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Jr., Reams, M., Agel, J

Cyanocobalamin is indicated for vitamin B12 deficiencies 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 PRECAUTIONS-Drug Interactions), use of a gluten-free diet in nontropical sprue, or administration of antibiotics in tropical sprue

Vitamin B12 can also be given as a subcutaenous injection

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For this reason, the NIH has not established a tolerable upper intake level for B12