Nitrous oxide (used in anaesthesia or misused recreationally) inactivates vitamin B12 and can precipitate or worsen neurological injury in patients with B12 deficiency
This approach extends the titration timeline significantly but can make the difference between tolerating the medication and quitting
Intramuscular injections Intramuscular shotsneedles that go deep into the muscle tissuewere believed to be superior because the medication can be absorbed into the bloodstream more quickly, due to muscle fibers having a greater blood supply than the tissue under your skin
If your doctor tries to get you off the shots in favor of oral B12 supplements (tablets, spray, etc), do not accept that as treatment
He had a keen interest as was recently needing B12 injections himself and not coping on the NHS regime
Oral, sublingual, and injectable forms absorb differently, affecting how well they work