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Always discard if: The solution is cloudy, discolored, or contains visible particles The medication was exposed to temperatures above 100 degrees Fahrenheit for more than 30 minutes The medication was left in a hot car during summer conditions for any extended period The medication has been frozen (ice crystals observed or vial was solid) The total room temperature exposure exceeds 21 days (pharmaceutical) or the pharmacy-specified BUD (compounded) The medication has passed its expiration date or Beyond-Use Date regardless of storage conditions You have observed a significant reduction in clinical effects after using doses from the vial Likely safe to use if: Left on the counter overnight in an air-conditioned home (below 86 degrees) and visual inspection is normal Brief exposure (under 30 minutes) to moderate warmth (86-95 degrees) with normal visual inspection Shipped with depleted cold packs but transit was overnight in moderate weather Fridge temperature rose slightly during a brief power outage (under 4 hours) but remained below room temperature Use with caution and monitor closely if: Extended room temperature storage approaching the 21-day limit Multiple brief temperature excursions that individually were acceptable but may have accumulated Storage in a room that may have briefly exceeded 86 degrees but returned to acceptable temperatures quickly Compounded formulation without clear stability data for the specific temperature exposure When the decision is borderline, ask yourself one question

I had been fine using the out of date B12 (04/2022) until I suspect a couple of months ago when I began feeling a fair bit weaker, more noticeable to me when out cycling

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