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Intramuscular replacement therapy is indicated for patients with: Significant B12 deficiency (thresholds depend on local laboratory reference ranges) Neurological symptoms or signs Pernicious anaemia Malabsorption syndromes The standard UK regimen for patients without neurological involvement involves hydroxocobalamin 1mg intramuscularly three times weekly for two weeks, followed by maintenance injections every 2-3 months (often 3-monthly)

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However, some people have difficulty absorbing vitamin B12 from their diet, including dietary restrictions, certain medical conditions like pernicious anemia, or medications that interfere with B12 absorption

Surgery (hemorrhoidectomy) is generally reserved only for the most severe cases which cannot be managed with simpler means

In aged mice, treatment with 5-amino-1mq combined with exercise produced remarkable results