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Hydroxocobalamin 1mg intramuscular injections reactivate metabolic pathways after chronic deficiency, potentially causing temporary symptoms during adjustment Common side effects include injection site pain, headaches, and nausea, typically resolving within 24–72 hours Rapid red blood cell production may increase demand for folate and iron, occasionally creating relative deficiencies in these co-factors Serious reactions requiring urgent assessment include difficulty breathing, chest pain, severe weakness, or progressive neurological symptoms Recovery follows a predictable pattern: blood cell improvement within 3–5 days, haemoglobin normalisation over 1–2 months, neurological recovery potentially taking several months Table of Contents Why Do I Feel Worse After My B12 Injection