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This is a black box warning for the entire GLP-1 class based on thyroid C-cell tumor findings in rodent studies

However, some patients receiving high-dose B12 supplementation or injections may experience adverse reactions, though these relate to the treatment rather than the elevated levels: Possible reactions to B12 supplementation (particularly injections): Skin reactions, including acneiform eruptions or rashes Pruritus (itching) Injection site reactions (with parenteral administration) Rare hypersensitivity reactions Non-specific symptoms such as headaches, dizziness, or gastrointestinal disturbances have been reported by some patients taking B12 supplements, but causality is not well established in clinical evidence

Vitamin E is essential for the conversion of non-active vitamin B12 into its active form

Well-studied and safe in most individuals

Muscle fiber type composition determines response patterns