Composition:
Application:
Utilisé dans le traitement:
Examiné médicalement par Militian Inessa Mesropovna, Pharmacie Dernière mise à jour le 02.04.2022
Attention! Information sur la page est réservée aux professionnels de la santé! Les informations sont collectées dans des sources ouvertes et peuvent contenir des erreurs significatives! Soyez prudent et revérifiez toutes les informations de cette page!
Top 20 des médicaments avec les mêmes ingrédients:
Top 20 des médicaments avec le même usage:
Le vaporisateur nasal Orofer (VITAMINS) (cyanocobalamine) est indiqué pour le maintien du statut hématologique normal chez les patients atteints d'anémie pernicieuse qui sont en rémission après la vitamine B intramusculaire12 thérapie et qui n'ont aucune atteinte du système nerveux.
Le vaporisateur nasal (VITAMINS) (cyanocobalamine) est également indiqué comme supplément pour d'autres vitamines B12 lacunes, notamment:
I. Carence alimentaire en vitamine B12 survenant chez les végétariens stricts (vitamine B isolée12 la carence est très rare).
II. Malabsorption de la vitamine B12 résultant de dommages structurels ou fonctionnels à l'estomac, où le facteur intrinsèque est sécrété, ou à l'iléon, où le facteur intrinsèque facilite la vitamine B12 absorption. Ces conditions comprennent l'infection par le VIH, le sida, la maladie de Crohn, la charrue tropicale et la charrue non tropicale (stéatorrhée idiopathique, entéropathie induite par le gluten). La carence en folates chez ces patients est généralement plus sévère que la vitamine B12 carence.
III. Sécrétion inadéquate de facteur intrinsèque, résultant de lésions qui détruisent la muqueuse gastrique (ingestion de corrosifs, néoplasie extensive) et d'un certain nombre de conditions associées à un degré variable d'atrophie gastrique (comme la sclérose en plaques, l'infection à VIH, le sida, certains endocriniens troubles, carence en fer et gastrectomie subtale). La gastrectomie totale produit toujours de la vitamine B12 carence. Lésions structurelles conduisant à la vitamine B12 la carence comprend l'iléite régionale, les résections iléales, les tumeurs malignes, etc.
IV. Compétition pour la vitamine B12 par des parasites ou des bactéries intestinales. Le ténia de poisson (Diphyllobothrium latum) absorbe d'énormes quantités de vitamine B12 et les patients infestés ont souvent associé une atrophie gastrique. Le syndrome de la boucle aveugle peut entraîner une carence en vitamine B12 ou folate.
V. Utilisation inadéquate de la vitamine B12 Cela peut se produire si des antimétabolites pour la vitamine sont utilisés dans le traitement de la néoplasie.
Il peut être possible de traiter la maladie sous-jacente par correction chirurgicale des lésions anatomiques conduisant à une prolifération bactérienne de l'intestin grêle, expulsion du ténia de poisson, arrêt des médicaments entraînant une malabsorption de la vitamine (voir Interactions médicament / test de laboratoire), utilisation d'un régime sans gluten dans une charrue non tropicale ou administration d'antibiotiques dans une charrue tropicale. Ces mesures éliminent la nécessité d'une administration à long terme de la vitamine B12.
Exigences en vitamine B12 au-delà de la normale (due à une grossesse, thyrotoxicose, anémie hémolytique, hémorragie, tumeur maligne, maladie hépatique et rénale) peut généralement être associée à une supplémentation intranasale ou orale.
Le vaporisateur nasal (VITAMINS) (cyanocobalamine) ne convient pas à la vitamine B12 test d'absorption (test de schilling).
The recommended initial dose of Orofer (VITAMINS) (cyanocobalamin) Nasal Spray is one spray (500 mcg) administered in ONE nostril once weekly. Orofer (VITAMINS) (cyanocobalamin) Nasal Spray should be administered at least one hour before or one hour after ingestion of hot foods or liquids. Periodic monitoring of serum B12 levels should be obtained to establish adequacy of therapy.
