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Patients should be reviewed 812 weeks after commencing treatment to assess: Symptomatic improvement, particularly resolution of fatigue and neurological symptoms Haematological response (normalisation of haemoglobin and mean cell volume) Reticulocyte count typically rises within one week, indicating bone marrow response Repeat serum B12 testing is generally not useful after starting parenteral therapy, as levels remain elevated for months

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To mitigate any potential negative effects on methylation, additional interventions can support the methyl cycle while using folinic acid therapy: Improving SAH (S-adenosylhomocysteine) levels by reducing homocysteine through methyl donors like betaine (TMG), vitamin B6 (P5P), and methylcobalamin (B12)

The frequency and approach to NAD injections at our clinic are always personalized