Methylcobalamin (high-dose neurological)

Tier 2 — promising · Neuropathy · Nerve repair · Sleep-wake cycle

The neurologically active coenzyme form of vitamin B12, used directly by the brain and peripheral nerves without hepatic conversion. High-dose IV methylcobalamin (25 mg/day) was evaluated in a phase I/II trial (Shibuya 2014, 14 patients, PMID 25175124) showing potential for axonal regeneration in peripheral neuropathy. Oral 1,500 mcg/day has been studied for diabetic peripheral neuropathy and sleep-wake cycle disorders. A 2019 Cochrane review (PMID 31201734) found that in head-to-head comparison with acetyl-L-carnitine for diabetic neuropathy, methylcobalamin showed equivalent outcomes…

Dose: General neurological support: 500-1,500 mcg/day sublingual. Peripheral neuropathy: 1,500 mcg/day oral studied in trials. High-dose IV (25 mg) is investigational and requires medical supervision.