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Functional Benefits of Hydroxocobalamin Supplements

Functional Benefits of Hydroxocobalamin Supplements

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Hydroxocobalamin is a precursor to methylcobalamin and Vitamin B12.

It is usually prescribed in conditions where B12 cannot be properly absorbed in the gut. It is manufactured naturally as a therapeutic agent with the help of your gut bacteria.1

Hydroxocobalamin is red in color and plays an integral part in DNA replication and synthesis, proper function of the nervous system, cellular energy, as well as converting homocysteine into methionine.2 It’s mostly used as an injection when there a vitamin deficiency or in cyanide poisoning.3

Role of Hydroxocobalamin as Cofactor

Vitamin B12 is one of the essential nutrients required for the body’s basic functions. It works with folate to carry out chromosomal replication and DNA synthesis in myeloid cells and bone marrow itself. Its role is also well established in maintaining the integrity and stability of myelin sheath on nerve cells.

Vitamin B12 converts methylmalonic acid to a succinate compound through the use of methylmalonyl-CoA mutase. As a succinate, it further helps in linking carbohydrate and lipid metabolism in the body for energy generation.5

Due to the methylation process, hydroxocobalamin is converted into methylcobalamin. Redox reactions, on the other hand, convert hydroxocobalamin into adenosylcobalamin in the presence of ATP. Both these compounds have an important role in decreasing the toxicity of nerve cells thereby helping in many neurological disorders.

Conversion of Homocysteine to Methionine

Hydroxocobalamin carries out methionine synthase activation through converting homocysteine to methionine. It is one of the rate-limiting steps and therefore controls the production of methionine.

Homocysteine is considered a toxic amino acid and affects blood vessels as well as nerves in the body when it is too high. When you’re B12 deficient, homocysteine levels increase resulting in toxicity in nerves cells and leads to impaired cognitive function. Increased levels of homocysteine are also connected to diseases such as stroke, Alzheimer’s disease, cardiovascular disorders and osteoporosis.

Taking hydroxocobalamin restores Vitamin B12 and reduces homocysteine levels in the body and therefore reverses the side effects. Because of its homocysteine-reversing property, hydroxocobalamin is also referred as a neural detoxifier.

Prescription as Therapeutic Agent

  • Hydroxocobalamin can be taken via capsules, lozenge, chewable tablet and injection. As an injection, it is often given as intramuscular injections of 1000 µg/dose as part of a Vitamin B12 replacement therapy. It’s often used in many causes of Vitamin B12 deficiencies such as Pernicious Anemia, Veganism, Digestive malabsorption, celiac hyperthyroidism, macrobiotics diets, Ileocecal resection, and tapeworm infestation.
  • Since 2006, hydroxycobalamin is an approved effective agent against cyanide poisoning. It binds with the cyanide molecules to convert it into cyanocobalamin which is then excreted through via the urine resulting in cyanide detoxification.
  • Studies have indicated hydroxocobalamin is the only form of Vitamin B12 capable of reducing the cellular toxicity of nitric oxide. The core atom of hydroxocobalamin, Cobalt (III), interacts with nitric oxide neutralizing the toxicity. A few studies cited hydroxocobalamin’s positive effects on reducing instances of migraines due to nitric acid build up.
  • Chronic fatigue Syndrome and fibromyalgia are two common conditions associated with Vitamin B12 deficiency. In both conditions, elevated levels of homocysteine persist due to low levels of Vitamin B12. Injectable hydroxocobalamin helped reduce and eventually control the level of homocysteine in the body by converting it to methionine.

If you are unsure if you can handle methyl products or you suspect that nitric acid levels are elevated, you can take hydroxocobalamin. A chewable and sublingual are the best oral alternatives as they are absorbed directly into the mucosa and bypass gut delivery. Particularly important if someone has gut issues.

The ideal way to start is 2,000 mcg chewable (make this 2,000 mcg chewable a link to our product)

  • Start with ¼ tablet and chew each morning before breakfast. If you don’t have any negative signs and symptoms (put link to our methyl side effects on our website) then increase to ½ tablet after 4-5 days.
  • Then take ½ chewable tablet for another 5 days.
  • Then take ¾ chewable tablet for another 5 days
  • Thereafter take 1 chewable tablet.

Make sure that your B12 levels are being addressed before you introduce any methyls.


[1] Hall CA, Begley JA, Green-Colligan PD. The availability of therapeutic hydroxocobalamin to cells. Blood. 1984 Feb; 63(2): 335-41. PMID: 6692038.

2 Andrès E, Fothergill H, Mecili M. Efficacy of oral cobalamin (vitamin B12) therapy. Expert opinion on pharmacotherapy. 2010 Feb; 11(2): 249-56. PMID: 20088746.

3 Carrillo-Carrasco N, Sloan J, Valle D, Hamosh A, Venditti CP. Hydroxocobalamin dose escalation improves metabolic control in cblC. Journal of inherited metabolic disease. 2009 Oct; 32(6): 728-31. PMCID: PMC3479241.

4 Hamel J. A review of acute cyanide poisoning with a treatment update. Critical care nurse. 2011 Feb; 31(1): 72-82. PMID: 21285466.

5 Seetharam B, Yammani RR. Cobalamin transport proteins and their cell-surface receptors. Expert reviews in molecular medicine. 2003 Jun; 5(18): 1-18. PMID: 14585166.

6 Andrès E, Fothergill H, Mecili M. Efficacy of oral cobalamin (vitamin B12) therapy. Expert opinion on pharmacotherapy. 2010 Feb; 11(2): 249-56. PMID: 20088746.

7 Bhattacharya R. Antidotes to cyanide poisoning: present status. Indian Journal of Pharmacology. 2000; 32(2): 94-101.

8 Shepherd G, Velez LI. Formulary Forum: Role of Hydroxocobalamin in Acute Cyanide Poisoning. Annals of Pharmacotherapy. 2008 May; 42(5): 661-9. PMID: 18397973.

9 Sauer SW, Keim ME. Hydroxocobalamin: improved public health readiness for cyanide disasters. Annals of emergency medicine. 2001 Jun; 37(6): 635-41. PMID: 11385334.

10 DesLauriers CA, Burda AM, Wahl M. Hydroxocobalamin as a cyanide antidote. American journal of therapeutics. 2006; 13(2): 161-165.

11 Greenberg SS, Xie J, Zatarain JM, Kapusta DR, Miller MJ. Hydroxocobalamin (vitamin B12a) prevents and reverses endotoxin-induced hypotension and mortality in rodents: role of nitric oxide. Journal of Pharmacology and Experimental Therapeutics. 1995 Apr; 273(1): 257-265. PMID: 7714773.

12 DesLauriers CA, Burda AM, Wahl M. Hydroxocobalamin as a cyanide antidote. American journal of therapeutics. 2006; 13(2): 161-165.


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