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And, by the time the patient awakes in the morning, the blood levels could be expected to have fallen more than they would have had the patient taken the drug at bedtime

For individuals sourcing either compound from unregulated online vendors, additional risks include contamination with unknown substances, incorrect dosing due to inaccurate labelling, and the use of non-sterile injection equipment, which can lead to serious infections including abscess formation or sepsis

This paradoxical response affects some patients receiving hydroxocobalamin treatment for vitamin B12 deficiency

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No serious adverse events were reported in the limited human data available as of 2026, but the sample sizes are insufficient for definitive safety conclusions

Researchers measured body composition, glucose tolerance, insulin sensitivity, circulating markers and liver histology