Priming (Activation) of Pump
Before the first dose and administration, the pump must be primed. Remove the clear plastic cover and the plastic safety clip from the pump. To prime the pump, place nozzle between the first and second finger with the thumb on the bottom of the bottle. Pump the unit firmly and quickly until the first appearance of spray. Then prime the pump an additional 2 times. Now the nasal spray is ready for use. The unit must be re-primed before each dose. Prime the pump once immediately before each administration of doses 2 through 8.
See LABORATORY TESTS for monitoring B12 levels and adjustment of dosage.
Sensitivity to cobalt and/or vitamin B12 or any component of the medication is a contraindication.
WARNINGS
Patients with early Leber's disease (hereditary optic nerve atrophy) who were treated with vitamin B12 suffered severe and swift optic atrophy.
Hypokalemia and sudden death may occur in severe megaloblastic anemia which is treated intensely with vitamin B12. Folic acid is not a substitute for vitamin B12 although it may improve vitamin B12-deficient megaloblastic anemia. Exclusive use of folic acid in treating vitamin B12-deficient megaloblastic anemia could result in progressive and irreversible neurologic damage.
Anaphylactic shock and death have been reported after parenteral vitamin B12 administration. No such reactions have been reported in clinical trials with Orofer (VITAMINS) (cyanocobalamin) Nasal Spray or Orofer (VITAMINS) (cyanocobalamin) Nasal Gel.
Blunted or impeded therapeutic response to vitamin B12 may be due to such conditions as infection, uremia, drugs having bone marrow suppressant properties such as chloramphenicol, and concurrent iron or folic acid deficiency.
PRECAUTIONS
General
An intradermal test dose of parenteral vitamin B12 is recommended before Orofer (VITAMINS) (cyanocobalamin) Nasal Spray is administered to patients suspected of cyanocobalamin sensitivity. Vitamin B12 deficiency that is allowed to progress for longer than three months may produce permanent degenerative lesions of the spinal cord. Doses of folic acid greater than 0.1 mg per day may result in hematologic remission in patients with vitamin B12 deficiency. Neurologic manifestations will not be prevented with folic acid, and if not treated with vitamin B12, irreversible damage will result.
Doses of vitamin B12 exceeding 10 mcg daily may produce hematologic response in patients with folate deficiency. Indiscriminate administration may mask the true diagnosis.
The validity of diagnostic vitamin B12 or folic acid blood assays could be compromised by medications, and this should be considered before relying on such tests for therapy.
Vitamin B12 is not a substitute for folic acid and since it might improve folic acid deficient megaloblastic anemia, indiscriminate use of vitamin B12 could mask the true diagnosis.
Hypokalemia and thrombocytosis could occur upon conversion of severe megaloblastic to normal erythropoiesis with vitamin B12 therapy. Therefore, serum potassium levels and the platelet count should be monitored carefully during therapy.
Vitamin B12 deficiency may suppress the signs of polycythemia vera. Treatment with vitamin B12 may unmask this condition.
If a patient is not properly maintained with Orofer (VITAMINS)® (cyanocobalamin) Nasal Spray, intramuscular vitamin B12 is necessary for adequate treatment of the patient. No single regimen fits all cases, and the status of the patient observed in follow-up is the final criterion for adequacy of therapy.
The effectiveness of Orofer (VITAMINS) (cyanocobalamin) Nasal Spray in patients with nasal congestion, allergic rhinitis and upper respiratory infections has not been determined. Therefore, treatment with Orofer (VITAMINS) (cyanocobalamin) Nasal Spray should be deferred until symptoms have subsided.
Laboratory Tests
Hematocrit, reticulocyte count, vitamin B12, folate and iron levels should be obtained prior to treatment. If folate levels are low, folic acid should also be administered. All hematologic parameters should be normal when beginning treatment with Orofer (VITAMINS)® (cyanocobalamin) Nasal Spray.
Vitamin B12 blood levels and peripheral blood counts must be monitored initially at one month after the start of treatment with Orofer (VITAMINS)® (cyanocobalamin) Nasal Spray, and then at intervals of 3 to 6 months.
A decline in the serum levels of B12 after one month of treatment with B12 nasal spray may indicate that the dose may need to be adjusted upward. Patients should be seen one month after each dose adjustment; continued low levels of serum B12 may indicate that the patient is not a candidate for this mode of administration.
