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B12 can be injected intramuscularly to give a more sustained and powerful energy boost than oral vitamins

The British National Formulary (BNF), for example, differentiates the prescription of hydroxocobalamin according to presenting symptoms, eg, For neurological involvement, it is advised to administer hydroxocobalamin by intramuscular injection, initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months. In the Netherlands, pharmacotherapeutic guidelines51 recommend (for the same neurological symptoms or abnormalities) administration of 1000 mcg once or twice weekly for up to two years

Because the symptoms are often non-specific, they are easy to attribute to other causes

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This can help prevent fatigue and other health problems

Water was changed weekly