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[3] For confirmed deficiency with neurological involvement: 1 mg IM on alternate days until no further improvement, then 1 mg every two months urgent initiation is essential to prevent irreversible nerve damage

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As mentioned earlier, certain medications or health conditions can reduce the effectiveness of oral B12

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13,14 Hematologists and hematopathologists frequently encounter patients with low B 12 levels that are found to have another cause for their macrocytosis with or without anemia (eg, hemolysis with reticulocytosis, drug-related macrocytosis, MDS, or other neoplasms)