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doi: 10.1111/acel.13921 [DOI] [PMC free article] [PubMed] [Google Scholar] 209.Czajkowski K, Herbet M, Murias M, Pitkowska-Chmiel I

Make sure that the injection site and top of the vial have both been thoroughly cleaned with alcohol

Adoption of air conditioning and insulation is a major factor that reduces sensitivity to non-optimal temperatures, but other factors (urban characteristics, access to health care, occupational distribution, behavior, information, etc.) appear to be important as well

Most patients notice improvement in fatigue within days to weeks of starting hydroxocobalamin injections, though neurological symptoms may take several months to resolve