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some people report headache, nausea, lightheadedness, fatigue, or changes in appetite/GI function

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Modification of NAD-dependent isocitrate dehydrogenase by the 2',3'-dialdehyde derivatives of NAD, NADH, NADP, and NADPH

As detailed by the NIH , these include: Pernicious Anemia: An autoimmune condition that destroys stomach cells producing intrinsic factor, requiring lifelong injections

Waiting too long between injections

Vitamin B12 also assists with the production of red blood cells and can help prevent anemia, which occurs when the blood does not have enough healthy red blood cells to transport sufficient oxygen throughout the body