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Cyanocobalamin should not be used in patients with early hereditary optic nerve atrophy (Lebers disease)

The primary difference is that the vials are only available in 2.5 mg and 5 mg doses, while the pens include those doses as well as 7.5 mg, 10 mg, 12.5 mg, and 15 mg. In clinical trials, patients on the 5 mg dose (maximum dose in single-dose vials) lost an average of 15% of their body weight in a year, while those on the 15 mg dose (maximum dose in single-dose pens) lost an average of 20% in a year