Note: Continue parenteral therapy until the deficiency has been corrected and signs and symptoms have resolved before switching to oral therapy (Means 2021).
Alternatively, if neurologic symptoms are present, may initiate 1,000 mcg every other day for up to 3 weeks or until no further improvement in signs or symptoms, then switch to 1,000 mcg once weekly for up to 12 weeks (Devalia 2014 Means 2021). Initial therapy: IM: 1,000 mcg every other day or once daily for 1 to 2 weeks, then 1,000 mcg once weekly for 4 to 8 weeks (Devalia 2014 Mechanick 2020 Stabler 2013). Severe/symptomatic anemia or neurologic/neuropsychiatric findings:
Oral vitamin B 12 (eg, cyanocobalamin) may be used for less severe deficiency and/or maintenance therapy (Devalia 2014). Note: Folic acid supplementation may also be required.
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