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Patients can experience generalized tonic-clonic seizures, in which they fall down, shake and become unresponsive

Common side effects include: Injection site reactions mild pain, redness, swelling, or bruising at the injection site, typically resolving within a few days Headache usually transient and manageable with standard analgesia Nausea or dizziness particularly in the initial treatment phase Skin reactions including itching, mild rash, or acneiform eruptions Temporary urine discolouration red or orange urine is harmless and expected Diarrhoea or flushing usually mild and self-limiting In patients with severe megaloblastic anaemia, low potassium levels (hypokalaemia) may occur during initial intensive treatment, but this is uncommon in routine maintenance therapy

The ability to absorb vitamin B12 from food often decreases with age

Rare reports describe more significant reactions