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2) ¸ÅÀÏ ¼¼ÀÜ ÀÌ»ó Á¤±âÀûÀ¸·Î ¼úÀ» ¸¶½Ã´Â »ç¶÷ÀÌ ÀÌ ¾àÀ̳ª ´Ù¸¥ ÇØ¿ÁøÅëÁ¦¸¦ º¹¿ëÇØ¾ß ÇÒ °æ¿ì ¹Ýµå½Ã ÀÇ»ç ¶Ç´Â ¾à»ç¿Í »óÀÇÇØ¾ß ÇÑ´Ù. ÀÌ·¯ÇÑ »ç¶÷ÀÌ ÀÌ ¾àÀ» º¹¿ëÇϸé À§ÀåÃâÇ÷ÀÌ À¯¹ßµÉ ¼ö ÀÖ´Ù. 
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2) ¾Ç¼ºÁ¾¾ç ȯÀÚ(Á¶Á÷¹ßÀ°¿¡ ´ëÇÑ ºñŸ¹Î B12ÀÇ ÀÛ¿ëÀ¸·Î ¼¼Æ÷ÀÇ Áõ½Ä¼Óµµ°¡ 
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       1) °ú¹ÎÁõ : µå¹°°Ô °¡·Á¿òÁõ, µÎµå·¯±â, È«¹Ý, Àϰú¼ºÀÇ ¹ßÁø, ¼ï µîÀÌ ÀϾ ¼ö 
ÀÖÀ¸¹Ç·Î ÀÌ·¯ÇÑ °æ¿ì¿¡´Â Åõ¿©¸¦ ÁßÁöÇÑ´Ù. 
2) ÇǺΠ: ¿©µå¸§ÀÌ »ý±æ ¼ö ÀÖ´Ù. 
3) ±âŸ : ¿äÀÇ Âø»öÀÌ ³ªÅ¸³¯ ¼ö ÀÖ´Ù. 
          
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    º´¿ë±Ý±â :
     
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    | Mechanism of Action | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Mechanism_Of_Action Á¤º¸ Vitamin B12 exists in four major forms referred to collectively as cobalamins; deoxyadenosylcobalamin, methylcobalamin, hydroxocobalamin, and cyanocobalamin. Two of these, methylcobalamin and 5-deoxyadenosyl cobalamin, are primarily used by the body. Methionine synthase needs methylcobalamin as a cofactor. This enzyme is involved in the conversion of the amino acid homocysteine into methionine. Methionine in turn is required for DNA methylation. 5-Deoxyadenosyl cobalamin is a cofactor needed by the enzyme that converts L-methylmalonyl-CoA to succinyl-CoA. This conversion is an important step in the extraction of energy from proteins and fats. Furthermore, succinyl CoA is necessary for the production of hemoglobin, the substances that carries oxygen in red blood cells. 
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    | Pharmacology | 
     
       Hydroxocobalamin¿¡ ´ëÇÑ Pharmacology Á¤º¸ Hydroxocobalamin is a synthetic, injectable form of Vitamin B12. Hydroxocobalamin is actually a precursor of two cofactors or vitamins (Vitamin B12 and Methylcobalamin) which are involved in various biological systems in man. Vitamin B12 is required for the conversion of methylmalonate to succinate. Deficiency of this enzyme could therefore interfere with the production of lipoprotein in myelin sheath tissue and so give rise to neurological lesions. The second cofactor, Methylcobalamin, is necessary for the conversion of homocysteine to methionine which is essential for the metabolism of folic acid. Deficiency of tetrahydrafolate leads to reduced synthesis of thymidylate resulting in reduced synthesis of DNA which is essential for cell maturation. Vitamin B12 is also concerned in the maintenance of sulphydryl groups in reduced form, deficiency leading to decreased amounts of reduced SH content of erythrocytes and liver cells. Overall, vitamin B12 acts as a coenzyme for various metabolic functions, including fat and carbohydrate metabolism and protein synthesis. It is necessary for growth, cell replication, hematopoiesis, and nucleoprotein as well as myelin synthesis. This is largely due to its effects on metabolism of methionine folic acid, and malonic acid. 
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    | Metabolism | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Metabolism Á¤º¸ # Phase_1_Metabolizing_Enzyme:Not Available 
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    | Protein Binding | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ ´Ü¹é°áÇÕ Á¤º¸ Very high (90%). Cobalamins are extensively bound to two specific plasma proteins called transcobalamin 1 and 2; 70% to transcobalamin 1, 5% to transcobalamin 2. 
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    | Half-life | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ ¹Ý°¨±â Á¤º¸ Approximately 6 days (peak plasma concentration after 8-12 hours from oral administration) 
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    | Absorption | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Absorption Á¤º¸ Readily absorbed from the gastrointestinal tract, except in malabsorption syndromes. Vitamin B12 is absorbed in the lower half of the ileum. 
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    | Pharmacokinetics | 
    
