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Individuals with demanding schedules or those who struggle to maintain adequate vitamin levels through diet alone may also find this treatment helpful

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Who to refer: Patients: with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) same day emergency admission not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal) with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology with neurological symptoms should be discussed with Neurology if advice required

Side Effects The most common side effects are gastrointestinal symptoms, injection-site reactions, mild flu-like symptoms, and transient headaches