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Extreme temperatures can also degrade the peptide itself

In all cases you should follow the manufacturers directions as one medical reference notes, the volume of the preparation to be used for diluting or dissolving any drug for injection is dependent on the vehicle concentration, dose and route as recommended by the manufacturer

Drugs such as carvedilol, lidocaine, propafenone, and verapamil exhibit reduced clearance and prolonged half-life, necessitating dose reductions of 23 fold in moderate to severe liver disease (11)

You can find genetic testing with various companies such as 23andme.com Its estimated that those with one mutation (heterozygous) decrease their ability to methylate by 30% and those with two mutations (homozygous) decrease their ability to methylate by 70%, making it virtually impossible to get adequate B12 from diet alone (19)