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Areas Without Adequate Human Evidence Cardiovascular safety Neurological and psychiatric effects Liver and kidney safety Effects on blood glucose in humans Effects on methylation pathways Genotoxicity Carcinogenicity Reproductive and developmental toxicity Use during pregnancy or breastfeeding Interactions with prescription medicines Interactions with supplements or research compounds Long-term exposure Product-Quality Risks Incorrect quinolinium compound Wrong substitution position Incorrect counterion Incorrect active-content calculation Residual starting materials Residual solvents Degradation products Heavy-metal or inorganic contamination Mismatched certificate of analysis Uncontrolled storage and transport Absence of published harm is not proof of safety A compound without routine regulated human exposure may generate very few formal safety reports simply because there is no organised pharmacovigilance system

2014 Nov Elif Funda Sener, Didem Behice Oztop, Yusuf Ozkul

The other vegans might have malabsorption issues and are likely a self-selecting population given that people suffering from a nutrient deficiency would be more likely to seek out nutrition counseling

Signs of an allergic reaction, such as hives or difficulty breathing

In some countries hydroxocobalamin has completely replaced cyanocobalamin as first choice for vitamin B 12 therapy because it is retained in the body longer and can be administered at intervals of up to three months