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Mechanism And Absorption Injections (IM or subcutaneous) Usually given as cyanocobalamin or hydroxocobalamin Absorbed directly from muscle or subcutaneous tissue into circulation Typically administered in a clinic, or self-injected after training B12 nasal spray Absorbed through the nasal mucosa directly into the bloodstream Avoids needles, first-pass metabolism, and GI issues Can be administered at home in seconds A quick side-by-side view can help: Clinical work with prescription cyanocobalamin nasal spray (e.g., Nascobal) shows that nasal B12 reaches effective blood levels and maintains them over time when used on a consistent schedule, with research from the Comparison of the Efficacy demonstrating superior absorption through nasal delivery compared to oral administration