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Initial treatment for patients with neurological involvement follows British National Formulary (BNF) guidance: Hydroxocobalamin 1 mg intramuscularly on alternate days for approximately 2-3 weeks (or until no further improvement) Maintenance therapy then consists of hydroxocobalamin 1 mg intramuscularly every two months Hydroxocobalamin is preferred over cyanocobalamin in the UK due to superior retention and fewer injections required

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Studies show that inhibiting nicotinamide Nmethyltransferase (NNMT) enhances metabolic health by reducing adipose tissue accumulation, improving insulin sensitivity, and promoting better energy utilization

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