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Intramuscular (IM) B12 injections — using hydroxocobalamin, the preferred licensed form in the UK — are recommended when: Oral supplementation has failed to correct a documented deficiency The patient has difficulty adhering to daily oral regimens Serum B12 levels remain persistently low despite adequate oral dosing There is clinical evidence of neurological or haematological complications In line with BNF guidance, the standard IM regimen for confirmed deficiency without neurological involvement is a loading course of 1 mg hydroxocobalamin on alternate days for two weeks , followed by maintenance of 1 mg every three months

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This approach prioritizes consistency and comprehensive pathway coverage