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intramuscular route: count injections given Visit 4 (week 52) Anamnesis: record lifestyle habits and use of alcohol Symptoms: record paresthesia, asthenia, loss or reduction of appetite, sadness or change in level of happiness, and concomitant pharmacological treatment Physical examination: for Hunters glositis, positional and vibrational sensitivity Record concomitant treatment Questionnaires: EuroQoL-5D, satisfaction and preferences Assessment of haemogram and serum vitamin B12 concentration Assessment of adverse effects Assess adherence to treatment: oral route count number of vials used

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There is no pill, supplement, or dietary change that lowers B12. You cannot flush excess B12 by drinking water or eating differently

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doi: 10.1001/jama.288.16.2015