What is Megamilbedoce?

Megamilbedoce contains Hydroxocobalamin, a form of vitamin B-12. It is used as an antidote to cyanide poisoning. Megamilbedoce works by helping cells in the body convert cyanide to a form that can be removed from the body through urination.

Megamilbedoce is used in an emergency to treat cyanide poisoning. This type of poisoning can occur if you are exposed to smoke from a house or industrial fire, if you swallow or breathe in cyanide, or if you get cyanide on your skin.

Megamilbedoce may also be used for purposes not listed in this medication guide.


Megamilbedoce is indicated for the treatment of known or suspected cyanide poisoning.

Identifying Patients with Cyanide Poisoning

Cyanide poisoning may result from inhalation, ingestion, or dermal exposure to various cyanide-containing compounds, including smoke from closed-space fires. Sources of cyanide poisoning include hydrogen cyanide and its salts, cyanogenic plants, aliphatic nitriles, and prolonged exposure to sodium nitroprusside.

The presence and extent of cyanide poisoning are often initially unknown. There is no widely available, rapid, confirmatory cyanide blood test. Treatment decisions must be made on the basis of clinical history and signs and symptoms of cyanide intoxication. If clinical suspicion of cyanide poisoning is high, Megamilbedoce should be administered without delay.

Table 1 : Common Signs and Symptoms of Cyanide Poisoning

In some settings, panic symptoms including tachypnea and vomiting may mimic early cyanide poisoning signs. The presence of altered mental status (e.g., confusion and disorientation) and/or mydriasis is suggestive of true cyanide poisoning although these signs can occur with other toxic exposures as well.

The expert advice of a regional poison control center may be obtained by calling 1-800-222-1222.

Smoke Inhalation

Not all smoke inhalation victims will have cyanide poisoning and may present with burns, trauma, and exposure to other toxic substances making a diagnosis of cyanide poisoning particularly difficult. Prior to administration of Megamilbedoce, smoke-inhalation victims should be assessed for the following:

  • Exposure to fire or smoke in an enclosed area
  • Presence of soot around the mouth, nose or oropharynx
  • Altered mental status

Although hypotension is highly suggestive of cyanide poisoning, it is only present in a small percentage of cyanide-poisoned smoke inhalation victims. Also indicative of cyanide poisoning is a plasma lactate concentration ≥ 10 mmol/L (a value higher than that typically listed in the table of signs and symptoms of isolated cyanide poisoning because carbon monoxide associated with smoke inhalation also contributes to lactic acidemia). If cyanide poisoning is suspected, treatment should not be delayed to obtain a plasma lactate concentration.

Use with Other Cyanide Antidotes

Caution should be exercised when administering other cyanide antidotes simultaneously with Megamilbedoce, as the safety of co-administration has not been established. If a decision is made to administer another cyanide antidote with Megamilbedoce, these drugs should not be administered concurrently in the same intravenous line.


Use Megamilbedoce kit as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with Megamilbedoce kit. Talk to your pharmacist if you have questions about this information.
  • Megamilbedoce kit is given as an injection at your doctor’s office, hospital, or clinic.
  • Do not use Megamilbedoce kit if it contains particles or is not dark red in color, or if the vial is cracked or damaged in any way.
  • If you miss a dose of Megamilbedoce kit, contact your doctor right away.

Ask your health care provider any questions you may have about how to use Megamilbedoce kit.

Use: Labeled Indications

IM injection: Treatment of pernicious anemia; treatment of vitamin B (eg, during neoplastic treatment)

IV infusion (Megamilbedoce): Treatment of cyanide poisoning (known or suspected)

Off Label Uses

Vasoplegic syndrome

Data from multiple case reports and a case series suggest that use of Megamilbedoce may be beneficial in the treatment of vasoplegic syndrome and may be used as an alternative to or in patients who are refractory to methylene blue, in patients with glucose-6-phosphate dehydrogenase deficiency, or risk factors for serotonin syndrome during cardiac surgery.


Injectable form of vitamin B 12 that has been used therapeutically to treat vitamin B 12 deficiency. [PubChem]


Comprehensive treatment of acute cyanide intoxication requires support of vital functions. Megamilbedoce should be administered in conjunction with appropriate airway, ventilatory and circulatory support.

Recommended Dosing

The starting dose of Megamilbedoce for adults is 5 g (i.e., both 2.5g vials) administered as an intravenous (IV) infusion over 15 minutes (approximately 15 mL/min), i.e., 7.5 minutes/vial. Depending upon the severity of the poisoning and the clinical response, a second dose of 5 g may be administered by IV infusion for a total dose of 10 g. The rate of infusion for the second dose may range from 15 minutes (for patients in extremis) to two hours, as clinically indicated.

Preparation of Solution for Infusion

Megamilbedoce contains Hydroxocobalamin, a form of vitamin B-12
Megamilbedoce contains Hydroxocobalamin, a form of vitamin B-12

Each 2.5 g vial of Megamilbedoce for injection is to be reconstituted with 100 mL of diluent (not provided with Megamilbedoce) using the supplied sterile transfer spike. The recommended diluent is 0.9% Sodium Chloride injection (0.9% NaCl). Lactated Ringers injection and 5% Dextrose injection (D5W) have also been found to be compatible with Megamilbedoce and may be used if 0.9% NaCl is not readily available. The line on each vial label represents 100 mL volume of diluent. Following the addition of diluent to the lyophilized powder, each vial should be repeatedly inverted or rocked, not shaken, for at least 30 seconds prior to infusion.

Megamilbedoce solutions should be visually inspected for particulate matter and color prior to administration. If the reconstituted solution is not dark red or if particulate matter is seen after the solution has been appropriately mixed, the solution should be discarded.

Incompatability Information

​Physical incompatibility (particle formation) and chemical incompatibility were observed with the mixture of Megamilbedoce in solution with selected drugs that are frequently used in resuscitation efforts. Megamilbedoce is also chemically incompatible with sodium thiosulfate and sodium nitrite and has been reported to be incompatible with ascorbic acid. Therefore, these and other drugs should not be administered simultaneously through the same IV line as Megamilbedoce.

Simultaneous administration of Megamilbedoce and blood products (whole blood, packed red cells, platelet concentrate and/or fresh frozen plasma) through the same IV line is not recommended. However, blood products and Megamilbedoce can be administered simultaneously using separate IV lines (preferably on contralateral extremities, if peripheral lines are being used). This drug helped you recover, and this site will help you find a great job https://jobstellar.com/uk/