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44 An open-label, uncontrolled trial in 51 patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) found improvements in 34 patients after 3 months of supplementation with hydroxo-B12, 10 000 mcg twice per week as nasal drops

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Step 3 Ongoing Monitoring & Optimization Regular follow-up (typically every 3-6 months for maintenance protocols, more frequently for correcting deficiencies) includes re-testing to monitor vitamin levels, assessment of symptom improvement, adjustment of dosing or frequency as needed, and transition to maintenance protocols once optimal levels are achieved