Most of the product licences, or marketing authorities as they are called in the UK, for hydroxocobalamin date from the 1990s when the requirement for evidence was different than it is now

Before reconstitution Lyophilized powder storage: Room temperature: Fine for months Refrigerator (2-8C): Extends shelf life to 12-24 months Freezer (-20C): Maximum shelf life (24-36 months) Keep in original packaging, protect from light Don't: Leave in hot car Expose to direct sunlight Open vial until ready to reconstitute Get moisture inside vial After reconstitution Critical: Refrigerate immediately: Store at 2-8C (36-46F) Main fridge section, not door (too much temperature fluctuation) Use within 28-30 days maximum Discard if cloudy or discolored Daily use: Remove from fridge briefly to draw dose Return to fridge immediately Don't leave out for hours Each removal should be 5 years continuous use) When to stop and consult physician: Severe or persistent side effects Allergic reaction (rash, difficulty breathing) Unexpected symptoms Contraindications Avoid BPC-157 if: Pregnant or breastfeeding (no safety data) Active cancer (theoretical tumor growth concern) Severe allergic reaction to previous dose Use caution if: Taking blood thinners (BPC-157 may affect coagulation) Scheduled for surgery (stop 1-2 weeks before) Significant health conditions (consult physician) See our peptide safety and risks guide

We do not believe steps 4 through 5 are necessary, because as discussed in the proposed rule, we believe the complex professional judgment of the physician or practitioner is sufficient to ensure a service can be safely furnished via telehealth and that the service will be clinically beneficial to the beneficiary
Transportation also matters
Hyperhomocysteinemia and risk of incident cognitive outcomes: An updated dose-response meta-analysis of prospective cohort studies
2016 (subcutaneous injection technique)