Available as injectable or intranasal
Individual Variability Risk: Responses to Dihexa can differ widely, influenced by genetics, lifestyle, and other health factors
It is not part of the standard GI workup
It includes 1-5 intramuscular or subcutaneous injections of 1000 mcg crystalline cyanocobalamin daily, followed by oral doses of 1000-2000 mcg/day Parenteral administration should be reserved for those with significant neurological symptoms NICE guideline: Vitamin B 12 deficiency in over 16s: diagnosis and management: Malabsorption as the confirmed or suspected cause of vitamin B 12 deficiency: Offer replacement to people if: lifelong intramuscular vitamin B12 Autoimmune gastritis is the cause They have had a total gastrectomy They have had a complete terminal ileal resection If the person has a vitamin B 12 deficiency because of malabsorption that is not caused by autoimmune gastritis, or a total gastrectomy or complete terminal ileal resection (for example, malabsorption caused by coeliac disease, partial gastrectomy or some forms of bariatric surgery): Offer vitamin B 12 replacement and Consider intramuscular instead of

Tisserand DJ, Pruessner JC, Arigita EJS, van Boxtel MPJ, Evans AC, Jolles J et al (2002)
With a focus on long-term recovery and pain management, Southern Care Anesthetics is the ideal place for anyone seeking the powerful benefits of BPC-157 peptide therapy