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В организме (преимущественно в печени) превращается в коферментную форму - аденозилкобаламин или кобамамид который является активной формой витамина В12 и входит в состав многочисленных ферментов в т.ч. в состав редуктазы восстанавливающей фолиевую кислоту в тетрагидрофолиевую. Обладает высокой биологической активностью. Кобамамид участвует в переносе метальных и других одноуглеродистых фрагментов поэтому он необходим для образования дезокеирибозы и ДНК креатина метионина -донора метальных групп в синтезе липотропного фактора - холина для превращения метилмалоновой кислоты в янтарную входящую в состав миелина для утилизации пропионовой кислоты. Необходим для нормального кроветворения - способствует созреванию эритроцитов.Способствует накоплению в эритроцитах соединений содержащих сульфгидрильные группы что увеличивает их толерантность к гемолизу. Активирует свертывающую систему крови в высоких дозах вызывает повышение тромбопластической активности и активности протромбина. Снижает уровень холестерина в крови. Оказывает благоприятное влияние на функцию печени и нервной системы. Повышает способность тканей к регенерации."}},{"type":"header","data":{"text":"Фармакокинетика:","level":3}},{"type":"paragraph","data":{"text":"В крови цианокобаламин связывается с транскобаламинами I и II которые транспортируют его в ткани. Депонируется преимущественно в печени. Связь с белками плазмы - 90 %. Максимальная концентрация после подкожного и внутримышечного введения достигается через 1 ч.Из печени выводится с желчью в кишечник и снова всасывается в кровь. Период полувыведения - 500 дней. Выводится при нормальной функции почек - 7-10 % почками около 50 % - с каловыми массами; при снижении функции почек - 0-7 % почками 70 - 100 % - с каловыми массами. Проникает через плацентарный барьер в грудное молоко."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Состояния сопровождающиеся дефицитом витамина В12:"}},{"type":"paragraph","data":{"text":"Хронические анемии протекающие с дефицитом витамина В12 (болезнь Аддисона- Бирмера алиментарная макроцитарная анемия) в составе комплексной терапии анемий (в т.ч. железодефицитной постгеморрагической апластической анемий вызванных токсическими веществами и/или лекарственными средствами)."}},{"type":"paragraph","data":{"text":"В комплексной терапии:"}},{"type":"paragraph","data":{"text":"Хронический гепатит цирроз печени печеночная недостаточность алкоголизм."}},{"type":"paragraph","data":{"text":"В неврологии: полиневрит радикулит гипотрофия невралгия (в т.ч. невралгия тройничного нерва) заболевания периферической нервной системы травматического генеза детский церебральный паралич болезнь Дауна."}},{"type":"paragraph","data":{"text":"В дерматологии: псориаз фотодерматоз герпетиформный дерматит атопический дерматит."}},{"type":"paragraph","data":{"text":"С профилактической целью: при назначении бигуанидов ПАСК аскорбиновой кислоты в высоких дозах патологии желудка и кишечника с нарушением всасывания цианокобаламина (резекция части желудка тонкой кишки болезнь Крона синдром мальабсорбции спру) энтерит диарея лучевая болезнь."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Повышенная чувствительность к компонентам препарата тромбоэмболия эритремия эритроцитоз беременность (имеются отдельные указания о возможном тератогенном действии витаминов группы В в высоких дозах) период лактации."}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Стенокардия доброкачественные и злокачественные новообразования сопровождающиеся мегалобластной анемией и дефицитом цианокобаламина склонность к образованию тромбов"}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Препарат применяется подкожно внутримышечно внутривенно.Подкожно при анемии Аддисона-Бирмера - по 100-200 мкг/сут через день; при фуникулярном миелозе макроцитарных анемиях с нарушением функции нервной системы - по 400-500 мкг/сут в первую неделю - ежедневно затем с интервалами между введениями до 5-7 дней (одновременно назначают фолиевую кислоту); в период ремиссии поддерживающая доза - 100 мкг/сут 2 раза в месяц при наличии неврологических симптомов - по 200-400 мкг 2-4 раза в мес.При острой постгеморрагической и железодефицитной анемии - 30-100 мкг 2-3 раза в неделю; при апластической анемии - по 100 мкг до наступления клинико-гематологического улучшения. При нарушениях со стороны нервной системы - по 200-400 мкг 2-4 раза в месяц.При заболеваниях центральной нервной системы и периферической нервной системы - по 200-500 мкг через день в течение 2 нед. При заболеваниях периферической нервной системы травматического генеза - 200-400 мкг через день в течение 40-45 дней. При гепатитах и циррозах печени - 30-60 мкг/сут или 100 мкг через день в течение 25-40 дней.При лучевой болезни - по 60-100 мкг ежедневно в течение 20-30 дней.Для устранения дефицита витамина В12 вводят внутримышечно (в/м) или внутривенно (в/в) по 1 мг ежедневно в течение 1-2 недели.Детям раннего возраста при алиментарной анемии и недоношенным детям - подкожно 30 мкг в день ежедневно в течение 15 дней. При дистрофиях у детей раннего возраста болезни Дауна и детском церебральном параличе - подкожно 15-30 мкг через день."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Аллергические реакции психическое возбуждение кардиалгия тахикардия диарея головная боль головокружение. При применении в высоких дозах - гиперкоагуляция нарушение пуринового обмена."