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It uses a methyl group donated by S-adenosylmethionine (SAM) to methylate nicotinamide a vitamin B3 form that would otherwise be recycled back into NAD+

Intramuscular B12 injections : Recommended for individuals with absorption issues or severe deficiency

Administration Considerations: Treatment approach, dosing, and frequency should be guided by a licensed clinician and dispensing pharmacy

Nature Metabolism

Unexplained hypercobalaminemia, particularly levels above 1,000 pg/mL, has been associated with liver disease, kidney dysfunction, myeloproliferative disorders, and certain solid cancers in multiple large-scale studies