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Both adenosylcobalamin and hydroxycobalamin are generally considered highly safe and well-tolerated, as they are water-soluble vitamins and excess amounts are easily excreted in the urine

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Mild side effects may include pain or redness at the injection site

While the RNI for maintenance is only 1.5 g daily, therapeutic oral doses typically range from: 50-150 g daily for mild deficiency prevention in at-risk groups 1,000-2,000 g daily for treating confirmed deficiency without malabsorption Some formulations contain up to 5,000 g, though there is no proven additional benefit over 1,000-2,000 g for most patients The reason for this dosage discrepancy lies in absorption efficiency