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People with the following should discuss risks carefully with a medical professional: Liver disease Kidney disease Pernicious anemia Known allergies to any ingredient in the formulation Pregnancy or breastfeeding (safety not well-studied avoid unless prescribed) Because ingredients differ between providers, always verify the formulation and follow prescribed dosing to minimize risk

Low blood sugar depends mainly on concurrent insulin or sulfonylurea use

B12 is naturally found in animal products like meat, dairy, and eggs, making vegetarians and vegans more susceptible to deficiencies

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Vidal-Alaball J, Butler CC, Potter CC: Comparing costs of intramuscular and oral vitamin B12 administration in primary care: a cost-minimization analysis

This is why injections are needed to keep B12 levels up