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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

They should be prescribed as part of a structured protocol with pharmacy-compounded medication and clear clinical oversight rather than ad hoc or self-directed dosing. Expect the availability of safe, medical-grade peptides to grow rapidly

[DOI] [PMC free article] [PubMed] [Google Scholar] 217.Wu Q, Sun S, Li Z, Yang Q, Li B, Zhu S, et al