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Vitamin B12 is water-soluble, which means excess amounts are usually excreted in urine

However, many patients eventually consider stopping treatment, either due to symptom resolution, persona

Without controlled trials, we cannot separate the responders from the non-responders in any statistically meaningful way

Although rare, adverse effects of high-dose vitamin B12 have been reported, including allergic reactions such as fever, rash, itching, hot flushes, dizziness, and nausea, across all cobalamin forms and administration routes ( Intramuscular (IM) injection is the most invasive and costly administration method, requiring trained personnel and clinical visits