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Vomiting occurs less frequently than nausea but can be problematic when it does occur, particularly if it leads to dehydration or interferes with nutrition and medication absorption

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A systematic review of randomized controlled trials found that high-dose oral vitamin B12 (2000 g daily) was as effective as intramuscular injections in increasing serum vitamin B12 levels and improving hematological and neurological outcomes in deficient patients

This allows the product to be supplied in multi-dose vials and used for repeated withdrawals, in contrast to preservative-free sterile water which is intended for single use only

Most patients describe it as a small pinch, similar to a routine vaccination

Some capsules are even made to absorb better in the gut of research animals