       HydroxocobalaminÀÇ ¾à¹°µ¿·ÂÇÐÀÚ·á 
- Èí¼ö : 
	
	- °æ±¸ Åõ¿©½Ã ¼ÒÀå ¿øÀ§ºÎ·ÎºÎÅÍ ºÒ±ÔÄ¢ÀûÀ¸·Î Èí¼öµÈ´Ù.
	
 - ´Éµ¿ Èí¼ö¿¡´Â IF¿ÍÀÇ º¹ÇÕü Çü¼ºÀÌ ÇʼöÀûÀ̸ç, Àå°üº®À» ÅëÇØ ¼öµ¿ Èí¼öµµ °¡´ÉÇÏ´Ù.
	
 - À§, ȸÀå¿¡ ±¸Á¶Àû ¼Õ»óÀ̳ª ±â´ÉÀû ¼Õ»óÀÌ ÀÖ´Â °æ¿ì Èí¼ö°¡ °¨¼ÒÇÑ´Ù.
	
  
 
 - ºÐÆ÷ : 
	
	- À§¿¡¼ À§Á¡¸·¿¡ ÀÇÇØ ºÐºñµÇ´Â ´ç´Ü¹éÀÎ IF (intrinsic factor)¿¡ °áÇÕÇÑ´Ù.
	
 - Àå°ü Á¡¸·¼¼Æ÷ ³»¿¡¼ vitamin B12-IF º¹ÇÕü·ÎºÎÅÍ vitamin B12°¡ À¯¸®µÈ ÈÄ, Ç÷¾× ³»¿¡¼ ÁַΠƯÀÌÀûÀÎ ¥â-globulin ¼ö¼Û´Ü¹éÁúÀÎ transcobalamin II¿Í °áÇÕÇÑ´Ù.
	
 - °£, °ñ¼ö ¹× ŹÝÀ» Æ÷ÇÔÇÑ ±âŸ Á¶Á÷À¸·Î ºÐÆ÷Çϸç, ÁÖ·Î °£ (50-90%)¿¡ ÀúÀåµÈ´Ù.
	
  
 - ´Ü¹é°áÇÕ : ÁÖ·Î transcobalamin II¿Í °áÇÕÇϸç, ¼Ò·®Àº transcobalamin I (¥á-glycoproteinÀÇ ÀÏÁ¾) ¹× transcobalamin III (inter-¥á-glycoproteinÀÇ ÀÏÁ¾)°ú °áÇÕÇÑ´Ù.
  - ´ë»ç : Àå°£¼øÈ¯
 - ¼Ò½Ç : 
	
	- Vitamin B12¸¦ Åõ¿©¹Þ°í ÀÖÁö ¾Ê´Â Á¤»óÀÎ : ¸¹Àº ¾çÀÌ ´ãÁó ¹è¼³ ÈÄ Àå°£¼øÈ¯ÇÑ´Ù.
		
		- ÀÏÀÏ turnover rate : ü³» ÃÑÀúÀå·®ÀÇ 0.05-0.2% (¹üÀ§ : 0.4-8 ¥ìg)
		
 - ÀÏÀÏ ½Å¹è¼³·®Àº ´ë°³ 0.25 ¥ìg ÀÌÇÏ
		
  
	 - Vitamin B12¸¦ Åõ¿©¹Þ´Â °æ¿ì : 0.1-1 mg ±ÙÀ°ÁÖ»ç ¶Ç´Â Á¤¸ÆÁÖ»ç ÈÄ 48½Ã°£ À̳»¿¡ 50-90%°¡ ½Å¹è¼³µÈ´Ù.
	
