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You can make finer dose adjustments (like stepping from 0.5 mg to 0.75 mg instead of jumping straight to 1.0 mg) and you can use split dosing strategies that pre-filled pens do not allow

Nisenblat, V., Bossuyt, P

Additional risk factors include: Chronic kidney disease : Reduced renal clearance may impair B12 excretion Liver disease : Hepatic dysfunction can disrupt B12 metabolism and storage Myeloproliferative disorders : Certain blood cancers increase B12-binding proteins Concurrent medication use : Some drugs may interact with B12 metabolism, including metformin, proton pump inhibitors, and H2 antagonists Patients with these conditions should have B12 supplementation carefully monitored by their healthcare team

Gastrointestinal permeability and absorptive capacity in sepsis

Rather than acting through a single receptor system, research suggests it may exert modulatory effects across neurotransmitter networks, including GABAergic signaling, opioid receptor activity, and hypothalamicpituitaryadrenal (HPA) axis regulation