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Conditions include alcoholic liver disease, viral hepatitis, cirrhosis, and primary or metastatic liver cancer Renal dysfunction : Impaired kidney function reduces B12 elimination, causing accumulation even with normal intake Haematological conditions : Myeloproliferative neoplasms, chronic myeloid leukaemia, polycythaemia vera, and hypereosinophilic syndrome increase transcobalamin production, elevating total serum B12 Laboratory interference : Macro-B12 (immunoglobulin-bound B12) and assay interference can cause spuriously elevated results without true excess In clinical practice, unexplained hypercobalaminaemia should prompt investigation for underlying disease, particularly in patients without obvious supplementation history

Reported Side Effects The most commonly reported side effects are mild and transient: Injection site reactions: Mild redness, itching, or discomfort at injection sites affects a small percentage of users

Topiramate may cause eye problems

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Although this interaction is not fully proven, its wise to use an additional non-hormonal birth control method while taking doxycycline