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Gastrointestinal symptoms (more common with oral preparations): Mild nausea or upset stomach Diarrhoea (typically with very high doses) Other effects: Headache, particularly when treatment is first initiated Dizziness or light-headedness Skin reactions such as mild rash or itching Temporary reddish discolouration of urine (chromaturia) after hydroxocobalamin injections, which is harmless It is important to note that many symptoms attributed to B12 supplementation may actually represent the body's response to correcting a deficiency

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(PubMed) Lahner E, Persechino S, Annibale B

Regular monitoring of B12 levels is typically recommended for those receiving ongoing treatment