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Common side effects include: Injection site reactions – mild pain, redness, swelling, or bruising at the injection site, typically resolving within a few days Headache – usually transient and manageable with standard analgesia Nausea or dizziness – particularly in the initial treatment phase Skin reactions – including itching, mild rash, or acneiform eruptions Temporary urine discolouration – red or orange urine is harmless and expected Diarrhoea or flushing – usually mild and self-limiting In patients with severe megaloblastic anaemia, low potassium levels (hypokalaemia) may occur during initial intensive treatment, but this is uncommon in routine maintenance therapy

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