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Patients should be advised about the urine discoloration (to avoid alarm) and counseled to report any persistent side effects

Some patients have also experienced a hypersensitivity reaction following intramuscular injection that has resulted in anaphylactic shock and death

Clean the septum with a fresh alcohol prep pad before each injection, allowing 30 seconds for air-drying

Who to refer: Patients: with symptoms suggestive of either a spinal cord lesion (subacute combined degeneration or peripheral neuropathy) or visual (optic neuropathy) same day emergency admission not responding haematologically to B12 replacement therapy (where folate and iron stores have been checked and are normal) with suspected malabsorption or disease of the terminal ileum should be referred to Gastroenterology with neurological symptoms should be discussed with Neurology if advice required

This is the preferred approach for anything requiring quarter-unit or half-unit accuracy

The good news is that these side effects typically peak in the first 1 to 2 weeks after a dose increase and then diminish as your body adjusts