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Common reasons for poor response Insufficient dose

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[95] Intramuscular or intravenous injection [edit] Injection of hydroxycobalamin is often used if digestive absorption is impaired, [2] but this course of action may not be necessary with high-dose oral supplements (such as 0.51.0 mg or more), [97] [98] because with large quantities of the vitamin taken orally, even the 1% to 5% of free crystalline B 12 that is absorbed along the entire intestine by passive diffusion may be sufficient to provide a necessary amount

Other research found a slightly higher rate of NAION in people using semaglutide, both for type 2 diabetes and weight loss