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For IV admixtures, sometimes medications reconstituted with sterile water are further diluted into larger IV bags of saline or glucose solution for infusion follow pharmacy or manufacturer instructions for any further dilution steps

Initial treatment for patients with neurological involvement follows British National Formulary (BNF) guidance: Hydroxocobalamin 1 mg intramuscularly on alternate days for approximately 2-3 weeks (or until no further improvement) Maintenance therapy then consists of hydroxocobalamin 1 mg intramuscularly every two months Hydroxocobalamin is preferred over cyanocobalamin in the UK due to superior retention and fewer injections required

Mild headache from transient vasodilation