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For individuals with atrophic gastritis, pernicious anaemia, or those taking proton pump inhibitors , food-bound B12 absorption is already compromised

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The dosing regimen varies depending on whether neurological symptoms are present: With neurological involvement: 1 mg intramuscularly on alternate days until no further improvement, then 1 mg every 2 months [3] [4] Without neurological involvement: 1 mg intramuscularly three times a week for 2 weeks, then 1 mg every 2-3 months for maintenance [3] [4] There is some evidence that high-dose oral B12 (1000-2000 micrograms daily) may be effective even in some malabsorption conditions, though UK practice still generally favours intramuscular treatment in these cases