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Whilst vitamin B12 toxicity is exceptionally rare due to its water-soluble nature, very high levelsparticularly from mega-dose supplements or frequent injectionshave been associated with certain adverse effects, most notably skin reactions

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Paul and Brady also note that various single-nucleotide polymorphisms (SNPs) may influence the efficacy and bioavailability, but that at this time there is neither sufficient clinical research in this area nor are tests for these SNPs commercially available