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For a regular patient with vitamin B12 deficiency, the doctors usually start with a high dosage

This is especially important for patients with absorption issues such as those with digestive conditions, low stomach acid (common with aging), or MTHFR gene variants who cannot adequately absorb B12 from food or oral supplements

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Blood pressure changes were not observed in clinical trials

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GPs can prescribe B12 injections following appropriate investigation, which should include: Full blood count to identify macrocytic anaemia Serum B12 and folate levels to confirm deficiency (using laboratory-specific reference ranges) Methylmalonic acid and/or homocysteine when B12 results are borderline Intrinsic factor antibodies if pernicious anaemia is suspected Additional tests depending on clinical presentation (e.g., thyroid function, coeliac serology) When both B12 and folate deficiency are present, B12 should be replaced before folate to avoid precipitating subacute combined degeneration of the spinal cord