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each case is judged individually.11 Solid evidence on the safety of parenteral, lifelong, high dose hydroxocobalamin is available from decades of treating patients with inborn errors of B 12 metabolism (eg, cobalamin C deficiency).6768 Symptom monitoring Monitor symptoms regularly (eg, every two to three months) as they may reappear, even after several months, if injection frequency is reduced

Reticulocyte count typically rises within a week, indicating bone marrow response

Moisture exclusion : Store peptide vials in secondary containers with desiccant packs

But mechanism is not the same as clinical proof