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Common side effects are rare but may include: Mild gastrointestinal symptoms such as nausea or diarrhoea (though less common with sublingual than oral routes) Headache or dizziness in some users Skin reactions, including itching or rash, particularly in individuals sensitive to cobalt (a component of cobalamin) Unlike some other B vitamins, oral B12 supplements rarely affect urine colour

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Many patients start weekly or biweekly for the first month, then shift to a maintenance schedule every 24 weeks

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Shiitake, black trumpet, golden chanterelle, and Lions mane all contain some bioavailable B12 to give an assist on the vegetarian, or vegan, diet

In September 1996, Pharmacia and Upjohn petitioned the FDA to increase the topical solution formulation from 2% to 5%