Patients with pernicious anemia have about 3 times the incidence of carcinoma of the stomach as in the general population, so appropriate tests for this condition should be carried out when indicated.
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Long-term studies in animals to evaluate carcinogenic potential have not been done. There is no evidence from long-term use in patients with pernicious anemia that vitamin B12 is carcinogenic. Pernicious anemia is associated with an increased incidence of carcinoma of the stomach, but this is believed to be related to the underlying pathology and not to treatment with vitamin B12.
Pregnancy
Pregnancy Category C: Animal reproduction studies have not been conducted with vitamin B12. It is also not known whether vitamin B12 can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Adequate and well-controlled studies have not been done in pregnant women. However, vitamin B12 is an essential vitamin and requirements are increased during pregnancy. Amounts of vitamin B12 that are recommended by the Food and Nutrition Board, National Academy of Science - National Research Council for pregnant women should be consumed during pregnancy.
Nursing Mothers
Vitamin B12 appears in the milk of nursing mothers in concentrations which approximate the mother's vitamin B12 blood level. Amounts of vitamin B12 that are recommended by the Food and Nutrition Board, National Academy of Science-National Research Council for lactating women should be consumed during lactation.
Pediatric Use
Intake in pediatric patients should be in the amount recommended by the Food and Nutrition Board, National Academy of Science-National Research Council.
Please also see PATIENT INFORMATION
Aucun.
Sensitisation to cyancobalamin is rare, but may present as an itching exanthema, and exceptionally as anaphylactic shock.
Acneform and bullous emptions have been reported rarely.
Patients who have become sensitised to Orofer (VITAMINS) by injection are often able to tolerate cyancobalamin by the oral route without trouble.
Reporting of side effects
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The data described below and in Table 1 reflect exposure in 25 subjects (age range 27-82 years; 17 women; 21 Caucasians) with vitamin B12 deficiency (12 with pernicious anemia, 4 secondary to gastrointestinal surgery, 9 with unknown cause) who received CaloMist Nasal Spray 50 mcg daily for 8 weeks in an uncontrolled clinical trial. Prior to enrollment, all subjects were required to have normal vitamin B12 levels with intramuscular vitamin BI2 injections. One patient who completed the study developed epistaxis on Day 12 of dosing and was noted to have irritation of the right nasal septum at study end. This patient had pre-existing allergic rhinitis and required a doubling of the CaloMist Nasal Spray dose during the last week of the study because of declining vitamin B12 concentrations.
Table 1. Potentially related adverse reactions reported during 8 weeks of treatment with CaloMist Nasal Spray in an uncontrolled clinical trial.
Preferred Term | Orofer (VITAMINS) Nasal Spray (cyanocobalamin) (N=25) n (%) |
Arthralgia | 3 (12%) |
Dizziness | 3 (12%) |
Headache | 3 (12%) |
Nasopharyngitis | 3 (12%) |
Rhinorrhea | 3 (12%) |
Bronchitis | 2 (8%) |
Nasal Discomfort | 2 (8%) |
Pain | 2 (8%) |
Rash | 2 (8%) |
Asthma | 1 (4%) |
Back Pain | 1 (4%) |
Cough | 1 (4%) |
Epistaxis | 1 (4%) |
Hypersomnia | 1 (4%) |
Influenza Like Illness | 1 (4%) |
Malaise | 1 (4%) |
Pharyngolaryngeal Pain | 1 (4%) |
Postnasal Drip | 1 (4%) |
Procedural Pain | 1 (4%) |
Pyrexia | 1 (4%) |
Scab | 1 (4%) |
Sinus Headache | 1 (4%) |
Sinusitis | 1 (4%) |
Tooth Abscess | 1 (4%) |
Experience with Parenteral Vitamin B12
The following adverse reactions have been reported with parenteral vitamin B12:
Generalized: Anaphylactic shock and death
Cardiovascular: Pulmonary edema and congestive heart failure early in treatment Peripheral vascular thrombosis
Hematological : Polycythemia vera
Gastrointestinal: Mild transient diarrhea Dermatological: Itching; transitory exanthema
Postmarketing Experience
The following adverse reactions have been identified during postapproval use of cyanocobalamin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Angioedema and angioedema-like reactions
The incidence of adverse experiences described in the Table below are based on data from a short-term clinical trial in vitamin B12 deficient patients in hematologic remission receiving Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration (N=24) and intramuscular vitamin B12 (N=25). In the pharmacokinetic study comparing Orofer (VITAMINS) (cyanocobalamin) Nasal Spray and Orofer (VITAMINS) (cyanocobalamin) Nasal Gel, the incidence of adverse events was similar.
