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Long-term use should be approached cautiously because some patients report mild side effects like nausea or injection site discomfort, and research on prolonged use is limited. To minimize the risk of adverse reactions, always get the injections from a registered physician

doi:10.1146/annurev.nutr.19.1.357

A deficiency can cause nerve damage, leading to symptoms such as numbness, tingling, or a"pins and needles" sensation in the hands and feet

A class of peptic ulcer and antacid drugs called histamine H2 receptor agonists, including Tagamet, Zantac, and Pepcid Anticonvulsants including phenobarbital, primidone, and phenytoin Bile acid sequestrants including colestipol and cholestyramine, which lower cholesterol Chemotherapy medications like methotrexate Metformin, which is a diabetes drug Proton pump inhibitor drugs used to treat acid reflux, such as omeprazole (Prilosec), esomeprazole (Nexium), or lansoprazole (Prevacid) Tetracycline, an antibiotic Lastly, it is also essential that you communicate with your provider if you have kidney disease or an allergy to cobalt or any other medication, vitamin, dye, food, or preservative

Affected people cannot cure or manage the condition at home by taking over-the-counter (OTC) vitamin B12 supplements or eating foods rich in vitamin B12