Hypersensitivity. Driving or working w/ machines or doing other dangerous activities. Pregnancy & lactation.
Methylcobalamin: Allergic hypersensitivity reactions have occurred rarely after parenteral doses of the vitamin B12 compounds, cyanocobalamin and hydroxocobalamin. Antibodies to hydroxocobalamin-transcobalamin II complex have developed during hydroxocobalamin therapy. Arrhythmias secondary to hypokalemia have occurred at the beginning of parenteral treatment with hydroxocobalamin. Intranasal cyanocobalamin may cause rhinitis, nausea and headache.
Cyanocobalamin or hydroxocobalamin should, if possible, not be given to patients with suspected vitamin B12 deficiency without 1st confirming the diagnosis. Regular monitoring of the blood is advisable. Use of doses >10 mcg daily may produce a hematological response in patients with folate deficiency; indiscriminate use may mask the precise diagnosis. Conversely, folate may mask vitamin B12 deficiency. Cyanocobalamin should not be used for Leber's disease or tobacco amblyopia since these optic neuropathies may degenerate further.
Pregabalin: The most common adverse effects reported during therapy with pregabalin are dizziness and somnolence. Other common adverse effects include blurred vision, diplopia, increased appetite and weight gain, dry mouth, constipation, vomiting, flatulence, euphoria, confusion, reduced libido, erectile dysfunction, irritability, vertigo, ataxia, tremor, dysarthria, paraesthesia, fatigue and edema. Disturbances of attention, memory, coordination and gait also occur frequently. Syncope and congestive heart failure have been reported less frequently. Reversible renal failure, elevation of creatine kinase concentration and rhabdomyolysis have been reported rarely. Hypersensitivity reactions have occurred shortly after starting pregabalin therapy; symptoms include rash, blisters, urticaria, dyspnea and wheezing. Stevens-Johnson syndrome has also been reported. An increased incidence of hemangiosarcoma was observed in mice that had been given high doses of pregabalin.
Treatment of adult patients with peripheral neuropathy (neuropathic pain associated with diabetic peripheral neuropathy & post hepatic neuralgia).
Each capsule contains: Pregabalin 75 mg and methylcobalamin 750 mcg.
Starting Dose: 1 cap twice daily; provided this is tolerable vis-a-vis renal function. Patients previously on gabapentin will have a wash-out period of 1 week prior to start of dosing with pregabalin.
Absorption of vitamin B12 from the gastrointestinal tract may be reduced by neomycin, aminosalicylic acid, histamine H2-antagonists, omeprazole and colchicine. Serum concentrations may be decreased by use of oral contraceptives. Many of these interactions are unlikely to be of clinical significance but should be taken into account when performing assays for blood concentrations.
Parenteral chloramphenicol may attenuate the effect of vitamin B
