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The frequency of B12 injections depends on the severity of your deficiency and your individual needs
Reduced effectiveness despite consistent dosing can also indicate degradation, though this is harder to confirm objectively
While B12 is generally safe, caution is needed in specific clinical situations: Lebers Disease (Hereditary Optic Neuropathy): B12 injections are generally contraindicated or should be used with extreme caution, as they may potentially aggravate optic atrophy in this rare condition
Brcic, I
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/Laboratory Test Interactions ), use of a gluten free diet in nontropical sprue, or administration of antibiotics in tropical sprue