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For absorption-related deficiency such as pernicious anaemia, intramuscular hydroxocobalamin 1 mg on alternate days for two weeks is used as a loading dose, followed by maintenance injections every two to three months

Michael Mimlitz, MD (NPI 1508891870), Chief Physician of GOAL.MD

In laboratory testing, it did not inhibit related SAM-dependent methyltransferases or interfere with other enzymes in NAD+ salvage pathways

Studies also show it upregulates genes linked to healing and downregulates those associated with damaging inflammation [2]

It depends on how bad your deficiency is and how you react to treatment

You have some wiggle room, but if you fall off your schedule for too long, those signs of fatigue will inevitably return, and they almost always arrive on the scene before any other symptom does