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For significant deficiency or neurological symptoms: Hydroxocobalamin injections are the standard treatment in the UK Initial regimen typically involves 1mg intramuscularly every other day for 1-2 weeks, then 1mg weekly until complete haematological response [16] Maintenance therapy is usually 1mg every 2-3 months for life in pernicious anaemia or other causes of permanent malabsorption Neurological symptoms may require more intensive initial treatment and careful monitoring For dietary deficiency (e.g., in vegans): Oral cyanocobalamin supplements (50-150 micrograms daily) may be sufficient Dietary modification with B12-fortified foods Regular monitoring to ensure adequacy of replacement Monitoring treatment: Full blood count after approximately 8 weeks Assessment of neurological symptoms Serum B12 levels may be checked to confirm normalisation Long-term monitoring for those on maintenance therapy Important considerations: Lifelong treatment is necessary for pernicious anaemia and after certain gastric surgeries Concurrent iron deficiency should be identified and treated Hydroxocobalamin injections may cause mild side effects including pain at the injection site Patients should report suspected adverse reactions to medicines via the MHRA Yellow Card scheme Patients taking metformin long-term should be monitored for B12 deficiency, as advised by the MHRA

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