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Keeping it on a shelf ensures a more consistent cool temperature.

If the patient is suspected to be sensitive to cobalt or other components of cobalamin, an intradermal test dose is recommended.[12][15] Several laboratory tests should be performed prior to treatment with cyanocobalamin, including serum vitamin B12, folate, iron, hematocrit, and reticulocyte count

These injections work best when combined with healthy lifestyle habits such as balanced nutrition and regular exercise

Such recommendations would be inconvenient for many people and could lead to some cases of acne-like symptoms in people sensitive to high doses of B12 (see Footnote B in Elevated Vitamin B12 Levels and Mortality)