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10-O-(N, N-dimethylaminoethyl) ginkgolide B methanesulfonate (XQ-1H) has been shown to normalize the expression of claudin-5, occludin, ZO-1, and -catenin in ischemic stroke model mice, leading to reduced BBB permeability and protection against oxygenglucose deprivation/reoxygenation injuries [292]

Given their non-invasive nature, accessibility, and cost-effectiveness of sublingual formulations, they may represent a promising approach for long-term B12 management, particularly in patients with impaired absorption or in resource-limited settings

Reported reactions include injection-site redness/itch, transient flushing and histamine-type reactions

Low levels of B12 may include fatigue, weakness, pale skin, neurological symptoms, mood changes, or gastrointestinal issues

At age 20, plasma levels sit around 200 nanograms per milliliter