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Patients with documented cobalamin anaphylaxis history, uncontrolled hypertension, or recent acute myocardial infarction should not receive the injection without specialist review

Serious adverse events

Cyanocobalamin dose for dogs is generally used in dogs with known or suspected deficiency, and those with chronic gastrointestinal (GI) disease, exocrine pancreatic insufficiency (EPI), intestinal dysbiosis, inflammatory bowel disease (IBD), malabsorption disease, severe malnutrition, or some inherited conditions that affect vitamin B12 absorption

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Various modalities, such as the Spray and Stretch technique, ultrasonography, manipulative therapy and injection, are used to inactivate trigger points