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[9] Visual disturbances have been reported in patients with Leber hereditary optic neuropathy, and rapid B12 administration may precipitate optic nerve atrophy in this genetically predisposed population, mandating extreme caution or alternative therapy

[24] How soon should neurologic symptoms begin to resolve after starting therapy

While animal models and in vitro cultures provided the "proof of concept," the 2026 reclassification has allowed for the validation of these mechanisms in human clinical settings

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Precautions General Precautions: Vitamin B 12 deficiency that is allowed to progress for longer than 3 months may produce permanent degenerative lesions of the spinal cord

Usually requires refrigerated and dark storage