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The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) tool was used to assess the certainty of the evidence for the two primary biochemical outcomesserum vitamin B12 concentration increase and homocysteine reductionacross all included studies, and separately for randomised controlled trials (RCTs) and observational studies

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C (Comparison): intramuscular administration of Vitamin B12

If it does not dissolve after 5 minutes of gentle swirling, possible causes include: degraded peptide (check storage history and expiration status ), contaminated water (use a fresh vial of bacteriostatic water), or water temperature (cold water from the refrigerator dissolves peptides more slowly than room temperature water)

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Wear powder-free gloves and replace them if they touch non-sterile surfaces