Table. Adverse Experiences by Body System, Number of Patients and Number of Occurrences by Treatment Following Intramuscular and Intranasal Administration of Cyanocobalamin.
Number of Patients (Occurrences) | |||
Body System | Adverse Experience | Vitamin B12 Nasal Gel, 500 mcg N=24 | Intramuscular Vitamin B12 , 100 mcg N=25 |
Body as a Whole | Asthenia | 1 (1) | 4 (4) |
Back Pain | 0 (0) | 1 (1) | |
Generalized Pain | 0 (0) | 2 (3) | |
Headache | 1 (2)* | 5 (11) | |
Infectiona | 3 (4) | 3 (3) | |
Cardiovascular System | Peripheral Vascular Disorder | 0 (0) | 1 (1) |
Digestive System | Dyspepsia | 0 (0) | 1 (2) |
Glossitis | 1 (1) | 0 (0) | |
Nausea | 1 (1)* | 1 (1) | |
Nausea & Vomiting | 0 (0) | 1 (1) | |
Vomiting | 0 (0) | 1 (1) | |
MusculoskeletalSystem | Arthritis | 0 (0) | 2 (2) |
Myalgia | 0 (0) | 1 (1) | |
Nervous System | Abnormal Gait | 0 (0) | 1 (1) |
Anxiety | 0 (0) | 1 (1)* | |
Dizziness | 0 (0) | 3 (3) | |
Hypoesthesia | 0 (0) | 1 (1) | |
Incoordination | 0 (0) | 1 (2)* | |
Nervousness | 0 (0) | 1 (3)* | |
Paresthesia | 1 (1) | 1 (1) | |
Respiratory | Dyspnea | 0 (0) | 1 (1) |
System | Rhinitis | 1 (1)* | 2 (2) |
a Sore throat, common cold * There may be a possible relationship between these adverse experiences and the study drugs. These adverse experiences could have also been produced by the patient's clinical state or other concomitant therapy. |
The intensity of the reported adverse experiences following the administration of Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration and intramuscular vitamin B12 were generally mild. One patient reported severe headache following intramuscular dosing. Similarly, a few adverse experiences of moderate intensity were reported following intramuscular dosing (two headaches and rhinitis; one dyspepsia, arthritis, and dizziness), and dosing with Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration (one headache, infection, and paresthesia).
The majority of the reported adverse experiences following dosing with Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration and intramuscular vitamin B12 were judged to be intercurrent events. For the other reported adverse experiences, the relationship to study drug was judged as “possible” or “remote”. Of the adverse experiences judged to be of “possible” relationship to the study drug, anxiety, incoordination, and nervousness were reported following intramuscular vitamin B12 and headache, nausea, and rhinitis were reported following dosing with Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration.
The following adverse reactions have been reported with parenteral vitamin B12:
Generalized: Anaphylactic shock and death (See WARNINGS and PRECAUTIONS).
Cardiovascular: Pulmonary edema and congestive heart failure early in treatment; peripheral vascular thrombosis.
Hematological: Polycythemia vera.
Gastrointestinal: Mild transient diarrhea.
Dermatological: Itching; transitory exanthema.
