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It is more likely to occur in those patients receiving too much of the medicine but can occur with small doses as well

doi:10.1016/j.bcp.2019.02.008 Dimet-Wiley A, Latham CM, Brightwell CR, et al

After 1 month of treatment in pernicious anemia patients, the once weekly dosing of 500 mcg B12 intranasal gel resulted in a statistically significant increase in B12 levels when compared to a once monthly 100 mcg IM dose

If you already have a diagnosed deficiency under NHS care and your symptoms return before your next scheduled dose, that is a conversation to have with your GP, who can review the schedule

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