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Regarding prescribing: under the Human Medicines Regulations 2012 (regulation 167), doctors and some independent prescribers may prescribe unlicensed medicines (known as 'specials') when clinically necessary and when no licensed alternative is suitable, taking personal responsibility for that decision (GMC: Good practice in prescribing and managing medicines and devices)

Some patients in edge cases may still be reviewed individually

When key nutrients like cobalamin fail to reach cellular receptors, nervous system performance declines

Presented for research literature review only Burch JB et al

Do not use after the expiration date

Durairaj says good topical skin care and lifestyle support are also important to enhance outcomes