Long-Term Safety Considerations: While safety data from clinical trials spanning up to 24 weeks is reassuring, long-term safety data spanning years of continuous use remains limited
Brain function: Brain fog, memory problems, cognitive impairment, insomnia, headaches (especially migraine), behavioural changes, learning problems, nominal aphasia Mood: Mood swings, irritability, depression, anxiety, hallucinations, delusions, psychosis Sensory: Peripheral paraesthesia (pins and needles), numbness, neuropathic pains, poor balance, reduced vibration sense or proprioception (joint position sense), tinnitus, ataxia, taste impairment, sometimes myelopathy Constitutional: Fatigue, anaemia (either macrocytic, or normocytic when also iron deficient or associated with thalassaemia minor), other cytopenia, abdominal complaints, malabsorption, failure to thrive, weight loss, diarrhoea, hyperpigmentation, glossitis, (aphthous) stomatitis, infertility, urinary tract infections Motor: Muscle weakness, altered reflexes (increased in degeneration of the spinal cord, reduced when peripheral neuropathy dominates), spasticity, seizures, cardiomyopathy Autonomic: Urinary and/or faecal incontinence, postural hypotension or dizziness, erectile dysfunction Diagnosing B 12 deficiency can be challenging because no single specific measurement exists to reliably diagnose or refute the presence of B 12 deficiency 11 12 26 27 (box 2)
Standard reconstitution involves adding 2 mL of bacteriostatic water to a 5 mg vial, yielding a concentration of 2.5 mg/mL (2,500 mcg/mL)
Adjusting Frequency Based on Response The dose frequency might change based on how a patient responds
They offer a flexible way to treat B12 deficiency
When combining peptides, it is advisable to start with conservative doses of each compound and gradually adjust based on individual response and tolerance
