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It's one of the first questions patients ask their providers, and honestly, it's the right question to ask

Optic Nerve Atrophy: Administering cyanocobalamin to patients with Leber's disease or hereditary optic nerve atrophy should be done cautiously, as it may worsen the condition

My preference is to give along with 5HTP in order to support serotonin pathways and improve mood

(ed.) Selenium: Its Molecular Biology and Role in Human Health

For 2 mg dose: 2 / 1 x 100 = 200 units (full vial) 5 mg vial + 2.5 mL water = 2 mg/mL

However, the current evidence base is largely preclinical, and no large-scale human clinical trials have confirmed its efficacy