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Refrigeration may be required, depending on the exact formulation

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"Cyanocobalamin reductase / alkylcobalamin dealkylase (MMACHC, Human)"

In a 2-year trial, acute pancreatitis was reported in 8 semaglutide-treated patients (0.27 cases per 100 patient-years) and 10 placebo-treated patients (0.33 cases per 100 patient-years), both on a background of standard of care.1 In trials of patients receiving oral semaglutide, pancreatitis was reported as a serious adverse event in 6 patients (0.1 events per 100 patient-years) receiving semaglutide versus 1 in comparator-treated patients (less than 0.1 events per 100 patient-years)

Anyone planning research-context use should treat outcome reports cautiously and weigh the FDA-approved alternatives discussed in the comparisons section

They have a lot of the same traits both mimic the GLP-1 hormone and are FDA-approved for weight loss but they arent identical