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NICE and British Society for Haematology guidelines recommend: Initial treatment with hydroxocobalamin (the preferred form in the UK) via intramuscular injection For patients without neurological involvement: 1 mg IM three times a week for 2 weeks For patients with neurological involvement: 1 mg IM on alternate days until no further improvement Maintenance: 1 mg every 3 months for patients without neurological involvement

A standard weight-management titration reference (based on FDA-approved Wegovy protocol): Weeks 14: 0.25 mg once weekly Weeks 58: 0.5 mg once weekly Weeks 912: 1.0 mg once weekly Weeks 1316: 1.7 mg once weekly Week 17 onward: 2.4 mg once weekly (maintenance for obesity) For T2DM glycemic control, lower maintenance doses (0.52.0 mg weekly) are used per Ozempic labeling

Tissue Specificity and Metabolic Effects Importantly, these metabolic effects appear to be tissue-specific to adipose tissue, as studies have not shown similar effects on muscle protein metabolism or bone growth

Avoid antacids and calcium supplements around meal-times

The outcome