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After Opening: For multi-dose vials of B12 injections, there is always a specific shelf life after the vial has been opened

References Wu J, Ma S, Sandhoff R, Ming Y, Hotz-Wagenblatt A, Timmerman V, et al

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Reactive oxygen species, not Ca2+, mediates methotrexate-induced autophagy and apoptosis in spermatocyte cell line

Absorption Issues from GI Conditions and Surgery Other health issues can throw up similar roadblocks to B12 absorption, making long-term injection therapy the only effective solution