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In the UK, intramuscular (IM) administration is standard practice for hydroxocobalamin, though subcutaneous (SC) may be used if specifically advised by your healthcare provider and following appropriate training

However, if extremely high doses are given for a long time, pyridoxine can cause nerve damage leading to numbness or tingling in the hands and feet (peripheral neuropathy)

Perez-Chavez, I

If a patient has specific or red flag features B 12 deficiency testing should be initiated (see Figure 1: B 12 Test Result Review and Process Algorithm for Patients with Risk Factor for B 12 Deficiency * and/or Non-specific ** or Specific Symptom of B 12 Deficiency )