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Liver Disease: Individuals with liver disease may have impaired vitamin B12 metabolism, and injections may need to be closely monitored

Procurement records should capture item name, quantity, lot number, expiry date, receiving condition, storage placement, and the internal protocol associated with the purchase

For brand-name pens: Manufacturer expiration dates allow longer storage, typically 18 to 24 months from manufacturing

Neuropathy or neurological disease: Although evidence is mixed, injections are often given when deficiency is linked to nerve pain or cognitive symptoms

[4] Fletcher MM, Keov P, Truong TT, Mennen G, Hick CA, Zhao P, Furness SGB, Kruse T, Clausen TR, Wooten D, Sexton PM