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Фармацевтически несовместим с аскорбиновой кислотой солями тяжелых металлов (инактивация цианокобаламина) тиамина бромидом пиридоксином рибофлавином (т.к. содержащийся в молекуле цианкобаламина ион кобальта разрушает другие витамины)."}},{"type":"paragraph","data":{"text":"Нельзя сочетать с препаратами повышающими свертываемость крови."}},{"type":"paragraph","data":{"text":"Аминогликозиды салицилаты противоэпилептические лекарственные средства колхицин препараты калия снижают абсорбцию цианокобаламина."}},{"type":"paragraph","data":{"text":"Риск развития аллергических реакций повышается при совместном применении с тиамином."}},{"type":"paragraph","data":{"text":"Усиливает токсическое действие в сочетании с фолиевой кислотой. Хлорамфеникол снижает гемопоэтический ответ цианокобаламина."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Дефицит витамина В12 должен быть подтвержден диагностически до назначения препарата поскольку может маскировать недостаток фолиевой кислоты. В период лечения необходимо контролировать показатели периферической крови: на 5-8 день лечения определяется содержание ретикулоцитов концентрация железа. Количество эритроцитов гемоглобин и цветной показатель необходимо контролировать в течение 1 мес. 1-2 раза в неделю а далее - 2-4 раза в месяц. Ремиссия достигается при повышении количества эритроцитов до 4-45 млн/мкл при достижении нормальных размеров эритроцитов исчезновении анизо- и пойкилоцитоза нормализации содержания ретикулоцитов после ретикулоцитарного криза. После достижения гематологической ремиссии контроль периферической крови проводится не реже 1 раза в 4-6 мес. Соблюдать осторожность у лиц склонных к тромбообразованию со стенокардией (в меньших дозах до 01 мг на введение). Принимать длительное время при пернициозной анемии предстоящих операциях на желудочно-кишечном тракте."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Раствор для инъекций 02 мг/мл и 05 мг/мл."}},{"type":"header","data":{"text":"Упаковка:","level":3}},{"type":"paragraph","data":{"text":"По 1 мл в ампулы нейтрального бесцветного стекла. По 10 ампул в контурную ячейковую упаковку. Одна контурная ячейковая упаковка вместе с инструкцией по применению в картонную пачку."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"Список Б. Хранить в защищенном от света месте при температуре не выше 25 °С. Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не использовать после истечения срока годности."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"Си Эс Пи Си Оуи Фармасьютикал Ко.Лтд, № 276 Zhongshan West Road, Shijiazhuang City, China, Китай "}},{"type":"paragraph","data":{"text":"ООО \"ВИАЛ\""}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"ООО \"ВИАЛ\""}}]}],"source":null},"description_toggle":false,"short_description":"Цианокобаламин оказывает метаболическое гемопоэтическое действие. В организме (преимущественно в печени) превращается в коферментную форму - аденозилкобаламин или кобамамид который является активной формой витамина В12 и входит в состав многочисленных ферментов в т.ч. в состав редуктазы восстанавливающей фолиевую кислоту в тетрагидрофолиевую. Обладает высокой биологической активностью. Кобамамид участвует в переносе метальных и других одноуглеродистых фрагментов поэтому он необходим для образования дезокеирибозы и ДНК креатина метионина -донора метальных групп в синтезе липотропного фактора - холина для превращения метилмалоновой кислоты в янтарную входящую в состав миелина для утилизации пропионовой кислоты. Необходим для нормального кроветворения - способствует созреванию эритроцитов.Способствует накоплению в эритроцитах соединений содержащих сульфгидрильные группы что увеличивает их толерантность к гемолизу. Активирует свертывающую систему крови в высоких дозах вызывает повышение тромбопластической активности и активности протромбина. Снижает уровень холестерина в крови. Оказывает благоприятное влияние на функцию печени и нервной системы. Повышает способность тканей к регенерации. В крови цианокобаламин связывается с транскобаламинами I и II которые транспортируют его в ткани. Депонируется преимущественно в печени. Связь с белками плазмы - 90 %. Максимальная концентрация после подкожного и внутримышечного введения достигается через 1 ч.Из печени выводится с желчью в кишечник и снова всасывается в кровь. Период полувыведения - 500 дней. Выводится при нормальной функции почек - 7-10 % почками около 50 % - с каловыми массами; при снижении функции почек - 0-7 % почками 70 - 100 % - с каловыми массами. Проникает через плацентарный барьер в грудное молоко.","substance":[],"branding":null,"valid_for_quick_buy":false,"is_available_to_delivery":false,"comments":null,"image_alt":"Цианокобаламин-Виал - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/55746/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/55746/share_default/"}},"diseases":[{"id":"109","title":"Хронический вирусный гепатит","slug":"109-hronicheskiy_virusnyy_gepatit"},{"id":"319","title":"Витамин-В12-дефицитная анемия","slug":"319-vitaminv12defitsitnaya_anemiya"},{"id":"328","title":"Другие апластические анемии","slug":"328-drugie_aplasticheskie_anemii"},{"id":"329","title":"Острая постгеморрагическая анемия","slug":"329-ostraya_postgemorragicheskaya_anemiya"},{"id":"583","title":"Детский церебральный паралич","slug":"583-detskiy_tserebralnyy_paralich"},{"id":"896","title":"Фиброз и цирроз 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