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B12 injections are contraindicated for individuals with Lebers hereditary optic neuropathy, severe kidney disease, known cobalt or cobalamin allergy, and polycythemia vera

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As of July 26, 2026, 21 CFR 216.23 lists six substances that can be used through this pathway: Brilliant Blue G, cantharidin for topical use only, diphenylcyclopropenone for topical use only, N-acetyl-D-glucosamine for topical use only, squaric acid dibutyl ester for topical use only, and thymol iodide for topical use only