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Common adverse effects include: Injection site reactions – pain, redness, swelling, or bruising at the intramuscular injection site Gastrointestinal disturbances – nausea, diarrhoea, or abdominal discomfort Headache and dizziness – particularly following initial doses Skin reactions – including rash, pruritus, or acne-like eruptions Flushing – temporary redness of the skin Chromaturia – red-coloured urine (harmless but can cause concern if unexpected) Less common but more serious reactions include: Hypersensitivity reactions – ranging from mild urticaria to anaphylaxis (rare but potentially life-threatening) Hypokalaemia – particularly during initial treatment when rapid cell production occurs [5] [16] Temporary changes in blood counts – during correction of deficiency Interference with laboratory tests – primarily with high-dose IV hydroxocobalamin used for cyanide poisoning, not typically with standard 1mg IM replacement doses Cautions and contraindications: Hypersensitivity to cobalt or vitamin B12 Cyanocobalamin should be avoided in Leber's hereditary optic neuropathy [2] [17] Chloramphenicol may reduce the haematological response to B12 therapy Patients receiving B12 injections outside clinical necessity face unnecessary risks without proven benefit