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A course of two at 90 spaced two to four weeks apart is a common starter for patients with a more depleted baseline, working out to 45 per session
When your levels are low, your body struggles to keep up, and tiredness is usually the first sign
The dosing regimen varies depending on whether neurological symptoms are present: With neurological involvement: 1 mg intramuscularly on alternate days until no further improvement, then 1 mg every 2 months [3] [4] Without neurological involvement: 1 mg intramuscularly three times a week for 2 weeks, then 1 mg every 2-3 months for maintenance [3] [4] There is some evidence that high-dose oral B12 (1000-2000 micrograms daily) may be effective even in some malabsorption conditions, though UK practice still generally favours intramuscular treatment in these cases
Protect the vial from exposure to light and heat
Quality assessment and risk of bias In line with PRISMA guidelines, the assessment of methodological quality was conducted to evaluate the strength of evidence, recognising that methodological limitations may introduce bias