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Severe hypokalaemia (low blood potassium) is rare but can develop in some cases, particularly in severe megaloblastic anaemia or in patients taking certain medications such as diuretics

But all that work can be undone in seconds with a sloppy reconstitution

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The double combination ((M+D)/2) significantly increased toxicity in IMR-32 and IMR-5/75 cells within 24 hours, persisting up to 72 hours

They do not share the drawbacks of cyanocobalamin, but seem to have significant benefits

Some of the human trials involved injecting the peptide under the skin (subcutaneously) and into the muscles (intramuscularly)