Positives

• Two-thirds of 51 ME/CFS patients on hydroxocobalamin injections reported improvement, with measurable gains in step counts, RAND-36 physical functioning and CIS-20 fatigue scores Frontiers in Pharmacology.
  
  
• A patient with severe ME/CFS reported being back at work and walking unaided after about a month of near-daily hydroxocobalamin injections Dr Myhill.
  
  

Negatives

• Patients on a Phoenix Rising B12 poll noted methylcobalamin injections out-performed hydroxocobalamin, with 42% of mild responders versus 7% of strong responders relying on the hydroxo form Phoenix Rising.
  
  
• A handful of patients have developed local itching, redness or swelling at the injection site after several doses, the only consistent reaction documented over years of use Dr Myhill.
  
  

Hurdles & Side Effects

• In the US hydroxocobalamin requires a prescription, and patients on Phoenix Rising routinely describe difficulty finding clinicians willing to prescribe it for ME/CFS or Long COVID Phoenix Rising.
  
  
• Best responses are tied to higher doses, more frequent self-injection and added folate, demanding self-administration skills and ongoing supplies many patients lack PMC.