Proper Use

Drug information provided by: IBM Micromedex

Use this medicine only as directed. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

This medicine comes with a patient information leaflet and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

This medicine is only used in the nose. Do not get it into your eyes or on your skin. If it does get on these areas, rinse it off right away and call your doctor.

Some patients may need a test dose of vitamin B12 injection before using Nascobal® nasal spray. This is to check if you have an allergic reaction to cyanocobalamin.

Carefully follow your doctor's instructions about diet and oral vitamin supplements (pills).

If you are using this medicine to treat pernicious anemia, you will need to use the medicine for the rest of your life.

Do not drink hot liquids or eat a hot meal for at least 1 hour before or 1 hour after using this medicine.

This medicine contains only 1 spray. Use each nasal spray device only one time. You do not need to prime the device before using it.

To use the nasal spray:

  • Gently blow your nose to clear the nostrils before you use this medicine.
  • Hold the nasal spray device with your thumb on the bottom and your pointer finger and middle finger on either side of the nozzle.
  • Close 1 nostril with your other index finger, then insert the nozzle into the open nostril about half an inch or as far as it feels comfortable. Tilt your head slightly forward.
  • Breathe in gently through your nose, close your mouth, and at the same time press the plunger firmly upwards with your thumb.
  • Remove the nozzle from your nostril. At the same time, keep your head straight for 10 to 20 seconds while gently breathing in through your nose and breathing out through your mouth.


The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For nasal dosage form (spray):
    • For pernicious anemia and vitamin B12 deficiency:
      • Adults—One spray into one nostril once a week. Each spray contains 500 micrograms (mcg). Your doctor may adjust your dose as needed.
      • Children—Dose must be determined by your doctor.

Missed Dose

This medicine needs to be given on a fixed schedule. If you miss a dose or forget to use your medicine, call your doctor or pharmacist for instructions.


Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep the medicine in its original container until you are ready to use it.