Triple-B

Each tablet contains Vitamin B1 (Triple-B) (thiamine mononitrate) 250 mg, Vitamin B6 (Triple-B) (pyridoxine hydrochloride) 250 mg and Vitamin B12 (Triple-B) (cyanocobalamin) 1000 mcg.

Cyanocobalamin is indicated for Vitamin B12 (Triple-B) deficiencies due to malabsorption which may be associated with the following conditions:

1. Addisonian (pernicious) anemia

2. Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomy

3. Fish tapeworm infestation

4. Malignancy of pancreas or bowel

5. Folic acid deficiency

It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption, use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue. Such measures remove the need for long-term administration of Cyanocobalamin.

Requirements of Vitamin B12 (Triple-B) in excess of normal (due to pregnancy, thyrotoxicosis, hemolytic anemia, hemorrhage, malignancy, hepatic and renal disease) can usually be met with oral supplementation.

Cyanocobalamin Injection, USP is also suitable for the Vitamin B12 (Triple-B) absorption test

1 tab orally or as directed by physician. Increased during pregnancy and breastfeeding.

Except under special circumstances, Triple-B should not be used when the following medical problem exists:

Cyanocobalamin: Leber's Disease: Optic nerve atrophy has occurred rapidly after administration. Cyanocobalamin concentrations are already elevated.

Risk-benefit should be considered when the following medical problems exist: Sensitivity to thiamine, pyridoxine, cyanocobalamin or hydroxocobalamin.

Thiamine: Wernicke's Encephalopathy: IV glucose loading may precipitate or worsen this condition in thiamine-deficient patients. Thiamine should be administered prior to glucose.

Persons taking most antibiotics, methotrexate and pyrimethamine invalidate folic acid and Vitamin B12 (Triple-B) diagnostic blood assays.

Colchicine para-aminosalicylic acid and heavy alcohol intake for longer than 2 weeks may produce malabsorption of Vitamin B12 (Triple-B).

Rare Incidence: Thiamine: Anaphylactic Reaction: Coughing, difficulty in swallowing, hives, skin itching, swelling of face, lips or eyelids, wheezing or difficulty in breathing usually after a large IV dose.

Pyridoxine: High doses taken for several months have caused severe sensory neuropathy, progressing from unstable gait and numb feet to numbness to clumsiness of hands.

Cyanocobalamin: Anaphylactic Reaction: Skin rash, itching, wheezing.

Less Frequent Incidence: Diarrhea, skin itching.