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Higher-Caution Situations Extra medical supervision is important if you: have a history of reactions to injectable vitamins/cobalamins have significant kidney or liver disease are pregnant or breastfeeding are offered a compounded MIC B12 product without clear labeling of ingredients, concentrations, and compounding source The FDAs overview of compounding helps explain why quality can vary (see Compounding and the FDA: Questions and Answers )

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Make sure patients understand exactly what off-label use means, what risks and benefits there are, and what the alternatives look like

Another RCT found a decrease in homocysteine with 1000 g hydroxo-B12 monthly for 3 months by 2 mol/l, whilst the control group had a 2 mol/l increase, although the difference was not statistically significant