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B12 injections tend to be most useful for: Patients on GLP-1 medications (semaglutide, tirzepatide) who feel fatigue in early weeks Patients with low energy, brain fog, or mood symptoms Vegetarians or vegans (plant foods don't contain B12) Adults over 50 (B12 absorption drops with age) Patients who've had digestive surgeries (bariatric, gallbladder) that affect absorption They're generally safe B12 is water-soluble, so your body excretes what it doesn't use

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The FDA has required labeling updates to include warnings about persistent side effects, acknowledging that they occur in a subset of users beyond the treatment period