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[3] Initial treatment of pernicious anemia typically consists of 1,000 mcg intramuscularly daily for one week, then weekly for four weeks, transitioning to 1,000 mcg monthly for life

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For oral administration, take on an empty stomach, preferably first thing in the morning at least 30 minutes before eating

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Consider intramuscular vitamin B 12 injections instead of oral replacement for suspected or confirmed vitamin B 12 deficiency caused by diet if: The person has another condition that may deteriorate rapidly and have a major effect on their quality of life (for example, a neurological or hematological condition such as ataxia or anemia)