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Very high doses of zinc, for example, can interfere with copper absorption and potentially impact glutathione metabolism

[19] [17] If B12 deficiency is clinically suspected, IM hydroxocobalamin should be started promptly without waiting for blood test results

Another consideration is that sterile water by itself has no ions in some cases, injecting a large volume of pure water can cause discomfort (due to being hypotonic), so when used for injection, usually only small volumes are administered or the peptide is further diluted into a buffer or saline before use

Those individuals may not convert cyanocobalamin efficiently, which could slow symptom relief despite adequate blood levels

The usual dose for adults is 0.25-2ml

Anes J, McCusker MP, Fanning S, Martins M