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Cyanocobalamin : Synthetic form, requires conversion to active B12, longer shelf life, lower cost Methylcobalamin : Bioactive form, immediate utilization, preferred for neurological symptoms, more expensive Hydroxocobalamin: Used for cyanide poisoning, longest-acting Standard dose: 1000mcg/ml Routes: Deep IM (gluteal/deltoid) or subQ (abdominal) Loading phase: Daily/weekly for 1-4 weeks Maintenance: Monthly or every 3 months (hydroxocobalamin) No need for aspiration before injection Oral absorption requires intrinsic factor (absent in pernicious anemia) and healthy ileum

References Sosne G, Qiu P, Kurpakus-Wheater M

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An intracerebroventricular ( ICV ) infusion of DPBS or dihexa (30ga needle

Dihexa activates the HGF/c-Met pathway, stimulating synaptogenesis (the creation of new connections between neurons)