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Prescriber Update Articles

Nitrous oxide - side effects reminder

Web site: August 2009
Prescriber Update 2009;30(3):20

Prescribers are reminded that prolonged use of nitrous oxide has been associated with neurological and haematological side effects such as megaloblastic anaemia and myelopathy due to inactivation of vitamin B₁₂. Neurological symptoms can occur without any overt haematological changes.

Where possible, prescribers are advised:

• To check vitamin B₁₂ levels in those with risk factors for vitamin B₁₂ deficiency prior to using nitrous oxide and to seek specialist advice if necessary.
• Not to use nitrous oxide continuously for more than 24 hours or more frequently than every 4 days without clinical supervision and haematological monitoring.