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Seek urgent medical care if you have bleeding signs, severe headache, dizziness, weakness or confusion

Submit a request for review (or ask about a standing institutional purchase order)

Patient expectations also create barriers to diagnostic approach changes

When to seek medical advice: Persistent or worsening injection site reactions (increasing redness, warmth, or discharge suggesting infection) Severe or persistent headaches Chest pain or palpitations Unexplained muscle weakness or cramps New or worsening neurological symptoms despite treatment Unexpected bleeding or bruising For non-emergency concerns, contact your GP or NHS 111

In this case, a B12 injection might help

Immediately after reconstitution, the vial must be refrigerated