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Subsequent Courses Community protocols typically include 1-2 courses per year, with each course consisting of 3-6 weekly cycles
as for patients with neurological improvement, 1 mg IM OH-Cbl on alternate days until there is no clinical improvement and then maintenance 1 mg IM OH-Cbl every 2 months is recommended ( g low-dose daily oral CN-Cbl is licensed ( In Canada, advice from the British Columbia Medical Association outlines that 1 mg daily oral CN-Cbl should be used for pernicious anemia or food-bound cobalamin malabsorption (FBCM) whereas in most other cases, a daily dose of 250 g may be used ( In Netherlands, controversy arose when the Dutch Organization of General Practitioners published a 2014 viewpoint that 1 mg daily oral OH-Cbl can be utilised as treatment in cases with a cobalamin count below 148 pmol/L and clinical symptoms, with the Dutch B12 Society disputing the efficacy of this and insisting that the advice from the Dutch Healthcare Institute Pharmacotherapeutic Compass should be followed instead (IM/SC starting dose of 10 injections of 1 mg OH-Cbl at intervals of at least 3 days
[35] Tangvarasittichai S
Capuani, C
References 1 AkagawaM.NakanoM.IkemotoK
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