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Although our experience suggests that hydroxocobalamin does not cause clinically significant interference with non-invasive pulse oximetry, there is evidence to suggest that co-oximetric blood gas analysis with several unique analyzers may be altered in the presence of hydroxocobalamin, specifically with false elevations of carboxyhemoglobin and methemoglobin concentrations and underestimation of true oxygen saturation values.5 There is no available evidence regarding the accuracy of other commonly utilized oximetric monitoring modalities (e.g., cerebral oximetry) following hydroxocobalamin administration

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This isnt practical for individuals who suffer from chronic B12 deficiency or frequently deplete the entirety of their B12 stores