Common in chronic starvation, advanced cancer, prolonged NPO states
This helps make sure treatment works well and keeps side effects low
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for example, valproic acid raises ammonia levels, and added glycine could theoretically exacerbate hyperammonemia
With intramuscular injections of B12, any excess will result in high levels within your blood so you may experience side effects such as headache, dizziness, tiredness, or gastrointestinal issues including nausea, until your body has metabolised any excess through your kidneys enroute to excretion via urine
The NHS provides resources on maintaining adequate B12 intake for those following plant-based diets, emphasising the importance of fortified foods such as breakfast cereals, plant-based milk alternatives, and yeast extract products commonly available in the UK