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Bariatric Surgery or Gastric Bypass may imact the
absorption of vitamin B₁₂ and cause vitamin B₁₂ deficiency.

Bariatric surgery causes part of the digestive tract to be bypassed, which limits vitamin B₁₂ absorption.

Bariatric surgery changes the process of digestion in the stomach. In general, things that interfere with the digestive process can lead to vitamin B₁₂ absorption problems. Since people who have had bariatric surgery may not absorb enough vitamin B₁₂, they could develop vitamin B₁₂ deficiency and may find that they need lifelong vitamin B₁₂ supplementation.

Vitamin B₁₂ supplementation may be necessary for you or someone you know who has had bariatric surgery. Only your doctor can determine if you're vitamin B₁₂ deficient. Start by talking to your doctor about testing and monitoring your vitamin B₁₂ levels.

Vitamin B₁₂ is an essential vitamin for your health. Vitamin B₁₂ has an important role in making red blood cells and also keeps nerve tissue healthy. It's important to have enough vitamin B₁₂ in your body to keep you healthy. If left untreated, vitamin B₁₂ deficiency can lead to serious problems with the blood and nervous system. Vitamin B₁₂ deficiency has been linked to psychiatric symptoms such as impaired memory, irritability, and depressed mood.

• Effective needle-free prescription nasal spray that helps maintain            vitamin B₁₂ levels
• Convenient self-administered weekly dosing
• Fewer visits to the doctor’s office for vitamin B₁₂ shots
• Avoid the pain associated with a shot

Make the switch to a flexible and convenient vitamin B₁₂ treatment option—make the move to Nascobal Nasal Spray.
Visit www.nascobal.com to learn more about this effective treatment option that may fit your lifestyle!

Available by prescription only.

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INDICATION
Nascobal^® (Cyanocobalamin, USP) Nasal Spray is indicated for the maintenance of normal hematologic status in pernicious anemia patients who are in remission following intramuscular vitamin B₁₂ therapy and who have no nervous system involvement.

Nascobal Nasal Spray is also indicated as a supplement for other vitamin B₁₂ deficiencies including: dietary deficiency of vitamin B₁₂ occurring in strict vegetarian diets; malabsorption of vitamin B₁₂ resulting from conditions including HIV infection, AIDS, and Crohn's disease; inadequate secretion of intrinsic factor resulting from lesions that destroy the gastric mucosa and other conditions associated with gastric atrophy including multiple sclerosis, HIV infection, AIDS, certain endocrine disorders, iron deficiency, and subtotal gastrectomy; total gastrectomy; competition for vitamin B₁₂ by intestinal parasites or bacteria; and inadequate utilization of vitamin B₁₂ that may occur if antimetabolites for the vitamin are employed in the treatment of neoplasia.

IMPORTANT SAFETY INFORMATION
Nascobal^® (Cyanocobalamin, USP) Nasal Spray is a prescription, man-made form of vitamin B₁₂.

Nascobal Nasal Spray is used to keep healthy levels of B₁₂. It is used to treat patients with pernicious anemia who do not have nervous system problems and who achieved healthy vitamin B₁₂ levels following vitamin B₁₂ shots.

Nascobal Nasal Spray is used to keep healthy vitamin B₁₂ levels in: strict vegetarians, people who cannot absorb vitamin B₁₂ because of damage to their stomach or intestine from diseases (HIV/AIDS, Crohn's disease and sprue) or surgery, infections caused by parasites or bacteria, and patients who cannot process vitamin B₁₂ because of certain cancer treatments.

Do not take Nascobal if you are sensitive to cobalt and/or vitamin B₁₂ or any ingredients in the medication. In patients with Leber's disease, treatment with vitamin B₁₂ can damage their sight (optic nerve atrophy). In patients with too many red blood cells (a condition called polycythemia vera), treatment with vitamin B₁₂ may cause this condition to return. In patients with severe anemia treated with vitamin B₁₂, low potassium levels (hypokalemia) and sudden death may occur.

Some patients will need a weekly spray of Nascobal in their nostril for the rest of their lives. Do not stop taking your medication without talking to your doctor. If you stop taking vitamin B₁₂, anemia could return, or you could develop permanent nerve damage.

Side effects thought to be related to Nascobal use are usually mild and include headache, nausea, and rhinitis.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch, or call
1-800-FDA-1088.

Please see full Prescribing Information. 

For more information, visit our Web site at www.nascobal.com

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©2010 Strativa Pharmaceuticals, a division of Par Pharmaceutical, Inc.
Nascobal is a registered trademark of Par Pharmaceutical, Inc.
NAS00 0151