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For malabsorption (e.g., pernicious anemia), injections are often preferred, though some clinicians still use very high-dose oral regimens (NIH ODS)

The theoretical argument is simple: going sub q bypasses the gut and first-pass metabolism entirely, so in theory youd get close to 100% bioavailability versus the ~38% seen orally

Its used extensively in injections due to its long-acting nature and is often the preferred form for treating severe B12 deficiencies

Injectable administration ensures rapid systemic absorption , particularly valuable for patients with malabsorption syndromes, gastrointestinal disorders, or those requiring higher therapeutic doses

usable activity persists for several weeks even without refrigeration