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In the UK, hydroxocobalamin 1 mg intramuscular injection is used: Without neurological involvement : 1 mg three times weekly for two weeks, then maintenance of 1 mg every two to three months With neurological involvement : 1 mg on alternate days until no further improvement in symptoms, then maintenance of 1 mg every two months Lifelong maintenance is required for pernicious anaemia or other irreversible causes of deficiency Oral B12 supplementation may be appropriate for diet-related deficiency in patients without neurological symptoms and with adequate absorption capacity

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ESG may be considered for class I patients who are ineligible for or decline surgery

Enzinger FM, Weiss SW, editors

While Lupron might not have a significant impact on very young children beyond the discomfort of daily injections they said continuing treatment into the teen years is another matter