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In the presence of neurological symptoms, following daily treatment, injections up to weekly or biweekly are indicated for six months before initiating monthly IM injections

Some people describe this as feeling mentally foggy or having trouble staying sharp during tasks that require attention

A 2025 meta-analysis of 16 studies involving 6,098 participants found no statistically significant difference between intramuscular, oral, and sublingual B12 supplementation routes (p=0.270)

**Biotin can interfere with some laboratory testing, this may cause results to be either falsely elevated or decreased

They work best as part of a comprehensive program that includes dietary modifications, exercise, and in many cases a primary weight loss medication such as semaglutide or tirzepatide

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