HCN toxicity. Additional work is needed to further understand and address barriers to hydroxocobalamin use."

Journal • Review • Acute Kidney Injury • Nephrology • Renal Disease

Metabolism Meets Microangiopathy: A Rare Case of TMA (NKF-SCM 2026) - "She completed a 6-month course of mycophenolate mofetil and prednisone, but was left with persistent proteinuria (500mg/24 hour) and abnormal kidney function (serum creatinine (sCr) 1.0-1.2 mg/dL). Lisinopril was initiated for anti-proteinuric therapy...In TMA cases without clear etiology, MM-TMA should be considered, particularly as it is relatively manageable with hydroxocobalamin injections and oral betaine. Although no improvement in kidney function or proteinuria was observed, the patient’s burden of MM-TMA was reduced with treatment."

Clinical • Chronic Kidney Disease • Nephrology • Renal Disease

Evaluating the Impact of a Standardized Protocol for Managing Refractory Vasoplegia After Cardiopulmonary Bypass. (PubMed, J Cardiothorac Vasc Anesth) - "Implementation of a stepwise protocol using MB, angiotensin II, and hydroxocobalamin for refractory vasoplegia resulted in significant cost savings, hastened NEeq reduction, and similar short-term clinical outcomes."

Journal

Impact of Early Intervention on the Developmental and Ocular Outcome of Patients With Cobalamin C Deficiency Identified Through Newborn Screening. (PubMed, J Inherit Metab Dis) - "Therapy with hydroxocobalamin (OH-Cbl) is recommended by clinical guidelines, and increasing the dosage may improve outcomes...Early treatment seems to prevent epilepsy. The potential role of genotype-phenotype correlations, particularly in relation to dosage response, warrants further investigation."

Journal • Retrospective data • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Epilepsy • Metabolic Disorders • Ophthalmology

SHARON: A Clinical Trial for Metastatic Cancer Using Chemotherapy and Patients' Own Stem Cells (clinicaltrials.gov) - P1 | N=24 | Recruiting | Sponsor: General Oncology, Inc. | N=10 ➔ 24 | Trial completion date: Aug 2027 ➔ Dec 2028 | Trial primary completion date: Aug 2026 ➔ Dec 2028

Enrollment change • Trial completion date • Trial primary completion date • Breast Cancer • HER2 Breast Cancer • HER2 Negative Breast Cancer • Oncology • Pancreatic Cancer • Pancreatic Ductal Adenocarcinoma • Solid Tumor • BRCA1 • BRCA2 • HER-2

Hydroxocobalamin, thiamine, and pyridoxine as an adjunct to standard treatment in chronic low back pain: a randomized clinical trial. (PubMed, Med Clin (Barc)) - "TPH as an adjunct to standard treatment was effective in reducing chronic low back pain and demonstrated an acceptable safety profile."

Clinical • Journal • Back Pain • Lumbar Back Pain • Musculoskeletal Diseases • Musculoskeletal Pain • Pain

Role of Non-catecholamines Vasopressors in the Management of Vasoplegic Syndrome after Cardiopulmonary Bypass: A Scoping Review. (PubMed, Ann Card Anaesth) - "Non-catecholamine drugs such as vasopressin, angiotensin II, MB, and hydroxocobalamin appear to be promising drugs for the treatment of patients with post-cardiac surgery vasoplegic syndrome. It is demonstrated to be effective in raising blood pressure in such patients, but these agents should be used cautiously due to their associated adverse effects."

Journal • Cardiovascular • Hypotension

Smoke-inhalation victims in a tertiary ED: prevalence of presumed hydrogen-cyanide co-poisoning and clinical correlates. (PubMed, Intern Emerg Med) - "Among the correctly diagnosed, all received hydroxocobalamin, while undiagnosed patients did not...The absence of airway soot may help rule out HCN poisoning. Our findings underscore the importance of clinical vigilance in the absence of confirmatory testing."

Journal • Cardiovascular

Cardiac arrest in adult patients following burn injury: a scoping review with expert recommendations on management. (PubMed, Scand J Trauma Resusc Emerg Med) - "Burn-associated cardiac arrest remains poorly characterized with uniformly poor outcomes except in electrical injury. These findings and consensus recommendations provide a structured foundation for future research and clinical guidance."

Journal • Review • Cardiovascular • Metabolic Disorders

Evidence for Hydroxocobalamin in Cyanide Toxicity Caused by Smoke Inhalation: An Updated Systematic Review. (PubMed, Emerg Med Int) - "In light of the uncertain benefits and potential risks associated with hydroxocobalamin use for cyanide poisoning from smoke inhalation injury, its administration should be approached with caution. Well-designed randomized controlled trials are urgently needed to establish optimal treatment strategies for this patient population."

Journal • Review • Acute Kidney Injury • Hematological Disorders • Nephrology • Renal Disease

Hydroxocobalamin for vasoplegia in cardiac surgery: an uncertain balance of risk and benefit. Comment on Br J Anesth 2025; 135: 870-7. (PubMed, Br J Anaesth) - No abstract available

Journal • Acute Kidney Injury • Cardiovascular • Nephrology • Renal Disease

Surviving cyanide poisoning: A case report highlighting the role of early antidote use. (PubMed, Toxicol Rep) - "In suspect of cyanide poisoning, hydroxocobalamin (2 doses of 5 g intravenous) and sodium thiosulfate (12.5 g intravenous) were administered...Subsequently, the patient admitted to ingesting potassium cyanide. He obtained the potassium cyanide from his workplace, a chemical laboratory."

Journal • Cardiovascular • Critical care • Metabolic Disorders

Simultaneous determination of vitamin B12 and cobalt (II) in infant milk power using liquid chromatography-inductively coupled plasma mass spectrometry. (PubMed, Sci Rep) - "A new method was developed for simultaneous determination of cobalamin compounds [cyanocobalamin (CN-Cbl), hydroxocobalamin (OH-Cbl), 5'-deoxyadenosylcobalamin (Ado-Cbl) and methylcobalamin (Me-Cbl)] and inorganic cobalt ions [Co(II)] in infant milk powder by liquid chromatography-inductively coupled plasma mass spectrometry (LC-ICP-MS). These results indicating that the method had a good accuracy and precision. The preparation of sample was simple and less time consuming since it avoiding solid phase extraction and follow steps."

Journal

Angiotensin II vs. Methylene Blue vs. Hydroxocobalamin for Post Cardiac Surgery Vasoplegia (PCSV) (ASHP 2025) - No abstract available

Surgery • Cardiovascular

Hydroxocobalamin, Methylene Blue or Angiotensin II for Vasoplegia following Cardiothoracic Surgery (ASHP 2025) - No abstract available

Surgery

Vasoplegia and cardiopulmonary bypass: role of oxidation-reduction dysregulation as a mechanism and therapeutic target. (PubMed, Br J Anaesth) - "Use of hydroxocobalamin (vitamin B-12) is a novel approach to increase perfusion pressure...Vitamin B-12 is an antioxidant that protects proteins, DNA, and lipids from attack by the unpaired electrons of free radicals. The observations that vitamin B-12 and other antioxidants, including ascorbic acid and methylene blue, all partially treat vasoplegia should signal to cardiac teams that focused research on the effects of oxidation-reduction dysregulation by inflammation needs further exploration."

Journal • Hypotension • Inflammation