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This document outlines essential safety information and warnings related to the use of vitamin B12 (cyanocobalamin). Please read the following points carefully and consult your healthcare provider if you have any questions or concerns:

• Allergic Reactions: Be aware that allergic reactions to vitamin B12 can occur and may be severe, including symptoms like facial swelling, shock, and anaphylaxis. If you experience difficulty breathing, a choking sensation, swelling around the eyes, lips, or tongue, dizziness, or nausea, seek immediate medical attention.

• Leber’s Disease Warning: Individuals with Leber’s disease, a rare hereditary eye condition, should avoid using vitamin B12 as it may lead to severe eye damage. Consult your healthcare provider for alternative vitamin B12 supplementation options if you have this condition.

• Monitoring in Severe Pernicious Anemia: Those with severe pernicious anemia should discuss the use of oral vitamin B12 with their healthcare provider, as treatment can lead to complications such as low potassium and high platelet levels. Regular monitoring of potassium and platelet levels through blood tests is advised. Contact your healthcare provider if you experience symptoms such as headache, confusion, shortness of breath, heart palpitations, muscle weakness, cramps, or unusual bleeding.

• Folic Acid Anemia Masking: Vitamin B12 can mask anemia caused by low folic acid levels by increasing red blood cell count without addressing low folic acid. Your provider should check folic acid levels before starting vitamin B12 supplementation to ensure comprehensive treatment of all nutrient deficiencies.

• Dosage Risk: Consuming more than 10 mcg of vitamin B12 daily may pose a risk, and should be done under medical supervision.

For any concerns or further guidance, please consult your healthcare professional.

Common side effects:

• mild allergic reactions such as skin rash
• itching
• hives
• swelling of the face, lips, tongue, or throat
• diarrhea
• fatigue
• headache
• nausea

Serious side effects:

• low potassium levels in the blood
• muscle cramps
• weakness
• irregular heartbeat
• serious allergic reaction
• severe dizziness
• difficulty breathing
• significant facial or throat swelling