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As a cofactor, cobalamins are essential for two cellular reactions: the mitochondrial methylmalonyl-CoA mutase conversion of methylmalonic acid (MMA) to succinate, which links lipid and carbohydrate metabolism, and the activation of methionine synthase, which is the rate-limiting step in the synthesis of methionine from homocysteine and 5-methyltetrahydrofolate

Long-term storage at -20C is recommended to maintain maximum purity

The NHS notes pain and itching at the injection site as common and self-limiting

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This strict protocol is critical because globally, 10-15% of untreated cases lead to neuropathy within just six months