Miscellaneous: Feeling of swelling of the entire body.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The data described below and in Table 1 reflect exposure in 25 subjects (age range 27-82 years; 17 women; 21 Caucasians) with vitamin B12 deficiency (12 with pernicious anemia, 4 secondary to gastrointestinal surgery, 9 with unknown cause) who received CaloMist Nasal Spray 50 mcg daily for 8 weeks in an uncontrolled clinical trial. Prior to enrollment, all subjects were required to have normal vitamin B12 levels with intramuscular vitamin BI2 injections. One patient who completed the study developed epistaxis on Day 12 of dosing and was noted to have irritation of the right nasal septum at study end. This patient had pre-existing allergic rhinitis and required a doubling of the CaloMist Nasal Spray dose during the last week of the study because of declining vitamin B12 concentrations.
Table 1. Potentially related adverse reactions reported during 8 weeks of treatment with CaloMist Nasal Spray in an uncontrolled clinical trial.
Preferred Term | CaloMist Nasal Spray (cyanocobalamin) (N=25) n (%) |
Arthralgia | 3 (12%) |
Dizziness | 3 (12%) |
Headache | 3 (12%) |
Nasopharyngitis | 3 (12%) |
Rhinorrhea | 3 (12%) |
Bronchitis | 2 (8%) |
Nasal Discomfort | 2 (8%) |
Pain | 2 (8%) |
Rash | 2 (8%) |
Asthma | 1 (4%) |
Back Pain | 1 (4%) |
Cough | 1 (4%) |
Epistaxis | 1 (4%) |
Hypersomnia | 1 (4%) |
Influenza Like Illness | 1 (4%) |
Malaise | 1 (4%) |
Pharyngolaryngeal Pain | 1 (4%) |
Postnasal Drip | 1 (4%) |
Procedural Pain | 1 (4%) |
Pyrexia | 1 (4%) |
Scab | 1 (4%) |
Sinus Headache | 1 (4%) |
Sinusitis | 1 (4%) |
Tooth Abscess | 1 (4%) |
Experience with Parenteral Vitamin B12
The following adverse reactions have been reported with parenteral vitamin B12:
Generalized: Anaphylactic shock and death
Cardiovascular: Pulmonary edema and congestive heart failure early in treatment Peripheral vascular thrombosis
Hematological : Polycythemia vera
Gastrointestinal: Mild transient diarrhea Dermatological: Itching; transitory exanthema
Postmarketing Experience
The following adverse reactions have been identified during postapproval use of cyanocobalamin. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Angioedema and angioedema-like reactions
No overdosage has been reported with Orofer (VITAMINS) Nasal Spray, Orofer (VITAMINS) (Cyanocobalamin, USP) Gel for Intranasal Administration or parenteral vitamin B12.
This medicine contains cyancobalamin vitamin B12, which is used for the treatment of pernicious anaemia, and nutritional deficiencies of vitamin B12 which results in macrocytic anaemia.
L'absorption des cobalamines de l'intestin dépend du facteur intrinsèque de la glycoprotéine. Les cobalamines sont transportées rapidement dans le sang lié aux protéines, appelées transcobalamines. Les cobalamines sont stockées dans le foie et excrétées dans la bile. Ils sont connus pour traverser le placenta.
Absorption
Une étude croisée à trois voies chez 25 sujets sains à jeun a été menée pour comparer la biodisponibilité du B12 spray nasal au B12 gel nasal et d'évaluer la biodisponibilité relative des formulations nasales par rapport à l'injection intramusculaire. Les concentrations maximales après l'administration de pulvérisation intranasale ont été atteintes en 1,25 +/- 1,9 heure. La concentration maximale moyenne de B12 obtenu après correction de base après administration de pulvérisation intranasale était de 757,96 +/- 532,17 pg / mL. La biodisponibilité du spray nasal par rapport à l'injection intramusculaire s'est avérée être de 6,1%. La biodisponibilité du B12 le spray nasal s'est révélé être 10% inférieur au B12 gel nasal. Les intervalles de confiance à 90% pour l'ASC transformée en loge(0-t) et la Cmax était de 71,71% - 114,19% et 71,6% - 118,66% respectivement.
Chez les patients atteints d'anémie pernicieuse, une dose intra-anasale hebdomadaire de 500 mcg B12 gel a entraîné une augmentation constante du sérum pré-dose B12 niveaux pendant un mois de traitement (p <0,003) au-dessus de ceux observés un mois après 100 mcg de dose intramusculaire (figure).
