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Key characteristics: 28 to 90 day beyond-use date from preparation (varies by pharmacy) May or may not contain preservatives Multi-dose vials requiring multiple punctures Potency can vary between batches Different pharmacies produce different quality levels Storage requirements may differ from brand-name The variability between compounding pharmacies is significant

For example, older people (because absorption declines with age) and those with gut-related conditions such as celiac disease and Crohns disease may struggle to absorb enough vitamin B12 to stave off symptoms of a deficiency, says Foxx

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The most comprehensive review to date, published in JAAOS Global Research & Reviews , reached the same conclusion: Although preclinical studies are promising, there is a current lack of clinical trials (Rahman et al., 2026)