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Other reactions warranting urgent GP contact include: Unexplained muscle weakness or cramping Persistent vomiting or severe abdominal pain Signs of hypokalaemia (low potassium) during initial treatmentmuscle weakness, irregular heartbeat, or severe fatigue In patients with severe, longstanding B12 deficiency, rapid correction can occasionally precipitate hypokalaemia as new red blood cells are produced, consuming available potassium

People taking high-dose B12 supplements (1,000 to 5,000 mcg daily), receiving B12 injections (cyanocobalamin or methylcobalamin), or consuming heavily fortified foods can easily push their serum levels above 900 pg/mL

NNMTi can block this process by precisely inhibiting NNMT, thereby reducing the formation of mature adipocytes

Preclinical fat-loss evidence Ng et al

Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those using diuretics concomitantly and the elderly

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