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For DSIP specifically, the substitution is far more consequential, and the reason follows directly from the half-life: Subcutaneous absorption competes with a 24 minute clearance

In addition, aberrant SQOR expression has been observed in bone lesions

Methylcobalamin is an active, native form, with zero recorded anaphylactic reactions in medical literature

The math below assumes a 5 mg vial with 3 mL bacteriostatic water, which is the max-volume assumption used on this page

This keeps vitamin B12 levels up and prevents deficiency from coming back

doi: 10.2174/0929867323666151127201732 580 MendonaRDCarvalhoNCMartin-MorenoJMPimentaAMLopesACSGeaAet al