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[9] Visual disturbances have been reported in patients with Leber hereditary optic neuropathy, and rapid B12 administration may precipitate optic nerve atrophy in this genetically predisposed population, mandating extreme caution or alternative therapy

[18] Cyanocobalamin is the most common form used in dietary supplements and food fortification because cyanide stabilizes the molecule against degradation

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Because the milligram amount is fixed, a lighter body gets more drug exposure per pound: roughly 22% more at 70 kg and about a third less at 120 kg, compared with a 90 kg reference. The dose still comes from response and tolerability, but a lighter person is running a hotter exposure at the same number on the vial

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