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People with Lebers hereditary optic neuropathy, a rare inherited optic nerve disorder, may be at risk of severe optic nerve damage with cyanocobalamin

Other people who are at risk of having vitamin B12 deficiency include those who have had intestinal surgery, or who have gut diseases like Crohns disease or celiac disease

While this represents a higher per-treatment cost than oral supplements, the superior absorption and reduced frequency often make injections cost-competitive over time, particularly for those who dont absorb oral forms effectively

While oral supplements can be a way to replace B12, oral supplements dont always absorb in the digestive system