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Clinical guidance recommends testing before deciding on injections aimed at improving energy or weight

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Cobalamin status influences methylation and homocysteine metabolism View Source Biochemistry and physiology of vitamin B12 View Source Absorption and cellular uptake of vitamin B12 View Source Vitamin B12 and neural integrity: mechanistic research View Source

In addition, patients should be more proactive when they are receiving cyclophosphamide than at other times and should not wait until they have a high fever to get medical assistance

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However, markedly elevated levels without supplementation may warrant GP review to exclude underlying conditions such as haematological disorders, liver disease, or renal impairment