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Some protocols use an extended break matching the cycle length (8 weeks on, 8 weeks off)

The Pernicious Anaemia Society notes this is recognised but not fully understood

The severity of the vitamin B12 deficiency Presence of underlying health conditions Patients response to initial treatment Age and weight considerations Healthcare providers can adjust the vitamin B12 injection dosage based on these factors

The MHRA advice reminds us that in a person with anaemia or neuropathy caused by vitamin B12 deficiency, it is important that treatment starts as soon as possible, in order to avoid the development of permanent symptoms

a more balanced and complete vitamin B shot

Reducing or stopping alcohol also helps and allows more of the other vitamins to be available for metabolism