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If levels decline, adding b12 becomes appropriate with clear justification

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A physician-supervised plan can help answer whether the medication is appropriate, which option fits the patients risk profile, what dose should be used, how quickly the dose should increase, what side effects should be expected, when the dose should be held or adjusted, how much protein the patient should eat, how muscle can be preserved, what labs should be tracked, and what long-term maintenance should look like

Some researchers split the powder between two reconstitution sessions to work around this limitation, though this requires advanced technique and introduces additional contamination risk

Ortega FB, Lavie CJ, Blair SN