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Compounded medications, if prescribed, are not FDA-approved and may be prepared by state-licensed 503A compounding pharmacies based on individual patient needs

10.1016/j.arr.2024.102299 115 HegaziA

133 One observational study reported that 92% of patients experienced clinically significant improvement (25 mg daily titrated up to 75 mg daily over several weeks)

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Over time, however, there is always a certain amount of inactive cob(II)-cobalamin produced, which must be reactivated through methylation into methylcobalamin with the help of a special enzyme