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Most are gastrointestinal, including nausea, vomiting, diarrhea, constipation, or abdominal discomfort, but some symptoms may signal dehydration, kidney stress, gallbladder disease, pancreatitis, hypoglycemia, or another problem that requires medical evaluation

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Disease-associated hypercobalaminemia and the differential that changes management After intake and interference are excluded, persistent elevation can point toward hepatic, renal, hematologic, inflammatory, or malignant disease

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Be aware of symptoms such as dry mouth, headache, or dizziness, all of which indicate that dehydration is contributing to the fatigue

Thiamine hydrochloride (vitamin B1) in the formulation is known to cause life threatening anaphylaxis especially on multiple administrations if patient is allergic to it