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To avoid the burden of frequent IM injections, SQ administration of 1 mg OHCbl was initiated using a subcutaneous catheter device together with a portable infusion pump

There's really no one-size-fits-all answer, which is why there's so much conflicting evidence

Different exotoxins use a wide variety of strategies to traverse the intestinal barrier via complex interactions with the enterocytes or their surface receptors or even the protein complex that controls the opening size of the paracellular pathways [84, 85]

This represents telogen effluvium triggered by rapid weight loss and potential nutritional deficiencies, not a direct drug effect