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At the time, the FDA presented a lot of adverse event data that showed there was a risk of immunogenicity immune reactions and that raised some red flags for the committee, said Gupta, an adjunct assistant professor of anesthesiology at the Johns Hopkins University School of Medicine

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A 2025 meta-analysis of 16 studies involving 6,098 participants found no statistically significant difference between intramuscular, oral, and sublingual B12 supplementation routes

Its benefit depends heavily on exercise and baseline carnitine status: it is most useful for physically active people, vegetarians, and those with lower dietary intake, and shows little benefit as a standalone, sedentary-use supplement

This property makes it valuable for joint health