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The most common include nausea, vomiting, diarrhea, constipation, and reduced appetite , especially when first starting treatment

Biochem., 23: 59-65

Breastfeeding Cyanocobalamin is excreted in the breast milk of nursing women in levels similar to the level of vitamin B12 in maternal plasma (18)

This is possible, but given that innate inflammation in the form of microglial activation and macrophage infiltration is a universal response to most types of CNS injury (Rivest, 2009), we would argue that it remains equally plausible that in MS microglia/macrophages are instead reacting to some persistent underlying pathological process in an attempt to limit and repair the expanding white matter damage

The more potent S-enantiomer is metabolized principally by cytochrome P450 (CYP) 2C9

Sequence: Ac-Glu-Glu-Met-Gln-Arg-Arg-Ala-Asp-NH