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parenteral treatments, such as intramuscular (IM) injections, may offer superior benefits over oral pills for vitamin B 12 supplementation in cases of conditions like pernicious anemia and post bariatric surgery but should be reserved for certain conditions

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Nevertheless, in cases of severe deficiency with neurological sequelae, we suggest that IM B12 is used in the first instance to replenish body stores with the treatment regimen, including dosage and formulation, optimised to keep the patient free of symptoms and tailored to the metabolic response of not only plasma B12 levels, but also confirmatory testing of homocysteine, methionine, and methylmalonic acid levels