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The pressure can damage the peptide structure

[PubMed] National Institutes of Health

Yes, bioavailability significantly affects how much you need

Uses of Hydroxocobalamin Injection Vitamin B12 deficiency Pernicious anemia Megaloblastic anemia Peripheral neuropathy due to B12 deficiency Maintenance therapy in vegans or elderly patients Cyanide poisoning (approved use in emergency medicine) How Does THydroxocobalamin Injection Works Hydroxocobalamin is converted in the body to active coenzyme forms of Vitamin B12, which: Help in red blood cell production Maintain nerve function and myelin sheath Participate in DNA and protein synthesis Act as a cyanide scavenger by binding to cyanide ions and converting them into non-toxic cyanocobalamin , which is excreted in urine Common Side Effects of Hydroxocobalamin Injection Temporary skin redness or itching Mild diarrhea Headache or dizziness Injection site pain or swelling Reddish urine discoloration (harmless) Rare: Hypersensitivity reactions Generally well tolerated

A Cochrane Review evaluated three clinical trials conducted in Germany, the U.S., and India