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A subcutaneous (under-the-skin) vial format exists, but the dose volume math makes injection awkward at common doses
These injections, usually containing hydroxocobalamin or cyanocobalamin, are administered intramuscularly, thus bypassing the digestive system where the absorption problem occurs
Both are naturally occurring copper-binding tripeptides found in skin, but with different N-terminal amino acids (Ala vs Gly)
Some patients might move from, say, weekly injections to monthly injections as maintenance, then eventually to none if possible
Mikus et al., 2001
The Journal of Nutrition
