Requirements may be higher for elderly people with impaired digestion or absorption.

• Sublingual cyanocobalamin: 1000-2000^g/day taken 30 minutes before breakfast.

• Pernicious anaemia: generally, vitamin B12 1000 ¡jg IM 2-4 times weekly is given until haematological abnormalities are corrected, and then it is given once monthly. Alternatively, oral B12 can be given in very large doses (0.5-2 mg/day). Correction of haematological abnormalities usually occurs within 6 weeks of treatment, but neural improvement may take up to 18 months.

• Homocysteine lowering: vitamin B12 6-400^g/day (typical dose 250^g/day) in conjunction with folic acid 20 ^g-2.5 mg/day and vitamin B6 200 fjg-25 mg/day (Anon 2003).

© 2007 Elsevier Australia

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