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Patients with acquired ulnar positive variance, discussed in greater detail later, are at higher risk for degenerative changes and recurrent injury from minor trauma

See PepPal's stacking safety guide

Situations where oral administration is not feasible (e.g., anorexia, nausea, pre-op, GI absorption issues)

NICE NG28 similarly recommends considering periodic monitoring of B12 in people at risk on long-term metformin this is not a blanket recommendation for all metformin users, but is targeted at those with relevant risk factors or symptoms

It does not provide medical advice

Elevated B12 levels often indicate underlying health conditions such as liver disease, kidney dysfunction, or haematological disorders rather than simple overconsumption