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Person receiving injection in arm

In general, treatment begins once a diagnosis of vitamin B12 deficiency has been confirmed. However, in some cases your doctor may decide it is appropriate to begin treatment whilst waiting for blood results to be confirmed.

It is also important to establish the cause of your deficiency so that the most appropriate treatment can be administered ensuring the best possible outcome and recovery.

Although we recommend 6 x 1000mcg hydroxocobalamin by intramuscular injection over a 2 week period as initial loading doses of for everyone diagnosed with a B12 deficiency, the follow up treatment can vary depending on the cause of your deficiency and the symptoms you are experiencing.

It is also the case that although vitamin B12 is required for every cell in the body, it does not work alone, so it is essential that you have sufficient levels of cofactors to ensure optimal uptake of your B12 therapy. The main cofactors are: Folate (vitamin B9), Ferritin (iron stores) and vitamin B6.

Your levels of these cofactors may well be “in range” or you could find yourself deficient in one or more of these also. Either way, when B12 therapy is being administered, it will put a higher demand on your body’s resources of these cofactor nutrients. Therefore, it is essential that you have OPTIMAL levels of these nutrients to ensure you get the best out of your B12 therapy.

If you are deficient or below the optimal levels in any of these cofactors, we recommend starting supplements in advance of your B12 therapy, or if this is not possible, then at least at the same time as your B12 in order to get the best response from your therapy.


The table below is a cofactor guide to help you optimise your B12 therapy:

B12 Cofactor Table

Please see our recommended treatment options in the table below. These recommendations are based on the current guidelines published in the British National Formulary (BNF), plus the anecdotal findings from our support group Vitamin B12 Wake Up:

Recommended B12 Treatment Plan
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