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Protocol Notes Injection burden: Separate vials may require up to 3 injections on TB-500 days and 2 on other days

Efficient Bypasses several problematic steps in the absorption cycle

B12 is a water-soluble vitamin with excess readily excreted, making toxicity virtually unknown in elderly patients

Endocrine disruptors induce cytochrome P450 by affecting transcriptional regulation via pregnane X receptor

More than two thirds of the B 12 excreted in bile is reabsorbed in the small intestine, but this reabsorption is reduced in people with pernicious anaemia or other causes of B 12 malabsorption.5859 Nitrous oxide toxicity The Association of British Neurologists has recently issued guidance on recognising and managing nitrous oxide toxicity associated with B 12 deficiency.14 It recommends rapid initiation of alternate-day intramuscular hydroxocobalamin therapy, and maintenance of this treatment until all symptoms have resolved or there is no further neurological improvement, with long term B 12 therapy depending on the presence of deficiency on presentation, together with total abstinence from the use of nitrous oxide