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NICE recommends intramuscular hydroxocobalamin as first-line treatment in these cases

10.1089/acm.2006.12.881 [DOI] [PubMed] [Google Scholar] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article

Ueland, E

Across a 2-4 week period, the vial gets punctured 20+ times

However, efficacy diminishes in older men (over 40-50) or those with primary hypogonadism, where testicular function is impairedresponse rates drop, and symptoms may persist