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This biphasic response curve, where both microgram and nanogram doses work equally well, is unusual and mechanistically unclear

A systematic review of randomized controlled trials found that high-dose oral vitamin B12 (2000 g daily) was as effective as intramuscular injections in increasing serum vitamin B12 levels and improving hematological and neurological outcomes in deficient patients

Unscrew the needle from the pen and dispose of it in a sharps container

Each mL contains: Hydroxocobalamin Acetate equivalent to 1000 mcg Hydroxocobalamin, Sodium Acetate Anhydrous 0.2 mg, Glacial Acetic Acid 0.442 mg, Sodium Chloride 8.2 mg, with Methylparaben 1.5 mg and Propylparaben 0.2 mg as preservatives, in Water for Injection q.s

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This approach has proven dramatically more effective in clinical trials