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Slowing the ramp to the label cadence (2.5 mg start, 2.5 mg steps, four-week holds) dropped that to mid-single digits at every maintenance dose, at no cost to the 12-week result, and the dedicated slow-titration trial reached placebo range. Reaching 15 mg is not the problem

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I don't see how you are getting that only 5mcg is lost daily: if you have injected say 1000 mcg of B12, most of it is peed out within a few days

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These formulations rely on enteric coatings or delayed-release polymers to protect the peptide until intestinal pH triggers release