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However, some patients receiving high-dose B12 supplementation or injections may experience adverse reactions, though these relate to the treatment rather than the elevated levels: Possible reactions to B12 supplementation (particularly injections): Skin reactions, including acneiform eruptions or rashes Pruritus (itching) Injection site reactions (with parenteral administration) Rare hypersensitivity reactions Non-specific symptoms such as headaches, dizziness, or gastrointestinal disturbances have been reported by some patients taking B12 supplements, but causality is not well established in clinical evidence

More common is malabsorption due to a number of gastrointestinal risk factors: Atrophic gastritis, which increases with age, impairs both the production of the acid and enzymes needed to break down food, and the production of intrinsic factor

In laboratory settings it has been studied alongside NAD+ pathway components to assess downstream effects on mitochondrial function

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