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Indications and Usage for Cyanocobalamin Cyanocobalamin is indicated for vitamin B 12deficiencies due to malabsorption which may be associated with the following conditions: Addisonian (pernicious) anemia Gastrointestinal pathology, dysfunction, or surgery, including gluten enteropathy or sprue, small bowel bacteria overgrowth, total or partial gastrectomy Fish tapeworm infestation Malignancy of pancreas or bowel Folic acid deficiency It may be possible to treat the underlying disease by surgical correction of anatomic lesions leading to small bowel bacterial overgrowth, expulsion of fish tapeworm, discontinuation of drugs leading to vitamin malabsorption (see Drug Interactions), use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue

The patients body fat density also makes a difference as you need to factor in how much the needle will have to travel beyond the skin to reach the muscle

The therapeutic goal is to reduce free copper as early in the course of the disease as possible to prevent manifestation in the liver and brain