Distribution
Dans le sang, B12 est lié à la transcobalamine II, une protéine porteuse de globuline B spécifique, et est distribué et stocké principalement dans le foie et la moelle osseuse.
Élimination
Environ 3-8 mcg de B12 est sécrété quotidiennement dans le tractus gastro-intestinal via la bile; chez les sujets normaux avec un facteur intrinsèque suffisant, tout sauf environ 1 mcg est réabsorbé. Quand B12 est administré à des doses qui saturent la capacité de liaison des protéines plasmatiques et du foie, le B non lié12 est rapidement éliminé dans l'urine. Conservation de B12 dans le corps dépend de la dose. Environ 80 à 90% d'une dose intramusculaire jusqu'à 50 mcg est conservée dans le corps; ce pourcentage tombe à 55% pour une dose de 100 mcg et diminue à 15% lorsqu'une dose de 1000 mcg est administrée.
12 niveaux de sérum auge après solution intramusculaire (IM) de 100 mcg et administration de gel nasal (IN) de 500 mcg de cyanocobalamine après doses hebdomadaires. "/> |
Figure. Vitamine B12 Niveaux de creux sérique après une solution intramusculaire (IM) de 100 mcg et une administration de gel nasal (IN) de 500 mcg de cyanocobalamine après des doses hebdomadaires. |
Figure. Vitamine B12 Niveaux de creux sérique après une solution intramusculaire (IM) de 100 mcg et une administration de gel nasal (IN) de 500 mcg de cyanocobalamine après des doses hebdomadaires.
Guide de médicamentsINFORMATIONS PATIENTES
Les patients atteints d'anémie pernicieuse doivent être informés qu'ils nécessiteront une administration intranasale hebdomadaire d'orofer (VITAMINS) (cyanocobalamine) Spray nasal pour le reste de leur vie. Ne pas le faire entraînera le retour de l'anémie et le développement de dommages incapacitants et irréversibles aux nerfs de la moelle épinière. En outre, les patients doivent être avertis du danger de prendre de l'acide folique à la place de la vitamine B12, car le premier peut prévenir l'anémie mais permettre une progression de la dégénérescence combinée subaiguë de la moelle épinière.
(Les aliments chauds peuvent provoquer des sécrétions nasales et une perte de médicament qui en résulte; par conséquent, les patients doivent être invités à administrer Orofer (VITAMINS) (cyanocobalamine) Nasal Spray au moins une heure avant ou une heure après l'ingestion d'aliments chauds ou de liquides).
Un régime végétarien qui ne contient aucun produit animal (y compris des produits laitiers ou des œufs) ne fournit aucune vitamine B12 Par conséquent, il faut conseiller aux patients suivant un tel régime de prendre Orofer (VITAMINS) (cyanocobalamine) Nasal Spray chaque semaine. Le besoin de vitamine B.12 est augmentée par grossesse et allaitement. La carence a été reconnue chez les nourrissons de mères végétariennes qui étaient allaitées, même si les mères ne présentaient aucun symptôme de carence à l'époque.
Parce que la posologie nasale se forme en vitamine B12 ont une absorption inférieure à la posologie intramusculaire, les formes posologiques nasales sont administrées chaque semaine plutôt que la posologie intramusculaire mensuelle. Comme le montre la figure ci-dessus, à la fin d'un mois, l'administration nasale hebdomadaire entraîne une vitamine B sérique significativement plus élevée12 niveaux qu'après administration intramusculaire. Le patient doit également comprendre l'importance de revenir pour des tests sanguins de suivi tous les 3 à 6 mois pour confirmer l'adéquation du traitement.
Des instructions minutieuses sur l'ensemble d'actionneur, le retrait du clip de sécurité, l'amorçage de l'actionneur et l'administration nasale d'Orofer (VITAMINS) (cyanocobalamine) Le vaporisateur nasal doit être administré au patient. Bien que les instructions pour les patients soient fournies avec des bouteilles individuelles, les procédures d'utilisation doivent être démontrées à chaque patient.
Aucune autre donnée pertinente.
Aucun n'a déclaré.
Aucun
However, we will provide data for each active ingredient