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According to NICE Clinical Knowledge Summaries and the British National Formulary (BNF), the recommended treatment regimens are: For patients without neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks Maintenance: hydroxocobalamin 1 mg intramuscularly every 3 months for life For patients with neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly on alternate days until no further improvement Maintenance: hydroxocobalamin 1 mg intramuscularly every 2 months for life If neurological symptoms are present, treatment should be started urgently to prevent irreversible damage

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Individuals with active gastrointestinal disease beyond mild sensitivity should exercise caution

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Kannt A, Rajagopal S, Kadnur SV, Suresh J, Bhamidipati RK, Swaminathan S, Hallur MS, Kristam R, Pieper MP