Persistent side effects beyond 2 weeks after a dose increase Transient nausea, mild constipation, and decreased appetite are expected and normal during the 1 to 2 weeks after each dose increase
Symptoms may begin subtly with fatigue or mood changes but progress if not addressed
It is banned at all times, in-competition and out-of-competition (WADA 2026 Prohibited List)
Hydroxocobalamin injections are the UK first-line treatment, administered intramuscularly to ensure reliable B12 delivery independent of gut absorption
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