Cyanocobalamin / Vitamin B12 + Ferric Ammonium Citrate + Folic Acid

Dosage Forms Available

• This combination may be available as tablets, capsules, syrup or other oral liquid formulations.
• The amount of each component may vary between products. The formulation and dose should be selected by a doctor based on the deficiency identified through appropriate tests.

Age and Dose Restrictions

• There is no single age limit or dose that applies to every product containing this combination. The dose depends on the patient’s age, the severity of the deficiency, blood test results, and the amount of each component in the product.
• Give this medicine to a child only when a doctor has recommended a suitable product and dose.
• An excessive amount of iron can be fatal to a child. Always keep this medicine out of the reach of children.

Contraindications

• Do not take this medicine if you are allergic to cyanocobalamin, ferric ammonium citrate, folic acid or any other ingredient in the product.
• It should not be taken by people who already have excessive iron levels or a condition that causes abnormal iron accumulation in the body.
• Do not take iron for anaemia that is not caused by iron deficiency unless advised by a doctor.
• Patients who receive repeated blood transfusions or have an inherited condition affecting iron levels should consult a doctor before taking it.

Other Medications to Avoid With This Medicine

• Iron can reduce the absorption of certain antibiotics, the thyroid medicine levothyroxine and the Parkinson’s disease medicine levodopa. Ask your doctor or pharmacist how much time to leave between these medicines and this combination.
• Folic acid can interact with methotrexate when used to treat cancer or certain other conditions. It may also interact with some medicines used to control epilepsy or seizures.
• Medicines that reduce stomach acid, antacids, calcium supplements and zinc supplements may affect the absorption of iron or vitamin B12.
• Tell your doctor or pharmacist before starting any prescription or non-prescription medicine, or any vitamin or mineral supplement.

Overdose and Missed Dose

• An overdose of this combination, particularly an excessive amount of iron, can be serious and potentially fatal. Symptoms may include severe abdominal pain, repeated vomiting, bloody vomit or diarrhoea, extreme drowsiness, dizziness, fainting and liver damage.
• If an adult or child may have taken too much, do not wait for symptoms to develop. Seek emergency medical help immediately.
• If you miss a dose, take it when you remember. If it is nearly time for your next dose, skip the missed dose. Do not take 2 doses together.

Management of Side Effects

• Iron may be absorbed better on an empty stomach, but it can cause stomach upset. If this occurs, it may be taken with a small amount of food after consulting your doctor or pharmacist.
• If constipation occurs, drink enough fluids, eat fibre-rich foods and remain physically active. Do not change the dose or medicine without medical advice.
• Dark-coloured stools can be a normal effect of iron. Contact a doctor immediately if your stools are black and sticky, contain visible blood or occur with severe abdominal pain.
• Seek medical help for persistent vomiting, severe abdominal pain, severe diarrhoea or signs of an allergic reaction.

Driving and Operating Machinery

• This combination is not normally expected to affect the ability to drive or operate machinery.
• Do not drive or operate heavy machinery until you feel well if you experience dizziness, weakness or discomfort after taking it.

Use in Pregnancy and Lactation

• The requirements for iron, vitamin B12 and folic acid may increase during pregnancy and breastfeeding. However, take this combination only in the dose recommended by a doctor.
• The correct folic acid dose and the time at which it is started are important during pregnancy. This combination may not provide the separate folic acid supplementation required by every pregnant woman.
• Tell your doctor before starting this medicine if you are pregnant, planning a pregnancy or breastfeeding.

Caution in Other Conditions

• Treating vitamin B12 deficiency with folic acid alone may improve blood-test results while allowing nerve damage to continue. Therefore, vitamin B12 deficiency must be identified and treated correctly.
• Tell your doctor if you have a stomach or intestinal condition, difficulty absorbing nutrients, a history of repeated blood transfusions, liver disease or excessive iron levels.
• During treatment, your doctor may monitor your haemoglobin, iron, vitamin B12 and folate levels.

Special Dietary and Lifestyle Recommendations

• Sources of iron include meat, fish, lentils, beans, green leafy vegetables and iron-fortified cereals.
• Vitamin B12 occurs naturally mainly in milk, eggs, meat, fish and other animal-derived foods. People following a vegan diet may require a vitamin B12 supplement under medical guidance.
• Good sources of folate include green leafy vegetables, lentils, beans, peas and folic-acid-fortified cereals.
• Tea, coffee, milk, calcium supplements and antacids can reduce iron absorption when taken at the same time. Ask your doctor or pharmacist how much time to leave between these products and your medicine.