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If symptoms persist, what is the next step (dose change, injection protocol, or specialist referral)

PARP inhibitors PARP is a family of proteins involved in DNA repair, genomic stability, and programmed cell death

Coenzyme Q10 (CoQ10) Ubiquinone : CoQ10: CoQ10: ALA

Reticulocyte count typically rises within a week, indicating bone marrow response

Where possible, avoid suddenly reducing the B 12 dose or injection frequency, as too rapid dose reduction may worsen symptoms or lead to symptom recurrence.26 Instead, gradually increase the interval between B 12 injections over the course of several months while monitoring symptoms