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The variable R group gives rise to the four most commonly known cobalamins: cyanocobalamin (CNCbl), methylcobalamin (MeCbl), adenosylcobalamin (AdCbl, also known as cobamamide or 5-deoxyadenosylcobalamin), and hydroxocobalamin (OHCbl)

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[8] The same copper that drives the biology is the primary safety liability systemically, and the therapeutic window enough copper to help, not enough to harm is uncharacterized for this route in humans

Scott Brunner of the Alliance for Pharmacy Compounding has described this as the start of a "protracted process." Even under the most optimistic scenario, broad clinical availability of legally compounded versions of these peptides is likely a mid-to-late 2026 proposition at the earliest and possibly longer if the political or regulatory environment shifts