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Biasi F, Tessitore L, Zanetti D, Cutrin JC, Zingaro B, Chiarpotto E et al

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According to NICE Clinical Knowledge Summaries and the British National Formulary (BNF), the recommended treatment regimens are: For patients without neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks Maintenance: hydroxocobalamin 1 mg intramuscularly every 3 months for life For patients with neurological involvement : Initial treatment: hydroxocobalamin 1 mg intramuscularly on alternate days until no further improvement Maintenance: hydroxocobalamin 1 mg intramuscularly every 2 months for life If neurological symptoms are present, treatment should be started urgently to prevent irreversible damage

Kannt A, Rajagopal S, Kadnur SV, Suresh J, Bhamidipati RK, Swaminathan S, Hallur MS, Kristam R, Pieper MP