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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

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The expiration may depend on whether youre using insulin from a glass vial, a prefilled disposable insulin pen, or a cartridge that goes into a reusable insulin pen