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Prescription and administration: Once B12 deficiency is confirmed, GPs prescribe hydroxocobalamin injections according to standardised protocols: Standard loading regimen: 1mg intramuscularly three times weekly for two weeks Neurological involvement: 1mg intramuscularly on alternate days until no further improvement Maintenance therapy: 1mg every three months for life in pernicious anaemia or malabsorption conditions (or every two months if there was neurological involvement) Injections are typically administered by practice nurses at GP surgeries

Tissue repair depends on timing, load management, inflammatory control, nutrition, sleep, and the accuracy of the original diagnosis

doi: 10.3382/ps.2007-00325 Waylan AT, Kayser JP, Gnad DP, Higgins JJ, Starkey JD, et al

Excretion: Metabolites are excreted primarily through the kidneys