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The evidence for meaningful additional benefit from niacinamide inclusion is limited, but like glycine, it adds minimal cost and no significant risk

Common side effects include nausea, dizziness, hot flashes, blood pressure fluctuations, and hepatic and renal complications

When needed, a single aliquot can be thawed for use

A study conducted in 2016 thus came to the following conclusion: If we had restricted the treatment of symptomatic patients to patients with both low serum levels and elevated metabolite levels, 63% of patients who responded well to the therapy would not have received treatment [] Only 16% of patients with good clinical improvement from vitamin B12 therapy had low serum levels and 54% of patients with good clinical improvement from vitamin B12 therapy had serum levels higher than 300 pg/mL. Some experts thus advise high-dose B12 treatment to treat all known nervous symptoms associated with B12 deficiency