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Conditions affecting any stage of this absorption pathwayincluding pernicious anaemia (an autoimmune condition destroying intrinsic factor-producing cells), Crohn's disease, coeliac disease, or surgical removal of stomach or ileal tissuecan significantly impair B12 absorption despite its water-soluble properties

The initial fatigue typically represents the body adjusting to the new compounds and usually gives way to improved energy within 1 to 2 weeks

So far, doctors do not report seeing these reactions after the second shot, however so few have been given so far that scientists are not sure how common it will be on round two

Its also recommended to be cautious in people on certain medications like levodopa (without carbidopa), as mentioned, or those with specific medical conditions, but these are matters of caution rather than strict contraindications