This article is really interesting and shows that i.v. methylcobalamin (500 ug, three times a week, postdialysis) makes folic acid (15 mg/d) much more effective in lowering homocysteine than folic acid alone. The homocysteine levels are really low in the methylcobalamin groups, but the serum cobalamin levels are extremely high and seem worrisome to me. I would wonder about the effects on kidney function in the long term. It took 3 weeks for the serum cobalamin levels to go from about 696 pg/mL (0.506 nM) to 47,048-50,526 pg/mL (34.2-36.7 nM). Those are some of the highest serum cobalamin levels I've ever seen. I'll bet the authors could have gotten the same extent of homocysteine reduction from lower dosages, but I don't claim to know what those lower dosages would be:
http://ndt.oxfordjournals.org/cgi/content/abstract/17/5/916
(pubmed: http://www.ncbi.nlm.nih.gov/pubmed/11981084?dopt=Abstract) (Katsushi Koyama et al., 2002)
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