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There are arguments against the use of oral cobalamin in initiation of cobalamin therapy in severely deficient individuals who have poor absorption, especially due to pernicious anaemia

Patients may experience: Sensory symptoms : Burning pain, sharp or shooting sensations, increased sensitivity to touch (allodynia), or reduced ability to feel temperature changes Motor symptoms : Muscle weakness, loss of coordination, difficulty walking, or foot drop Autonomic symptoms : Changes in blood pressure, heart rate irregularities, digestive problems, or abnormal sweating Many patients describe the discomfort as worse at night, which can significantly impact sleep quality and overall well-being