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Starting Dosage Protocol Most beginner-friendly protocols follow this conservative escalation model: Week 14 : 2.5 mg once weekly (starting dose) Week 58 : 5 mg once weekly Optional Increase : 7.5 mg 10 mg up to 15 mg weekly (only as needed) Gradual dose escalation reduces the risk of nausea, vomiting, and gastrointestinal intolerance while maintaining efficacy. Min et al., Drugs in Context Injection Guidance Use an insulin syringe or pre-filled pen (depending on prescription or compounded version) Inject into fatty tissue: abdomen, thigh, or back of the arm Rotate sites weekly to reduce local irritation Timing and Consistency Pick a consistent day and time each week (e.g., Sunday morning), and set reminders

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Other warnings Intensive therapy for megaloblastic anemia may result in hypokalemia, thrombocytosis, and life-threatening complications