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It is not approved as a drug, supplement, or food ingredient in the US, EU, Australia, and similar markets

Aggressive mixing, wrong water types, and improper temperatures can all damage the peptide structure through a process called denaturation, which permanently reduces or eliminates biological activity

The BNF suggests the use of oral tablets to replace any dietary deficiency in B12 but does not recommend them for treating Pernicious Anaemia that should be treated with injections

However, much of the data supporting the contraindication and interaction is based on the use of intravenous methylene blue, or extrapolation of similar drugs that work on MAOIs