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Clinicians must also avoid intravenous administration in the presence of severe sino-atrial, atrioventricular, or intraventricular conduction block in the absence of functional pacemaker support, as well as in classic Adams-Stokes or Wolff-Parkinson-White syndromes, where suppression of accessory pathways may paradoxically precipitate fatal arrhythmias

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When adverse effects occurred, they were typically mild and transient, with the most common being mild to moderate headaches (similar frequency to placebo groups), minor injection site reactions (redness, slight swelling), and gastrointestinal effects at higher oral doses (nausea, diarrhea)

B 12 deficiency can also result in neurological problems