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Little robust, reliable evidence supports current recommended dosing schedules, and no clinical studies assess the effectiveness and optimal dosing of intramuscular cobalamin preparations for symptom relief, other than studies assessing attained serum B 12 concentrations and sometimes haematological response.525354 Studies as early as the 1960s reported considerable differences between individuals in pharmacodynamics5253545556 and dose requirements.57 Some patients may require a more frequent injection regimen, especially those with neurological symptoms, varying from twice weekly to every 2-4 weeks to become and remain asymptomatic