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Human clinical trials typically report mild gastrointestinal disturbances and occasional allergic reactions, but rare cases of elevated liver enzymes have been noted, underscoring the need for cautious use, especially in individuals with preexisting liver conditions (92, 93)

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H., Sprecher, D

It's important to be aware of these interactions if you are taking any of the following long-term: Acid-Reducing Drugs : Medications like Proton Pump Inhibitors (PPIs) (e.g., omeprazole) and H2 Receptor Antagonists (e.g., cimetidine) reduce the stomach acid needed to release B12 from food