  
  
 
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    | Biotransformation | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Biotransformation Á¤º¸ Primarily hepatic. Cobalamins are absorbed in the ileum and stored in the liver. They continuously undergo enterohepatic recycling via secretion in the bile. Part of a dose is excreted in the urine, most of it in the first 8 hours. 
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    | Toxicity | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Toxicity Á¤º¸ Not Available 
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    | Drug Interactions | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Drug_Interactions Á¤º¸ Alfentanil	The macrolide increases the effect and toxicity of alfentanilAlprazolam	The macrolide increases the effect of the benzodiazepineAminophylline	The macrolide increases the effect and toxicity of theophyllineAmiodarone	Increased risk of cardiotoxicity and arrhythmiasAnisindione	The macrolide increases anticoagulant effectAprepitant	This CYP3A4 inhibitor increases effect and toxicity of aprepitantAstemizole	Increased risk of cardiotoxicity and arrhythmiasAtorvastatin	The macrolide possibly increases the statin toxicityBretylium	Increased risk of cardiotoxicity and arryhthmiasBromocriptine	Erythromycin increases serum levels of bromocriptineBuspirone	The macrolide increases the effect and toxicity of buspironeCabergoline	Erythromycin increases serum levels and toxicity of cabergolineCarbamazepine	The macrolide increases the effect of carbamazepineCerivastatin	The macrolide possibly increases the statin toxicityCilostazol	Erythromycin increases the effect of cilostazolCinacalcet	This macrolide increases the serum levels and toxicity of cinacalcetCisapride	Increased risk of cardiotoxicity and arrhythmiasCitalopram	Possible serotoninergic syndrome with this combinationClozapine	Erythromycin increases the effect of clozapineColchicine	Severe colchicine toxicity can occurCyclosporine	The macrolide increases the effect of cyclosporineDiazepam	The macrolide increases the effect of the benzodiazepineDicumarol	The macrolide increases anticoagulant effectDigoxin	The macrolide increases the effect of digoxin in 10% of patientsDihydroergotamine	Possible ergotism and severe ischemia with this combinationDihydroergotoxine	Possible ergotism and severe ischemia with this combinationDyphylline	The macrolide increases the effect and toxicity of theophyllineDisopyramide	Increased risk of cardiotoxicity and arrhythmiasDivalproex sodium	Erythromycin increases the effect of valproic acidDocetaxel	The agent increases the serum levels and toxicity of docetaxelDofetilide	Increased risk of cardiotoxicity and arrhythmiasEletriptan	The macrolide increases the effect and toxicity of eletriptanEplerenone	This CYP3A4 inhibitor increases the effect and toxicity of eplerenoneErgotamine	Possible ergotism and severe ischemia with this combinationErlotinib	This CYP3A4 inhibitor increases levels/toxicity of erlotinibImatinib	The macrolide increases levels of imatinibFelodipine	Erythromycin increases the effect of felodipineFluoxetine	Possible serotoninergic syndrome with this combinationGefitinib	This CYP3A4 inhibitor increases levels/toxicity of gefitinibGrepafloxacin	Increased risk of cardiotoxicity and arrhythmiasItraconazole	The macrolide increases the effect and toxicity of itraconazoleLevofloxacin	Increased risk of cardiotoxicity and arrhythmiasMesoridazine	Increased risk of cardiotoxicity and arrhythmiasMethylergonovine	Possible ergotism and severe ischemia with this combinationLovastatin	The macrolide possibly increases the statin toxicityMethylprednisolone	The macrolide increases the effect of corticosteroidMethysergide	Possible ergotism and severe ischemia with this combinationMidazolam	The macrolide increases the efect of the benzodiazepineMoxifloxacin	Increased risk of cardiotoxicity and arrhythmiasOxtriphylline	The macrolide increases the effect and toxicity of theophyllinePimozide	Increased risk of cardiotoxicity and arrhythmiasQuetiapine	This macrolide increases the effect/toxicity of quetiapineQuinidine	Increased risk of cardiotoxicity and arrhythmiasQuinidine barbiturate	Increased risk of cardiotoxicity and arrhythmiasQuinupristin	This combination presents an increased risk of toxicityRanolazine	Increased levels of ranolazine - risk of toxicityRepaglinide	This macrolide increases effect of repaglinideRifabutin	The rifamycin decreases the effect of the macrolideRifampin	The rifamycin decreases the effect of the macrolideRitonavir	Increased toxicity of both agentsSertraline	Possible serotoninergic syndrome with this combinationSibutramine	Erythromycin increases the effect and toxicity of sibutramineSildenafil	The macrolide increases the effect and toxicity of sildenafilSimvastatin	The macrolide possibly increases the statin toxicitySirolimus	The macrolide increases sirolimus levelsSotalol	Increased risk of cardiotoxicity and arrhythmiasSparfloxacin	Increased risk of cardiotoxicity and arrhythmiasTacrolimus	Erythromycin increases the effect and toxicity of tacrolimusTerfenadine	Increased risk of cardiotoxicity and arrhythmiasTheophylline	The macrolide increases the effect and toxicity of theophyllineThioridazine	Increased risk of cardiotoxicity and arrhythmiasVerapamil	Increased risk of cardiotoxicity and arrhythmiasTriazolam	The macrolide increases the effect of the benzodiazepineVardenafil	The macrolide increases the effect and toxicity of vardenafilVinblastine	Erythromycin increases vinblastine toxicityWarfarin	The macrolide increases anticoagulant effectZafirlukast	Erythromycin decreases the effect of zafirlukastErgonovine	Possible ergotism and severe ischemia with this combinationEverolimus	The macrolide increases everolimus levels/toxicityLincomycin	Possible antagonism of action with this combinationAcenocoumarol	The macrolide increases anticoagulant effect 
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    CYP450  Drug Interaction | 
    
