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Oral B12 (50–150 µg daily) may be appropriate for dietary deficiency without neurological involvement, but intramuscular hydroxocobalamin injections remain first-line treatment in the UK for patients with nerve symptoms or malabsorption conditions

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“It does not require proof of efficacy in large trials the way we typically expect from drugs, but it facilitates prescribing, and that changes things a lot, because there won’t be a black market anymore