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(17) Cigarette smoking and other tobacco use can lead to the depletion of glutathione and an increased need for more to combat oxidative stress

According to the UK SmPC, the most common side effects include: Nausea (very common, affecting more than 1 in 10 people): Usually most pronounced during the first few weeks of treatment and often diminishes with continued use Diarrhoea (common, affecting up to 1 in 10 people): Typically mild to moderate in severity Vomiting (common): More frequent at higher doses Constipation (common): May occur alongside other gastrointestinal effects Abdominal pain or discomfort (common): Relatively frequent during treatment initiation Decreased appetite (very common): An expected effect related to the medication's action Dyspepsia/indigestion (common): May contribute to discomfort after eating Beyond gastrointestinal effects, other recognised adverse reactions include injection site reactions (redness, itching, or swelling at the subcutaneous injection site), fatigue , and dizziness

Such conditions are also referred to as demyelinating diseases and are suspected to be closely related to B12 deficiency

10.1172/jci.insight.85717 JCI Insight

Milosavljevi et al