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How is hydroxocobalamin different from cyanocobalamin

Sublingual administration, which bypasses the gastrointestinal tract, appears to be equally effective as IM injections while being less invasive and more cost-efficientparticularly in patients with atrophic gastritis, post-gastrectomy status, or conditions that impair intrinsic factor-mediated absorption, where long-term intervention is often required

In lipodystrophy, patients lack adipose tissue due to genetic mutations in the ability to properly form functional adipocytes or to store FAs as TAGs (168)

But if they dont get better or get worse, you should talk to a doctor

The rest is inert material or impurities

Heres what may be happening