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This phase includes 1000 mcg (1 mg) injections daily for the first week

Common experiences after the first injection include: Mild soreness or redness at the injection site (usually resolves within 12 days) Slight improvement in energy levels or mood No immediate noticeable change (particularly common if deficiency is severe) Rarely, mild side effects such as headache or dizziness Some patients report their urine becoming brighter or more intensely coloured following injection, which occurs because excess B12 is excreted renally

Present with mild fatty liver disease or signs of poor hepatic detoxification

For individuals requiring supplementation due to confirmed deficiency or malabsorption, therapeutic doses vary considerably depending on the underlying cause: Dietary deficiency : 50150 micrograms daily orally, or cyanocobalamin tablets as prescribed Pernicious anaemia : Initially hydroxocobalamin 1 mg intramuscularly three times weekly for two weeks, then maintenance injections every two to three months [3] Neurological involvement : More intensive regimens may be required, with hydroxocobalamin injections on alternate days until symptom improvement [3] NICE guidance emphasises that supplementation should be evidence-based rather than speculative

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