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When hydroxocobalamin is given in high doses (such as during cyanide poisoning treatment), unique effects can be observed: patients often experience a transient reddening of the skin or mucous membranes and a reddish discoloration of the urine due to drug excretion

Kannt A, Rajagopal S, Kadnur SV, et al

These can include improved mood, enhanced mental clarity, and better sleep patterns

There are some very rare side effects listed in medical literature (mostly when large doses are given): for example, one out of many thousands of patients might develop a disturbance in liver enzymes or a tingling in the fingers or toes

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