We do not know whether the buccal absorption of methylcobalamin from an ODT is sufficient to fully compensate for the B12 absorption impairment caused by semaglutide
Addressing the problem while tissue retains regenerative capacity offers better outcomes than waiting until degeneration becomes established
Vitamin B12 There is four types of parenteral Vitamin B12 available: Cyanocobalamin 100 mcg/ml and 1000 mcg/ml best used as IM to prevent rapid loss via kidneys Hydroxycobalamin IM (compounded 1000 mcg/ml or more) known as long acting B12 (binds better to plasma proteins than cyanocobalamin) Methylcobalamin IV (compounded 1000 mcg or more up to 5000 mcg/ml) Adenosylcobalamin IV Common dose is 1000 mcg IM or IV Vitamin B12 as hydroxycobalamin is synthesized exclusively by microorganisms and is found in the liver of animals bound to protein as methylcobalamin = metabolically active form of Vitamin B12 Hydroxycobalamin is a chelator of cyanide and is used in cyanide poisoning Hydroxocobalamin is most generally used for vitamin B12 replacement therapy and is considered the drug of choice for vitamin B12 deficiency by the Martindale Extra Pharmacopoeia (Sweetman, 2002) and the World Health Organization (WHO) Model List of Essential Drugs
It is one of the twelve peptides the FDA removed from the list that restricted compounding in April 2026, and one of seven under formal advisory review on July 2324, 2026
On average, it takes 7 to 10 days for the effects to become apparent
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