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Delayed gastric emptying extends the time B12 spends in the acidic stomach environment, which might initially seem beneficial

If significant deficiency is confirmed via blood test, a loading dose protocol may be recommended in line with NICE guidance typically more frequent injections over the initial weeks to rapidly restore levels

Patients experiencing persistent gastrointestinal adverse effects may benefit from slower titration schedules or maintaining lower doses for longer periods before attempting escalation

For compounded products, specifically, the FDA has stated that some may have additional secret ingredients or other formulations

Although one-third of patients with vitamin B12 deficiency can have normal serum B12 concentrations, measuring serum vitamin B12 is still a convenient screening test when the clinical picture is suggestive of vitamin B12 deficiency