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According to the NICE Clinical Knowledge Summary (CKS) and the British National Formulary (BNF) , the standard treatment for B12 deficiency without neurological symptoms involves: Hydroxocobalamin 1 mg intramuscularly three times weekly for two weeks Followed by maintenance doses of 1 mg every three months For patients with neurological symptoms (such as paraesthesia, numbness, cognitive changes, or gait disturbances), more intensive treatment is required: Hydroxocobalamin 1 mg intramuscularly on alternate days until no further improvement occurs Followed by 1 mg every two months for maintenance Pernicious anaemia , an autoimmune condition where the body cannot produce intrinsic factor, requires lifelong treatment

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These dosages are typically given to treat deficiency resulting from pernicious anemia, gastrointestinal disorders (such as Crohns disease), malabsorption syndromes, gastric surgeries and long-term use of medications (such as proton pump inhibitors)

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