Used as a precursor in the synthesis of vitamin B12 derivatives, hydroxocobalamin acetate plays a role in pharmaceutical formulations aimed at treating vitamin B12 deficiency. It is particularly valuable in injectable forms due to its stability and ability to convert into active coenzyme forms in the body. It is also employed in the management of cyanide poisoning, where it acts by binding cyanide to form cyanocobalamin, which is then excreted in urine. Its application extends to diagnostic use in identifying certain metabolic disorders related to cobalamin metabolism. Due to its low toxicity and high efficacy, it is preferred in sensitive patient populations, including those with renal impairment.