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One way to create methylcobalamin in a lab is to use sodium borohydride to reduce cyanocobalamin in an alkaline solution and then add methyl iodide

People with the following should discuss risks carefully with a medical professional: Liver disease Kidney disease Pernicious anemia Known allergies to any ingredient in the formulation Pregnancy or breastfeeding (safety not well-studied avoid unless prescribed) Because ingredients differ between providers, always verify the formulation and follow prescribed dosing to minimize risk

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Compounded medications are specially prepared for individual patient needs based on a valid prescription and, as such, are not reviewed or approved by the U.S

It is most useful when a conventional treatment path has been followed appropriately and has plateaued

- Results can vary depending on individual factors and the reason for use