      [CYP450 TableÁ÷Á¢Á¶È¸] 
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    | Food Interaction | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Food Interaction Á¤º¸ Not Available 
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    | Drug Target | 
    
      
      [Drug Target]
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    | Description | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Description Á¤º¸ Injectable form of vitamin B 12 that has been used therapeutically to treat vitamin B 12 deficiency. [PubChem] 
     | 
   
  
   
    | Drug Category | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Drug_Category Á¤º¸ Anti-anemic AgentsHematinicsNutritional SupplementVitamin B Complex 
     | 
   
  
   
    | Smiles String Canonical | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Smiles_String_canonical Á¤º¸ O.[Co++].CC(CNC(=O)CCC1(C)C(CC(N)=O)C2[N-]C1=C(C)C1=NC(=CC3=NC(=C(C)C4=NC2(C)C(C)(CC(N)=O)C4CCC(N)=O)C(C)(CC(N)=O)C3CCC(N)=O)C(C)(C)C1CCC(N)=O)OP([O-])(=O)OC1C(CO)OC(C1O)N1C=NC2=C1C=C(C)C(C)=C2 
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    | Smiles String Isomeric | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Smiles_String_isomeric Á¤º¸ O.[Co++].C[C@H](CNC(=O)CC[C@]1(C)[C@@H](CC(N)=O)[C@H]2[N-]\C1=C(C)/C1=N/C(=C\C3=N\C(=C(C)/C4=N[C@]2(C)[C@@](C)(CC(N)=O)[C@@H]4CCC(N)=O)[C@@](C)(CC(N)=O)[C@@H]3CCC(N)=O)C(C)(C)[C@@H]1CCC(N)=O)O[P@]([O-])(=O)O[C@@H]1[C@@H](CO)O[C@@H]([C@@H]1O)N1C=NC2=C1C=C(C)C(C)=C2 
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    | InChI Identifier | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ InChI_Identifier Á¤º¸ InChI=1/C62H90N13O14P.Co.H2O/c1-29-20-39-40(21-30(29)2)75(28-70-39)57-52(84)53(41(27-76)87-57)89-90(85,86)88-31(3)26-69-49(83)18-19-59(8)37(22-46(66)80)56-62(11)61(10,25-48(68)82)36(14-17-45(65)79)51(74-62)33(5)55-60(9,24-47(67)81)34(12-15-43(63)77)38(71-55)23-42-58(6,7)35(13-16-44(64)78)50(72-42)32(4)54(59)73-56;;/h20-21,23,28,31,34-37,41,52-53,56-57,76,84H,12-19,22,24-27H2,1-11H3,(H15,63,64,65,66,67,68,69,71,72,73,74,77,78,79,80,81,82,83,85,86);;1H2/q;+2;/p-2/t31-,34-,35-,36-,37+,41-,52-,53-,56-,57+,59-,60+,61+,62+;;/m1../s1/fC62H88N13O14P.Co.H2O/h69H,63-68H2;;/q-2;m;/b42-23-,54-32-,55-33-;; 
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    | Chemical IUPAC Name | 
    
       Hydroxocobalamin¿¡ ´ëÇÑ Chemical_IUPAC_Name Á¤º¸ Hydroxocobalamin 
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