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Since a 10mg vial at the starting dose provides four weeks of doses, you need the preservative to keep the solution safe across all four draws

Its mechanism of action involves being a precursor to active forms of vitamin B12, specifically methylcobalamin and adenosylcobalamin, which play crucial roles in DNA and fatty acid metabolism, nerve function maintenance, myelin formation, and red blood cell synthesis

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For patients with elevated liver enzymes, further workup may include hepatitis B and C serologies, iron studies, autoimmune markers, and ceruloplasmin to exclude alternative causes of liver disease

Federal rules for pharmacy compounding place limits on the ingredients, prescribers and circumstances involved