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Category 2 substances also have sufficient supporting information, but the FDA has identified significant safety risks

There are no head-to-head studies showing that adding methylcobalamin to semaglutide improves weight loss outcomes, reduces side effects, or meaningfully prevents B12 depletion better than taking a separate B12 supplement

As a prescription-only treatment, B12 injections must be assessed and prescribed by a qualified independent prescriber before administration

doi:10.1210/endo.142.12.8522 Heffernan MA, Thorburn AW, Fam B, et al

Note: Oral use only

For most healthy adults, oral B12 is absorbed well and works fine