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Cyanocobalamin should not be given before a diagnosis has been fully established because of the possibly of masking symptoms of subacute degeneration of the spinal cord.
Cyanocobalamin is not suitable form of vitamin B12 for the treatment of optic neuropathies associated with raised plasma concentrations of cyanocobalamin.
Long term administration of large doses of pyridoxine is associated with the development of severe peripheral neuropathies. This may occur with doses in excess of about 2 grams daily. Cyanocobalamin should not be used in megaloblastic anemia of pregnancy. Administration of doses greater than 10 microgram daily may produce a hematologival response in patients with folate deficiency.
