contact your prescriber for instructions on adjusted dosing or vial replacement
Excess hydroxocobalamin can bind to other plasma proteins such as albumin, which helps explain the very high B12 levels seen after injections of that form

Other groups who may benefit include: Patients following gastric surgery (gastrectomy, bariatric procedures) where intrinsic factor production or absorption sites are compromised Individuals with malabsorption disorders such as Crohn's disease, coeliac disease, or chronic pancreatitis Strict vegans and vegetarians with dietary insufficiency, though oral supplementation is usually tried first Elderly patients with atrophic gastritis or reduced gastric acid production Patients on long-term metformin or proton pump inhibitors, which can impair B12 absorption [6] [8] Individuals with nitrous oxide exposure (recreational or medical), which can cause functional B12 deficiency Diagnosis typically involves serum B12 measurement, with levels below approximately 148 pmol/L (though thresholds vary between laboratories) generally indicating deficiency
However, penicillamine, a copper chelator used in Wilson's Disease, has been reported to, at times, both induce psychosis or reverse psychosis
You can talk to your doctor about potential alternatives
Oral glutathione supplements are rarely absorbed, enzymes in our stomach immediately begin to dissolve the bonds holding the three amino acids together