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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

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

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