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Rapidly progressing maculopathy with severe photoreceptor and ganglion cell loss, renal thrombotic microangiopathy, hemolytic uremic syndrome, pulmonary hypertension, and pulmonary thrombotic events have also been described in adult-onset cobalamin C defect (42

This means most of a high-dose supplement remains in the gastrointestinal tract, though the direct link to digestive symptoms is not well established

[8] Although not an absolute contraindication, patients with coronary artery disease or unstable angina should only use B-Complex injections containing niacinamide under physician supervision, since high-dose niacin supplements have been linked to arrhythmias in such patients

That matters a lot for people who struggle to absorb B12 through food or oral supplements

For patients with considerable weight to lose, the weight loss could reach up to 15-20 pounds in a month