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A list of common conditions besides pernicious anemia associated with a B12 deficiency includes the following: Crohns disease Celiac disease Atrophic gastritis, otherwise known as a thinning of the stomach lining Bacteria or parasites in the intestines Immune system disorders, including Graves disease and lupus Inflammatory bowel disease (IBD) Medications Medications can also interfere with B12 absorption, such as some heartburn medicines and proton pump inhibitors prescribed to diabetics

So even at 0.25mg per week, you would need a new vial after week 4 regardless

Hum Exp Toxicol 41:9603271221093988 Deshpande LS, Lou JK, Mian A et al (2008) Time course and mechanism of hippocampal neuronal death in an in vitro model of status epilepticus: role of NMDA receptor activation and NMDA dependent calcium entry [J]

doi: 10.1016/j.biopha.2018.10.075 289 NargesiS.RezaieS