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Their digestive system simply cannot process the vitamin, making injections a medical necessity

Reduced secretion of gastric acid and pepsin, from the use of H 2 blocker or proton-pump inhibitor (PPI) drugs, can reduce the absorption of protein-bound (dietary) vitamin B 12 , although not of supplemental vitamin B 12

Vigorous agitation can also destabilize protein and peptide solutions

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