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The standard schedule is a starting point, not a strict rule The 2024 NICE guideline NG239 on B12 deficiency in over 16s makes an important point: the optimal route, dose and frequency of B12 replacement have never been firmly established, and have often followed custom and historical practice

Anyone with significant medical conditions, anyone pregnant or breastfeeding, and anyone on multiple medications needs a careful review first not because problems are expected, but because limited human data means we don't assume

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For intramuscular injections, 22-25 gauge is preferred, while for subcutaneous injections, 25-27 gauge is suitable