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Banerjee I, Robinson J, Sathian B

There are no other absolute contraindications reported for hydroxocobalamin use in deficiency states, but caution is advised in individuals with conditions such as early Lebers optic neuropathy (a rare hereditary optic atrophy) due to the theoretical risk of worsening vision

Cheap, mass-produced, or pre-mixed formulations sitting on shelves rapidly oxidize and lose potency

10.1038/sigtrans.2017.23 63 LiuS.JinX.GeY.DongJ.LiuX.PeiX.et al (2025)

[17] The ratio of reduced glutathione to oxidized glutathione within cells is a measure of cellular oxidative stress [18] [11] where increased GSSG-to-GSH ratio is indicative of greater oxidative stress