TriHEMIC Special Precautions

Folic Acid alone is an improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where Cyanocobalamin (Vitamin B₁₂) is deficient.
Some patients afflicted with pernicious anemia may not respond to orally administered Cyanocobalamin (Vitamin B₁₂) with intrinsic factor concentrate and there is no known way to predict which patients will respond or which patients may cease to respond. Periodic examinations and laboratory studies of pernicious anemia patients are essential and recommended. If any symptoms of intolerance occur, the drug should be temporarily or permanently discontinued. Folic Acid in doses above 0.1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations remain progressive. Doses greater than 10 mcg of Cyanocobalamin (Vitamin B₁₂) may produce a hematological response in patients with folate deficiency; indiscriminate use may mask the precise diagnosis.