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But so is the caution around powerful medications

monitoring may be required Polycythemia vera: Correcting B12 deficiency may unmask underlying polycythemia Masking folate deficiency: B12 supplementation can mask the hematologic signs of folate deficiency while allowing neurological damage to progress Allergic reactions: Rare hypersensitivity reactions have been reported, including anaphylactic shock with cyanocobalamin Common Side Effects Mild diarrhea Injection site reactions: pain, swelling, itching Feeling of generalized body swelling Mild headache Temporary reddish urine (normal B12 is water-soluble and excreted) Seek Medical Attention For Signs of serious allergic reaction: rash, hives, facial swelling, difficulty breathing Chest pain or irregular heartbeat Signs of low potassium: muscle cramps, weakness, irregular heartbeat Vision changes (especially if you have Lebers disease) Drug Interactions Chloramphenicol: May antagonize the hematopoietic response to B12 Metformin, proton pump inhibitors, H2 blockers: Can reduce B12 absorption (these are reasons to use injectable B12 instead of oral) Nitrous oxide: Can inactivate B12 in the body Use in Pregnancy and Breastfeeding B12 is generally considered safe during pregnancy and breastfeeding when used at appropriate doses

Lancet Gastroenterol Hepatol 2023;8:20-30

At these low doses, a 60 mg vial could theoretically last 40 to 120 weeks

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